Abstract text (incl. figure legends and references)

Objective: To assess the real-world efficacy of CGRP monoclonal antibodies (mAb) in an Australian setting.

Methodology: A retrospective cohort study was undertaken of all patients commenced on a CGRP monoclonal antibody at two Victorian tertiary hospitals over the first 12-months of listing of the medication on the Pharmaceutical Benefits Scheme (PBS).

Results: Over the study period, 163 patients were commenced on either galcanezumab or fremanezumab. The study population had a median age of 44 (IQR 16), was 71.3% female, had failed a median of 5 previous migraine preventers (IQR 4) and a baseline mean monthly headache day (MHD) of 23.9 (SD 7.7). Amongst patients who were CGRP mAb naïve, the 50% responder rate was 55.9%, with a mean reduction of MHD of 10.4 (SD 9.7). A total of 25 patients were transitioned to a CGRP mAb from onabotulinumtoxinA (onaB) for incomplete response, with a baseline median MHD of 18 (IQR 23). The 50% responder rate was 40%, with a mean reduction of MHD of -3 (-7.8-1.7) beyond the effect of onaB. A Kaplan-Meier test was run to determine if there were differences in the survival distribution between galcanezumab and fremanezumab. The survival distributions for these interventions were not statistically significantly different, X2(2)=0.673, p=0.412.

Conclusion: CGRP monoclonal antibodies were effective treatments of migraine in an Australian population of migraine who had failed multiple preventative medications, including in patients who had sub-optimal responses to onaB.