Eptinezumab for the preventive treatment of episodic and chronic migraine: a narrative review

Pablo Irimia; Sonia Santos-Lasaosa; Patricia Pozo-Rosich; Rogelio Leira; Julio Pascual; José Miguel Láinez

doi:10.3389/fneur.2024.1355877

Eptinezumab for the preventive treatment of episodic and chronic migraine: a narrative review

Front Neurol. 2024 Mar 8:15:1355877. doi: 10.3389/fneur.2024.1355877. eCollection 2024.

Authors

Pablo Irimia¹, Sonia Santos-Lasaosa², Patricia Pozo-Rosich^{3

4}, Rogelio Leira⁵, Julio Pascual⁶, José Miguel Láinez⁷

Affiliations

¹ Clínica Universidad de Navarra, Pamplona, Spain.
² Aragon Institute for Health Research (IIS Aragon), Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain.
³ Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
⁴ Headache and Neurological Pain Research Group, VHIR, Universitat Autònoma Barcelona, Barcelona, Spain.
⁵ Department of Neurology, Headache Unit, Hospital Clínico Universitario, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain.
⁶ Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain.
⁷ Department of Neurology, Hospital Clínico Universitario, Universidad Católica de Valencia, Valencia, Spain.

Abstract

Eptinezumab, a monoclonal antibody that targets calcitonin gene-related peptide (CGRP), was recently approved in Europe for the prophylactic treatment of migraine in adults who have at least four migraine days a month. Eptinezumab is administered by intravenous infusion every 12 weeks. During recent months, a considerable amount of evidence from eptinezumab trials has been published. The aim of this review is to describe the existing evidence on the tolerability, safety and efficacy of eptinezumab in patients with migraine. Data from randomized (PROMISE-1, PROMISE-2, RELIEF and DELIVER) and open-label (PREVAIL) phase 3 clinical trials have demonstrated the favorable effect of eptinezumab in migraine symptoms from first day of treatment. These studies showed that eptinezumab results in an overall reduction in mean monthly migraine days (MMDs), increases in the ≥50% and ≥ 75% migraine responder rates (MRRs) and improvements in patient-reported outcome measures in both patients with episodic migraine (EM) and with chronic migraine (CM), including patients who failed previous preventive treatments. The RELIEF trial also showed that eptinezumab, within 2 h of administration, reduced headache pain, migraine-associated symptoms and acute medication use when administered during a migraine attack. Eptinezumab benefits manifested as early as day 1 after dosing and with the subsequent doses lasted up to at least 2 years. Treatment-emergent adverse events reported by ≥2% of patients included upper respiratory tract infection and fatigue. Current evidence demonstrates that eptinezumab has a potent, fast-acting, sustained migraine preventive effect in patients with EM and CM. Eptinezumab has also shown to be well tolerated, supporting its use in the treatment of patients with migraine and inclusion in the current migraine therapeutic options.

Keywords: calcitonin gene-related peptide; chronic migraine; clinical development; episodic migraine; eptinezumab; fast onset of action; narrative review; preventive treatment.

Publication types

Review

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. Medical writing was funded by Lundbeck Spain in accordance with Good Publication Practice (GPP3) guidelines. Lundbeck Spain was not involved in the study design, collection, analysis, interpretation of data, or the decision to submit it for publication.