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

Abstract 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 response 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 percentage 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.