Abstract text (incl. figure legends and references)

QUESTION

To evaluate efficacy and safety of erenumab (E), Galcanezumab (G) and fremanezumab (F) as preventive treatment in a difficult to treat migraine population in our headache unit.

METHODS

Prospective and descriptive study of the use of E, G and F in our headache unit since their approval. Measures of efficacy: migraine days per month (MMD), triptans days per month (TDM) and overuse of symptomatic medication. We use scales as Patient Related Outcome (PROs): MIDAS, HIT-6, Pain Catastrophizing scale (PCS) and migraine-specific quality of life questionnaire (MsQol). We evaluate each patient at baseline and every 3 months. Follow up of adverse events also every 3 months.

RESULTS

336 patients reached at least 3 months of treatment and 233 patients 6 months. 140 patients were treated with E, 139 with G and 57 with F. Mean age was 46,78 years, 81,55% were women and 88,09% were diagnosed of chronic migraine. They had failed an average of 5,39 previous preventive treatments.

At baseline they had: 19,50 MMD; 13,78 TDM; 69% overuse of triptans; MIDAS: 90,62, HIT-6: 68,75, PCS: 31,77, MsQol: 31,23.

MMD with E at baseline, 3 and 6 months was: 20,53; 13,48 y 10,73.

With G: 19,33; 11,34 y 9,83.

With F: 17,40; 9,47 y 8,41.

PROs changed in the same way with all the anti-CGRP mAbs. MIDAS scale was reduced to 53,69 points at 3 months and to 40,66 at 6 months; HIT-6 reduced to 60,37 points at 3 months and 58,33 at 6 months and the overuse of triptans reduced to 31,54% at 3 months and 29,18% at 6 months.

Regarding adverse events (AE), constipation is the most frequent AE, reaching 19% of all patients. It trends to reduce its prevalence as time goes by.

CONCLUSION

All anti-CGRP mAbs are effective in patients with difficult to treat migraine. Constipation is the most frequent AE, greater than in clinical trials, not clinically significant and improving over time with treatment. The results of efficacy and safety are similar among the 3 a-GCRP mAbs.