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

Expert Opin Biol Ther. 2024 May;24(5):327-333. doi: 10.1080/14712598.2024.2354386. Epub 2024 May 14.

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; headache; migraine; monoclonal antibodies; switching.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal* / therapeutic use
  • Calcitonin Gene-Related Peptide Receptor Antagonists / administration & dosage
  • Calcitonin Gene-Related Peptide Receptor Antagonists / therapeutic use
  • Calcitonin Gene-Related Peptide* / antagonists & inhibitors
  • Calcitonin Gene-Related Peptide* / immunology
  • Drug Substitution
  • Humans
  • Migraine Disorders* / drug therapy
  • Receptors, Calcitonin Gene-Related Peptide / immunology
  • Receptors, Calcitonin Gene-Related Peptide / metabolism
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Calcitonin Gene-Related Peptide
  • Receptors, Calcitonin Gene-Related Peptide
  • Calcitonin Gene-Related Peptide Receptor Antagonists