Clinicians are being encouraged to document the use and benefit of bridge therapies for patients who experience CGRP MAb wearing off during migraine treatment. This follows a retrospective chart review of patients attending a US headache centre which showed wearing-off in 20% of patients, equivalent to approximately 25% of the anticipated duration of monthly CGRP MAb therapy.
The study of 204 patients, 85% with chronic migraine (85%), 12% with episodic migraine without aura and 3% with episodic migraine with aura was carried out between May 2018 and October 2020. Of the 38 patients who experienced wearing off, 50% were prescribed galcanezumab, 34% erenumab and 16% fremanezumab. Average wearing-off happened eight days prior to the next injection in the 18 patients with documented information (galcanezumab 9 days; erenumab 6 days and fremanezumab 10 days). The remaining patients who experienced wearing-off were advised to have their CGRP MAb treatment every 28 days to prevent wearing off.
Use of bridge medication and its effects was not recorded in patient records. The researchers therefore recommended further research into CGRP MAb wearing-off, potential differences in wearing-off by CGRP MAb medication type, and treatment options for affected patients.
“Clinicians may consider documenting the use and benefit of bridge therapies during the wear-off period, and may also consider trialing a different CGRP MAb if wear-off has been identified,” they concluded.
Garcia-Ayala ME; Veronesi MA, Verhaak A, Grosberg BM. Calcitonin gene-related peptide (CGRP) monoclonal antibody (MAB) wear-off phenomenon in the treatment of migraine. Headache 2021; 61 (S1): 56 (P-107)