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

Area of Science:

• Neurology
• Pharmacology

Background:

• Migraine affects millions globally, with CGRP monoclonal antibodies (mAbs) offering a new preventative treatment.
• Approximately 50% of patients discontinue CGRP mAb therapy due to various reasons.
• Limited therapeutic alternatives exist for patients who discontinue CGRP mAb treatment.

Purpose of the Study:

• To review and summarize existing data on the efficacy of switching to a different CGRP mAb after prior discontinuation.
• To address the clinical need for understanding alternative treatment strategies in migraine management.

Main Methods:

• A comprehensive database search was conducted using terms related to "CGRP monoclonal antibody switch" and "CGRP monoclonal antibody switching."
• All available literature and data on the efficacy of switching CGRP mAbs were compiled and analyzed.

Main Results:

• Current data regarding the efficacy of switching CGRP mAbs is scarce and continues to evolve.
• Expert opinion aligns with the European Headache Federation's stance on insufficient evidence for CGRP mAb switching efficacy.

Conclusions:

• There is insufficient clinical data to definitively determine the efficacy of switching CGRP mAbs for migraine prevention.
• Further research and data collection are crucial to establish the therapeutic value of CGRP mAb switching for patients who discontinue initial therapy.