Real-World Effectiveness of Eptinezumab after Treatment with Subcutaneous CGRP Monoclonal Antibodies in Patients with Migraine (P12-12.009)

Abstract

<h3>Objective:</h3> To evaluate the effectiveness of eptinezumab in patients with migraine after 6 and 12 months. <h3>Background:</h3> Patients who switched from subcutaneous CGRP mAbs to intravenous CGRP mAb (i.e., eptinezumab) are refractory to most preventive medications. While several real-world studies reported positive outcomes within 6 months of eptinezumab use, the eptinezumab usage pattern and treatment response after 1-year remain unknown. <h3>Design/Methods:</h3> This single-center retrospective study examined the first 30 subjects who received eptinezumab at the Jefferson Headache Center. We collected demographics, reasons for the switch, and usage pattern/response to eptinezumab after 6 and 12 months. The generalized estimating equation (GEE) test adjusted for age, sex, and BMI was used for repeated measure analysis. Missing data were not included. <h3>Results:</h3> We reviewed 30 patients (25 female, age 52.3±12.6, BMI 28.3±6.1) who experienced headaches for 26.8±17.8 years and switched to eptinezumab. At the index date, all subjects received a 100mg regimen and reported a mean monthly headache (MHD) of 24.6±8.6 and average pain intensity (API) of 6.2±1.8. After 6 months, 23 subjects continued, and 14 (61%) received a 300mg regimen. They had an MHD of 24.5±9.4 (n=16) and API of 5.7±1.4 (n=14). After 12 months, 15 subjects continued, and 10 (71.4%) were on a 300mg regimen. These subjects had an MHD of 22.5±10.5 (n=12) and API of 5.5±1.3 (n=12). The main reasons for eptinezumab discontinuation were inadequate response (n=6/15; 40%), intolerance (n=3/15; 20%), and insurance (n=5/15, 33%). There were insignificant reductions at 6 and 12 months of MHD (−0.71, 95%CI −3.42 to 2.00, p=0.61; −1.36, 95%CI −4.52 to 1.81, p=0.40) and API (−0.46, 95%CI −1.17 to 0.24, p=0.20; −0.63, 95%CI −1.38 to 0.13, p=0.11). <h3>Conclusions:</h3> In our study, patients may sustain no apparent benefit upon switching to eptinezumab after 6 or 12 months, reflecting the refractory nature of this study population. More prospective studies are needed. <b>Disclosure:</b> Miss Casaletto has nothing to disclose. Dr. Yang has nothing to disclose. Mr. Waters has nothing to disclose. Mr. Curran has nothing to disclose. Mr. Lowe has nothing to disclose. An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Trillen Medical. The institution of Dr. Yuan has received research support from NIH. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as a Grant reviewer with NIH.