Switching CGRP(r) MoAbs in migraine: what evidence?

ABSTRACT

Introduction

Approximately 50% of patients that receive a CGRP(r) MoAb for the preventative treatment of migraine are expected to discontinue therapy. For patients that discontinue CGRP(r) MoAb therapy, few clinical options are available. One potential option is to switch CGRP(r) MoAbs, however, data concerning the efficacy of this intervention is scarce.

Areas covered

This manuscript aims to summarize all available data concerning the potential efficacy of switching CGRP(r) MoAbs following previous medication discontinuation. Data was sourced by completing a database search for the terms: ‘CGRP monoclonal antibody switch OR CGRP monoclonal antibody switching.’

Expert opinion

While data considering the potential efficacy of CGRP(r) switching continues to grow, our expert opinion supports the most recent European Headache Federation statement regarding CGRP(r) MoAb prescribing practices, concluding that there remains insufficient data to determine the efficacy of this intervention. As this topic is of significant clinical importance, we recommend a call-to-action to expand on current data considering the therapeutic options for patients that discontinue CGRP(r) MoAb therapy.

KEYWORDS:

• CGRP
• monoclonal antibodies
• migraine
• switching
• headache

Article highlights

• Recently published real-world data has demonstrated significant response rates in patients switched from a previous CGRP(r) MoAb to an alternative CGRP(r) Moab.

• Switching from either erenumab or galcanezumab to fremanezumab in the case of previous therapeutic inefficacy has been the most studied intervention.

• Of the scarce available data, it appears that response rates to CGRP(r) MoAb therapy vary between switched patients and CGRP(r) MoAb naïve patients.

• While CGRP(r) switching is gaining popularity within real-world studies, due to the lack of randomized control trials, a recommendation regarding the effectiveness of CGRP(r) MoAb switching remains impossible.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Both authors have contributed equally to this manuscript. Both authors have read and agreed to the published version of the manuscript.

Additional information

Funding

This paper was not funded.