Eptinezumab shows varied cross-response among migraine patients previously treated with subcutaneous CGRP mAbs
Background
Migraine is a debilitating neurological disorder significantly impacting quality of life. While calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) have revolutionized preventive migraine therapy, real-world data on switching between these agents, particularly from subcutaneous (SC) to intravenous (IV) formulations like eptinezumab, remains limited. Understanding cross-response patterns is crucial for optimizing treatment strategies and addressing the unmet needs of patients who fail initial CGRP mAb therapies. This study addresses the gap in real-world evidence for sequential CGRP mAb use.
Study Design
This prospective real-world study analyzed 190 adult patients from the French FHU InovPain registry. All participants had previously received one or more subcutaneous CGRP mAbs and subsequently received eptinezumab 100 mg via intravenous infusion. The primary endpoint was the 50% responder rate in monthly migraine days after 6 months of eptinezumab treatment. Patients were categorized into three subgroups based on their response to all CGRP mAbs used: cross-effectiveness, cross-ineffectiveness, and no cross-response. Factors associated with response were investigated using multivariate logistic regression.
Results
Eptinezumab achieved a 76.0% (95% CI: 67.3-83.1) 50% responder rate in patients who had responded to at least one previously used CGRP mAb. In contrast, only 30.4% (95% CI: 20.2-42.8) of patients with no prior response to CGRP mAbs responded to eptinezumab. Overall, cross-effectiveness (all CGRP mAbs effective) was observed in 46.8% (95% CI: 39.6-54.2) of patients. Cross-ineffectiveness (all CGRP mAbs ineffective) occurred in 28.9% (95% CI: 22.7-36.0), while 24.2% (95% CI: 18.4-31.7) showed no cross-response (mixed responses). A lower helplessness score was the only factor significantly associated with response to at least one CGRP mAb.
Why It Matters
Switching CGRP monoclonal antibodies can be a viable strategy for migraine patients, especially if they've responded to a prior CGRP mAb. This real-world evidence supports the clinical utility of sequential CGRP mAb use, offering hope for patients who may not achieve optimal results with their first treatment. Eptinezumab, an intravenous option, provides an important alternative, particularly for those who may have failed subcutaneous CGRP mAbs. The findings suggest that a subset of patients will benefit from switching, while others may be truly refractory to the entire class, guiding future treatment algorithms.