Partial and nonresponders to onabotulinumtoxinA can benefit from anti-CGRP monoclonal antibodies preventive treatment: A real-world evidence study.

Abstract

Monoclonal antibodies targeting CGRP or its receptor, anti-CGRP mAbs, are proven to be effective treatments in migraine prevention. Real-world evidence studies assessing their efficacy are scarce. Our objective was to assess the efficacy of anti-CGRP mAbs in our clinical cohort resistant to onabotulinumtoxinA. We prospectively analyzed ≥50% response rate in patients who initiated treatment with anti-CGRP mAbs and who were partial or nonresponders to onabotulinumtoxinA. One hundred fifty-five patients completed treatment with anti-CGRP mAbs at 3 months of follow-up. No statistically significant differences were found in ≥50% response in headache frequency in patients with prior onabotulinumtoxinA treatment partial or complete failure. Regarding dual therapy with onabotulinumtoxinA and anti-CGRP mAbs, no statistically significant differences were found in ≥50% response in headache frequency between monotherapy or dual therapy. Patients with prior treatment failure or partial efficacy to onabotulinumtoxinA respond to anti-CGRP mAbs. After 3months, in our cohort, dual therapy does not seem to add more benefit than anti-CGRP mAbs in monotherapy.