EHC 2022 | Real-world data on anti-CGRP monoclonal antibodies

Gisela Terwindt, MD, PhD, Leiden University, Leiden, Netherlands, discusses real-world findings on anti-CGRP monoclonal antibodies and their impact on clinical practice. Typically, clinical trials assess the efficacy of anti-CGRP monoclonal antibodies across the spectrum of response thresholds (50%, 75%, 100%) based on monthly migraine days (MMD) reduction. Still, those rates are for each month rather than at an individual level as needed in clinical practice. A real-world study on patients with chronic migraine and high-frequency episodic migraine who were resistant to previous preventive treatments found that for those groups, a 30% reduction in MMD is reached for half of the treatment period. Therefore, if patients should be treated for at least six months, the threshold desired would be a 30% reduction or more in MMD in 3 months. Prof. Terwindt explains that the threshold shouldn’t be set too high; otherwise, the patients will have to stop treatment because they are regarded as nonresponders by insurance companies. Accordingly, predicting if patients will respond to treatments is highly important. Various studies have examined response predictors, including trigeminal vascular reactivity, CGRP-like immunoreactivity, and depressive symptoms. Finally, real-world studies can provide insights into concerns raised during postmarketing surveillance. For instance, a real-world study assessed the safety of elevated blood pressure (BP) associated with anti-CGRP monoclonal antibodies reported in previous analyses. They found that while most patients remained within the normal BP limits, some required antihypertensive treatment. This interview took place at the 16th European Headache Congress (EHC) in Vienna, Austria.

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