Talbot Jamie, Stuckey Rebecca, Wood Natasha, Gordon Alexander, Crossingham Ginette, Weatherby Stuart
Department of Neurology, Derriford Hospital, Plymouth, UK
University of Birmingham, Birmingham, UK.
Eur J Hosp Pharm. 2025 Feb 21;32(2):178-185. doi: 10.1136/ejhpharm-2023-003779.
The anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP-mAb) are effective in migraine; however, few studies have examined the benefit of switching from one anti-CGRP-mAb to another. In order to better inform clinical practice in this situation, we present our real-world findings of switching anti-CGRP-mAb in chronic migraine.
Individuals with chronic migraine that switched anti-CGRP-mAb treatment (erenumab, fremanezumab or galcanezumab) due to ineffectiveness or adverse effects were retrospectively identified. Headache diary data before and up to 6 months after anti-CGRP-mAb switch were analysed. Main outcome measures were monthly red days (days with headaches limiting activity or requiring triptans), headache days (days with any kind of headache), triptan use, other analgesic use and headache disability (Headache Impact Test-6 (HIT-6) score) at 3 months.
The analysis included 66 instances of switching among 54 individuals. There were non-significant reductions of -1.2 (-2.7, 0.3) red days from baseline at 3 months, with 10 individuals (15%) showing ≥50% improvement and 22 (33%) experiencing a ≥30% improvement. Improvements in headache days, triptan days, other painkiller use and HIT-6 score were non-significant. When individuals that switched due to side effects were excluded from the analysis, significant reductions in headache (Friedman p=0.044) and a trend for improvement in red days (Friedman p=0.083) were observed. With regard to side effects, on 12 occasions these improved or resolved on switching to a different anti-CGRP-mAb, while new symptoms were reported on eight occasions following a switch.
We recorded modest improvements in headache outcomes, although significant results were only observed in those that switched anti-CGRP-mAb due to ineffectiveness. Switching may therefore be a viable option for these individuals.
降钙素基因相关肽单克隆抗体（抗CGRP单克隆抗体）对偏头痛有效；然而，很少有研究探讨从一种抗CGRP单克隆抗体转换为另一种的益处。为了更好地指导这种情况下的临床实践，我们展示了在慢性偏头痛中转换抗CGRP单克隆抗体的真实世界研究结果。
回顾性确定因无效或不良反应而转换抗CGRP单克隆抗体治疗（依瑞奈尤单抗、夫雷西尤单抗或加卡奈尤单抗）的慢性偏头痛患者。分析抗CGRP单克隆抗体转换前及转换后6个月内的头痛日记数据。主要结局指标为3个月时的每月红色天数（因头痛限制活动或需要使用曲坦类药物的天数）、头痛天数（出现任何类型头痛的天数）、曲坦类药物使用情况、其他镇痛药使用情况以及头痛残疾程度（头痛影响测试-6（HIT-6）评分）。
分析包括54例患者的66次转换情况。3个月时，与基线相比，每月红色天数非显著减少-1.2（-2.7，0.3）天，10例患者（15%）改善≥50%，22例患者（33%）改善≥30%。头痛天数、曲坦类药物使用天数、其他止痛药使用情况和HIT-6评分的改善均不显著。当排除因副作用而转换的患者后进行分析，观察到头痛天数显著减少（Friedman检验p=0.044），红色天数有改善趋势（Friedman检验p=0.083）。关于副作用，12次转换后副作用改善或消失，而8次转换后报告出现了新症状。
我们记录到头痛结局有适度改善，尽管仅在因无效而转换抗CGRP单克隆抗体的患者中观察到显著结果。因此，转换可能是这些患者的一个可行选择。
