Monoclonal Antibodies Against CGRP (R): Non-responders and Switchers: Real World Data from a Large Case Series

Objective: Assessement of the responder and non-responder rate to consecutive monoclonal CGRP-antibody (CGRP-mAb) treatment, the presence of side effects, analysis of predictors of response and loss of efficacy evaluation over time. Methods: We conducted a retrospective analysis including 171 patients with episodic (EM) or chronic migraine (CM), who received one, two or three different CGRP-(R)-mAbs. Non-response was defined as ≤50% reduction of monthly migraine days (MMDs) in EM and ≤ 30% reduction of MMDs in CM after 3 months of treatment. Results: 71.9% responded to the first mAb. Side effects led to treatment discontinuation in 5.3%. Of the 26 patients who did not respond to the first mAb or experienced a loss of efficacy over time, 11 (42.3%) responded to the second and two of 7 to the third monoclonal antibody. Poor response to therapy was associated with a higher monthly headache frequency (p = 0.042), pre-existing psychiatric disorder (p = 0.032), and a higher number of prior preventive migraine therapies (p = 0.022). Conclusion: Our findings support mAb-class switch in non-responders or in patients experiencing a loss of efficacy. The use of a third CGRP-mAb could be beneficial for some patients. Early use of CGRP-mAbs in the prevention of migraine might help to avert chronification of migraine and treatment-refractory patients.