An observational study on monoclonal antibodies against calcitonin- gene- related peptide and its receptor

Background and purpose: Based on their pharmacological target, two classes of calcitonin- gene-related peptide (CGRP) monoclonal antibodies (mAbs) have been identified: antibodies against the CGRP ligand-; galcanezumab, fremanezumab, eptinezumab- and antibodies against the CGRP receptor (CGRP- R), erenumab. The aim of the present study was to compare anti-CGRP versus anti-CGRP-R mAbs in patients with high frequency episodic and chronic migraine. Methods: All patients on monthly treatment with anti- CGRP mAbs with an available 6 months' follow- up at January 2022 were included. Data on efficacy outcome were collected following one (T1), three (T3) and six (T6) months of treatment, and included monthly headache/migraine days, the Migraine Disability Assessment Scale (MIDAS) and Headache Impact Test 6 (HIT- 6) scores, pain intensity, analgesics consumption and re-sponse rates (> 50% headache days reduction compared to baseline). Results: In all, 152 patients were enrolled, of whom 68 were in treatment with anti- CGRP mAbs (49 galcanezumab, 19 fremanezumab) and 84 with the anti-CGRP- R (erenumab). MIDAS scores were significantly lower in the anti- CGRP group at T1 and T3 (respectively p < 0.02 and p < 0.03) as well as the number of mean migraine days at T3 (p < 0.01). At T3 and T6 outcome measures were comparable, although a significantly higher percent-age of super-responders was found in the anti- CGRP group (respectively p < 0.04 and p < 0.05), with a similar overall percentage of responders. Conclusions: The present study on a real- world sample confirms the beneficial effect of both anti- CGRP and anti-CGRP- R mAbs, with a more favorable outcome for anti- CGRP antibodies.