CGRP Inhibitors Significantly Reduce Disability in Migraine


Study results add to the body of evidence demonstrating the efficacy of CGRP inhibitors for migraine treatment and prophylaxis.

Calcitonin gene-related peptide (CGRP) inhibitors—a novel class of medications for migraine treatment and prophylaxis—are associated with significant reductions in patient-reported migraine disability scores, according to research results presented at the 2023 American Society of Health-System Pharmacists (ASHP) Summer Meetings and Exhibition, held June 10 to 14 in Baltimore, Maryland.

There are limited data directly evaluating the real-world outcomes of patients with migraine who are treated with CGRP inhibitor medications. At the University of Kentucky Specialty Pharmacy Services and Infusion Services Health System Specialty Pharmacy, researchers sought to evaluate the use of CGRP inhibitor therapy in patients with migraine as assessed by change in Migraine Disability Assessment Test (MIDAS) score.

Investigators conducted a retrospective chart review of patients with headache disorder—either migraine or cluster headache—who initiated treatment with a CGRP inhibitor and completed the Migraine Disability Assessment Questionnaire (MDAQ) between July and October 2022. Participants were excluded if they did not have a follow-up MDAQ within 120 days of the baseline questionnaire.

Collected data included demographic and baseline characteristics such as age, gender, ethnicity, indication for CGRP inhibitor use, specific CGRP inhibitor agents used, the goal of therapy—abortive or prophylactic—MIDAS score at both baseline and follow-up, and migraine therapy changes at follow-up.

The cohort included 125 patients who met inclusion criteria (median age, 42; 84% women). The majority of patients—84.8%—were diagnosed with chronic migraine; 15.2% were diagnosed with episodic migraine and only 1.6% of patients, each, had cluster headache or other types of headaches. Within the study cohort, 26.4% were CGRP inhibitor-naïve.

In terms of MIDAS evaluation, median days to follow-up was 86. Composite MIDAS score showed a significant decrease at the time of follow-up, along with a mean score decrease of 36.7 points (88.1 vs 51.4 at baseline vs follow-up). At baseline, 80.8% of participants were rated MIDAS grade 4, or severe disability; this rating decreased to 62.4% at the time of follow-up. Also at follow-up, 28.8% had a change in migraine therapy, most commonly discontinuation of medication (44.4%) or medication substitution (26.1%). The most common therapy change was treatment failure, seen in 72.2% of patients.

“Real-world evidence…demonstrates that CGRP [inhibitor] agents are associated with a significant reduction in patient-reported MIDAS score after approximately 3 months of treatment,” the researchers wrote, adding, “This finding adds to the body of evidence supporting CGRP [inhibitor] use for migraine.”

Additional studies are needed to further explore the efficacy of these medications, as well as to determine the reason for therapy changes in this patient population.

1. Huffmyer M. Real-world evidence of patient-reported efficacy and tolerability of CGRPi agents at a health-system specialty pharmacy. Presented at: American Society of Health-System Pharmacists 2023 Summer Meetings and Exhibition; June 10-14, 2023; Baltimore, MD. Poster 35-T.
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