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Switching from ligand to receptor anti‐calcitonin gene‐related peptide ( CGRP ) antibodies or vice versa in non‐responders: A controlled cohort study

Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND PURPOSE: Limited options exist for migraine prevention after stopping anti-calcitonin gene-related peptide monoclonal antibodies. A systematic review examining the benefits of switching between different classes (ligand vs. receptor monoclonal antibody) is essential, alongside well-designed real-world studies. METHODS: In this cohort study 67 patients were included, who discontinued their first treatment with erenumab or fremanezumab. Patients (n = 31) switched to another monoclonal antibody class within 3 months, whilst those in the control group (n = 36) received standard care. Allocation to either group relied largely on the availability of alternative monoclonal antibody treatments, introducing pseudo-random allocation. Changes in monthly migraine days were compared between groups 3 months post-discontinuation of the first monoclonal antibody or initiation of a different monoclonal antibody class. A multivariate regression model was conducted that accounted for potential confounding factors. RESULTS: The groups were comparable at baseline and poor treatment response was the main reason for treatment discontinuation of the first monoclonal antibody. The switching cohort experienced a reduction of 3.9 monthly migraine days (95% confidence interval -6.4, -1.3, p = 0.004) compared with the control group. CONCLUSION: Transitioning to a different anti-calcitonin gene-related peptide monoclonal class yields reduction in monthly migraine days compared to returning to standard care for patients with inadequate initial treatment response.
DOI: 10.1111/ene.16542
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,600
OpenAlex ID: W4404821402
FWCI: 2.144
Cites: 36
Cited by: 8
Related to: 10