B. MORALES RIVERO¹, A.J. MORENO LOPEZ¹, M.D.P. LOPEZ LOPEZ¹, V. CAO VIÑA¹, A. PLAZA, ARBEO¹.

¹HOSPITAL UNIVERSITARIO DE JAÉN, SERVICIO DE FARMACIA, JAÉN, SPAIN.

Received Date: April 01, 2025; Accepted Date: April 07, 2025; Published Date: April 11, 2025;

^*Corresponding author: B. MORALES RIVERO, HOSPITAL UNIVERSITARIO DE JAÉN, SERVICIO DE FARMACIA, JAÉN, SPAIN.

Keywords: Calcitonin, Eptinezumab, Migraine, Refractory

Background and importance

Migraine is a highly prevalent neurological disease characterized by incapacitating episodes of headache that affect quality of life. Many patients fail one or more lines of calcitonin-gene-related-peptide (CGRP) inhibitor drugs, causing therapeutic exhaustion and a high health

impact. Therefore, new CGRP inhibitor, eptinezumab, may represent a new therapeutic alternative for refractory patients.

Aim and objectives

To evaluate the effectiveness of eptinezumab in patients refractory to one or more lines of CGRP inhibitor drugs (fremanezumab, erenumab and galcanezumab).

Material and methods

Retrospective observational study conducted between November 2023 and September 2024. To evaluate the effectiveness of eptinezumab, we compared the days with migraine per month (MMD) at baseline and after 12 weeks, mean reduction in MMD, rates of patients with response ≥75% and ≥50% based on the previous lines of CGRP received by the patients. For statistical analysis, the R studio program was used and demographic and clinical data were extracted from the patients’ electronic medical records.

Results

34 patients with a mean age of 53.86 years (sd: 5.9) and 87.5% women. 20.6% of patients had received a single prior line, 61.8% two prior lines and the remaining 17.6% all 3 drugs. Of those who had received two drugs, the most frequent was erenumab and galcanezumab 54.5%, followed by erenumab and fremanezumab 27.2%. In those patients who had only received one prior line, the initial DDM was 25 days (sd: 5.0), and after 12 weeks of treatment 16.4 (sd: 7.9). The response rate ≥75% during weeks 0-12 was 28.6% and the response rate ≥50% MDD was 57.1%. With two prior lines of therapy: initial DMM was 20.3 days (sd:9.7); 12.3 (sd: 8.7), and response rates 19% and 71.4% respectively. Those who had received all three possible lines had: prior DDM 27 (sd:6.7); at 12 weeks 17.2 (sd: 13.6), response rate ≥75% DDM of 33.3%; and response rate ≥50% DMM of 50%.

Conclusion and relevance

Treatment with eptinezumab has been effective regardless of the previous lines of treatment with subcutaneous CGRP inhibitor drugs, so it may constitute an effective alternative for patients refractory to this group of drugs. However, larger studies are needed to corroborate the data obtained in this study.

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