Real-world studies of CGRP monoclonal antibodies and gepants for migraine

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Chia-Chun Chiang, MD, Mayo Clinic, Rochester, MN, discusses the real-world use of calcitonin gene-related peptide (CGRP) monoclonal antibodies and gepants as preventive and acute treatments for migraine. Four CGRP monoclonal antibodies are currently available for the prevention of migraine, including erenumab, fremanezumab, ocrelizumab, and eptinezumab. More recently, the FDA has approved two gepants for the acute treatment of migraine: ubrogepant and atogepant; and rimegepant approved for both the acute and preventive treatment of migraine. Dr Chiang discusses how the CGRP monoclonal antibodies performed in a real-world setting – stating that many patients with previous unsuccessful treatment trials reported a reduction in frequency and severity of headaches. The efficacy was reported to be similar to that reported in the Phase III clinical trials – inferring success in the real world. However, the real-world studies with the CGRP monoclonal antibodies demonstrated a significantly higher rate of adverse side effects than the clinical trials. In terms of gepants, a real-world study demonstrated similar results to that of the CGRP monoclonal antibodies – whereby gepants had high efficacy levels like in the clinical trials. Yet, a higher percentage of patients also reported adverse side effects in the real-world study. This interview took place at the AAN 2022 Congress in Seattle, WA.

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