PO-43 | Eptinezumab in migraine patients unresponsive to prior subcutaneous CGRP(-R) monoclonal antibody treatment: a retrospective case series

Elena Cresta, Irene Mattioli, Michele Di Pasquale, Alice Lanfranchi, Renata Rao, Alessandro Padovani | Neurology Unit and Headache Centre, Dipartimento di continuità di cura e fragilità, ASST Spedali Civili e Università degli studi di Brescia, Brescia, Italy

Background: In real-world studies, anti-CGRP(-receptor, -R) monoclonal antibodies (mAbs) have achieved a ≥50% reduction in monthly migraine days (MMDs) in up to 77% of patients. Despite these generally favorable outcomes, up to one-third of patients do not respond to subcutaneous CGRP(-R) mAbs. These patients may benefit from switching to a different CGRP(-R) mAb, with highly variable 30% response rates to these switches. This study aims to evaluate the short-term effectiveness of eptinezumab following a single infusion in patients who had previously failed treatment with a subcutaneous mAb.

Methods: We retrospectively collected data from 13 migraine patients treated at the Headache Centre of Spedali Civili of Brescia. All had previously received subcutaneous mAbs without benefit and were subsequently administered a single intravenous dose of eptinezumab (100 mg). MMDs, days of acute medication use, and migraine pain intensity were recorded using standardized headache diaries at baseline (T0) and after 12 weeks (T3). The Migraine Disability Assessment (MIDAS) questionnaire was also completed at both time points.

Results: Of the 13 patients included (3 males, 10 females), 92% had chronic migraine at baseline, and 69% exhibited medication overuse (triptans and/or NSAIDs). Additionally, 61% had previously received treatment with onabotulinumtoxinA. Nine patients had been treated with erenumab, two with fremanezumab, and two with galcanezumab, each following a washout period of at least two months. After 12 weeks of eptinezumab treatment, 38% (5/13) were classified as responders (≥50% reduction in MMDs), 23% (3/13) as partial responders (≥30% reduction), and 15% (2/13) experienced a significant reduction in migraine intensity without changes in attack frequency. Non-response was observed in 23% (3/13) of patients. At week 12, 38% of patients still met criteria for symptomatic medication overuse. In patients who responded to treatment, a mean reduction in the MIDAS score of 55.4 ± 62.04 was observed.

Conclusion: These preliminary results suggest that eptinezumab may represent a valuable therapeutic option for challenging-to-treat patients who did not respond to an initial subcutaneous anti-CGRP(-R) mAb. This efficacy may be hypothetically attributed to its intravenous administration, rapid onset of action, and distinct biochemical characteristics. A larger sample and a longer follow-up are needed to confirm these findings.