{
  "abstract": "Background and Importance Migraine is a prevalent and disabling neurological disorder with major impact on quality of life and healthcare resources. Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway are effective and well tolerated in migraine prevention. However, many patients show limited response or intolerance to the first anti-CGRP agent, and evidence on switching between these therapies in clinical practice remains scarce. Understanding real-world outcomes of sequential anti-CGRP therapy may help guide personalised treatment strategies.Aim and Objectives To evaluate the real-world effectiveness of sequential anti-CGRP monoclonal antibody therapy as second-line preventive treatment after lack of efficacy or intolerance to galcanezumab.Material and Methods A retrospective observational study was conducted from January 2020 to February 2025. Patients with chronic or high-frequency episodic migraine who started a second anti-CGRP monoclonal antibody after galcanezumab failure or intolerance were included. Eligible patients received second-line therapy for at least 6 months. Variables collected included demographic (age, sex), clinical (monthly migraine days (MMD), Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6)) and treatment data (drug, duration). Effectiveness was defined as a ≥50% reduction in MMD and/or improvement in HIT-6 or MIDAS scores versus pre-galcanezumab values.Results Thirty-one patients were included (median age 55 years; 93.5% women); 28 (90.3%) had chronic and 3 (9.7%) high-frequency episodic migraine. Second-line treatment was erenumab in 30 patients (96.9%) and fremanezumab in one (3.2%). Median treatment duration was 16.8 months for first-line and 7.3 months for second-line therapy. Reasons for switching were lack of efficacy (n = 23), intolerance (n = 7), or both (n = 1). Four patients required erenumab dose escalation to 140 mg. A ≥50% reduction in MMD was achieved in 10 patients (32.3%), all on erenumab; these and 17 others showed improvement in MIDAS or HIT-6 scores.Conclusion and Relevance Sequential use of a second anti-CGRP monoclonal antibody after galcanezumab failure or intolerance was effective in a subset of patients, supporting its role as a therapeutic option. Further studies are needed to identify predictors of response and optimise individualised migraine management.References and/or Acknowledgements 1. López-Moreno JA, et al. Switching between CGRP pathway monoclonal antibodies in migraine: a real-life experience. Headache. 2023;63(1):77–87. doi:10.1111/head.14432Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Universitario De Cabueñes, Farmacia, Gijón, Spain"
      ],
      "name": "A Gonzalo González"
    },
    {
      "affiliations": [
        "Hospital Universitario De Cabueñes, Farmacia, Gijón, Spain"
      ],
      "name": "L Curras Varela"
    },
    {
      "affiliations": [
        "Hospital Universitario De Cabueñes, Farmacia, Gijón, Spain"
      ],
      "name": "J Rodriguez Carballo"
    },
    {
      "affiliations": [
        "Hospital Universitario De Cabueñes, Farmacia, Gijón, Spain"
      ],
      "name": "A Gallego Casado"
    },
    {
      "affiliations": [
        "Hospital Universitario De Cabueñes, Farmacia, Gijón, Spain"
      ],
      "name": "S Fuertes Camporro"
    },
    {
      "affiliations": [
        "Hospital Universitario De Cabueñes, Farmacia, Gijón, Spain"
      ],
      "name": "R Pampín Sánchez"
    },
    {
      "affiliations": [
        "Hospital Universitario De Cabueñes, Farmacia, Gijón, Spain"
      ],
      "name": "A Goenaga Ansola"
    },
    {
      "affiliations": [
        "Hospital Universitario De Cabueñes, Farmacia, Gijón, Spain"
      ],
      "name": "M Fernández Vicente"
    },
    {
      "affiliations": [
        "Hospital Universitario De Cabueñes, Farmacia, Gijón, Spain"
      ],
      "name": "C Martínez-Múgica Barbosa"
    }
  ],
  "title": "4CPS-152 Real-world effectiveness of sequential anti-CGRP therapy in migraine prophylaxis",
  "uid": "8df50346-6c8a-5837-961d-07566c295c10"
}