Youn Michelle Sojung, Kim Namoh, Lee Mi Ji, Kim Manho
Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.
Department of Neurology, Seoul National University Hospital, Seoul, Korea.
J Clin Neurol. 2024 May;20(3):300-305. doi: 10.3988/jcn.2023.0311.
Monoclonal antibodies (mAbs) targeting calcitonin-gene-related peptide (CGRP) or its receptor (anti-CGRP-R) have been widely administered to patients with migraine who show inadequate responses to preventive medications. Among patients in whom a particular anti-CGRP-R mAb is ineffective, switching between different anti-CGRP-R mAbs can be the next option. Few studies have investigated treatment outcomes for antibody switching, especially between mAbs with the same target of the CGRP ligand. We aimed to determine the treatment outcome after switching between two anti-CGRP mAbs (galcanezumab to fremanezumab).
We identified migraine patients in a prospective headache clinic registry who received galcanezumab for ≥3 months and were switched to fremanezumab for a further ≥3 months at a single university hospital. We defined a treatment response as a ≥50% reduction in the number of days with a moderate or severe headache at the third month of treatment relative to baseline. The treatment response after switching to fremanezumab was compared with the initial treatment response to galcanezumab.
Among 21 patients identified in the registry, 7 (33.3%) were initial responders to galcanezumab. After switching to fremanezumab, 7 (33.3%) showed a treatment response. The treatment response rate was 28.6% in the initial responders and 71.4% in the nonresponders to galcanezumab (>0.999).
Switching between anti-CGRP mAbs (galcanezumab to fremanezumab) yielded a treatment outcome comparable to that reported previously when switching from an anti-CGRP-R mAb (erenumab) to an anti-CGRP mAb (galcanezumab or fremanezumab). The treatment response to fremanezumab seems to be independent of the prior treatment response to galcanezumab. Our findings suggest that switching to another anti-CGRP mAb can be considered when a particular anti-CGRP mAb is ineffective or intolerable.
靶向降钙素基因相关肽（CGRP）或其受体的单克隆抗体（mAb）（抗CGRP-R）已广泛应用于对预防性药物反应不佳的偏头痛患者。在对特定抗CGRP-R mAb无效的患者中，换用不同的抗CGRP-R mAb可能是下一步选择。很少有研究调查抗体转换的治疗效果，尤其是在具有相同CGRP配体靶点的mAb之间。我们旨在确定在两种抗CGRP mAb（加卡尼单抗换为夫雷西单抗）之间转换后的治疗效果。
我们在一家大学医院的前瞻性头痛门诊登记处识别出接受加卡尼单抗治疗≥3个月且换用夫雷西单抗再治疗≥3个月的偏头痛患者。我们将治疗反应定义为治疗第三个月时中度或重度头痛天数相对于基线减少≥50%。将换用夫雷西单抗后的治疗反应与加卡尼单抗的初始治疗反应进行比较。
在登记处识别出的21例患者中，7例（33.3%）对加卡尼单抗初始有反应。换用夫雷西单抗后，7例（33.3%）有治疗反应。加卡尼单抗初始有反应者的治疗反应率为28.6%，无反应者为71.4%（>0.999）。
抗CGRP mAb之间（加卡尼单抗换为夫雷西单抗）转换产生的治疗效果与先前报道的从抗CGRP-R mAb（依瑞奈单抗）转换为抗CGRP mAb（加卡尼单抗或夫雷西单抗）时相当。对夫雷西单抗的治疗反应似乎与先前对加卡尼单抗的治疗反应无关。我们的研究结果表明，当特定抗CGRP mAb无效或无法耐受时，可以考虑换用另一种抗CGRP mAb。
