Abstract text (incl. figure legends and references)

Question: The objective of this study was to assess predictors of galcanezumab response in Korean patients with migraine.

Methods: We prospectively recruited and followed up patients from June 2020 to October 2021 who received monthly galcanezumab treatment in Samsung Medical Center. We defined the treatment response with ≥ 50% reduction in monthly migraine days. Demographics, migraine characteristics, comorbid medication overuse, disease duration, triptan response, previous response to botulinum toxin treatment, monthly headache days, headache impact, depression (Patient Health Questionnaire-9 score ≥ 8), anxiety (Generalized Anxiety Disorder-7 score ≥ 5), number of previously failed preventive medication classes, and the presence of pain-free day were tested by using the univariable logistic regression analysis. Variables with univariable p <0.2 were include in the multivariable analysis.

Results: Among 104 patients (81.7% female; mean age 42.0 ± 13.02; 76.9% chronic migraine; and 45.5% medication overuse headache) recruited, 58 (55.7%) were responders. From the univariable logistic regression analysis, chronic migraine, medication overuse headache, nausea or vomiting, triptan response, monthly headache days, depression, the number of previously failed preventive medication classes, and the presence of pain-free day were included in the multivariable logistic regression analysis. The multivariable analysis showed chronic migraine (OR 0.05 [95% CI 0.00–0.82], p=0.036) and the number of previously failed preventive medication classes (OR 0.55 [95% CI 0.33–0.92], p=0.024] were independently associated with treatment response.

Conclusion: Chronic migraine and multiple failures from preventive medication are associated with poor galcanezumab response. Further studies are needed to investigate if earlier treatment before disease chronification may lead to a greater therapeutic gain from anti-CGRP(-receptor) monoclonal antibody treatments.