Anti-CGRP monoclonal antibodies achieve optimal migraine control in 30% of high-burden patients in real-world settings

Migraine, particularly chronic migraine, significantly impacts quality of life, yet achieving high standards of care in real-world settings remains a challenge. The International Headache Society has introduced new treatment goals for migraine prevention, emphasizing outcomes beyond just a 50% reduction in monthly migraine days. Current standard-of-care oral preventive medications often have suboptimal efficacy or tolerability. Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (anti-CGRP MAbs) offer targeted prevention by blocking the CGRP pathway, a key mediator of nociceptive transmission, but their real-world effectiveness against these new, higher standards has been largely unquantified.

This prospective, real-world, European multicenter study (EUREkA cohort) included 5818 adults with migraine treated with anti-CGRP MAbs. Researchers assessed the proportion of individuals achieving specific treatment goals after 6 months of therapy. The primary endpoint categorized patients into: migraine freedom (no monthly migraine days [MMD]), optimal control (< 4 MMD), modest control (4-6 MMD), or insufficient control (> 6 MMD). All participants had insufficient headache control at baseline, with a median of 15.0 MMD. Data from 4963 individuals with 6-month follow-up were analyzed.

After 6 months of treatment with anti-CGRP MAbs, a significant proportion of patients achieved higher standards of migraine control. Of the 4963 individuals with 6-month data, 82.3% (4086/4963) were females, with a median age of 48.0 years. At baseline, median monthly headache days (MHD) were 20.0 and MMD were 15.0. All participants initially presented with insufficient headache control (> 6 MMD). By month 6:

6.9% (342/4963) achieved migraine freedom (no MMD), and 22.9% (1137/4963) achieved optimal control (< 4 MMD). Another 24.6% (1223/4963) reached modest control (4-6 MMD), while 45.6% (2261/4963) remained in the insufficient control category. Notably, within the insufficient control group, 27.1% (613/2261) still experienced a ≥50% reduction in MMD, indicating some benefit despite not meeting higher control thresholds.