Ana Rita Pinheiro (Lisbon/ PT), André Rego (Lisbon/ PT), Pedro Neves (Lisbon/ PT), Sofia Delgado (Lisbon/ PT), Joana Dionísio (Lisbon/ PT), Beatriz Madureira (Lisbon/ PT), José Costa (Lisbon/ PT), Duarte Carapinha (Lisbon/ PT), Ângela Abreu (Lisbon/ PT), Marlene Saraiva (Lisbon/ PT), Elsa Parreira (Lisbon/ PT)
Abstract text (incl. figure legends and references)
Question: Are there putative predictors of super-response to CGRP monoclonal antibodies?
Methods: This was a unicentric prospective study between February 2019 and April 2022. We collected demographic, clinical, comorbid, and therapeutic data. We applied validated clinical scales to assess baseline severity and therapeutic response. We defined super-responders as patients who achieved a consistent ≥75% reduction in migraine frequency after 6 months of treatment and non-responders as patients with reduction <25%. We used SPSS v.23 for statistical analysis and compared groups of super-responders to non-responders using univariate linear logistic regression.
Results: From a total of 63 patients and after excluding 8 (12.8%) (short follow-up), we analyzed 42 patients. Median age was 44 years (IQR 52) and 41 (97.6%) were women. Twenty-one (50%) had chronic migraine with median duration of 22.9 years (IQR 56), 17 (40.5%) had medication overuse and 24 (57.1%) responded to triptans. We treated patients with Erenumab (n=31), Fremanezumab (n=7) and Galcanezumab (n=4). We had 29 super-responders and 13 non-responders. We found a statistically significant association between super-responders and lower baseline frequency of migraine (OR=0.901), episodic migraine (OR=0.096) and response to triptans (OR=5.000). After treatment, there was a statistically significant association between reduction of migraine frequency and lower HURT scale score (OR=0.771) and decreased headache intensity (OR=0.644). We noticed a trend towards statistically significant results between super-responders and >3 failed preventives (p=0.072) and lower baseline intense episodes (p=0.085).
Conclusions: In CGRP monoclonal antibody treatment, episodic migraine, response to triptans and lower baseline intense episodes may be potential predictors of super-response. HURT scale may be appropriate to monitor these patients. This real-life data may allow better selection and management of patients.