by Jessica Ailani, MD

Clinical trials are how we learn about medication safety and efficacy in a specific disease state, but real-world studies are imperative to describe how medications are utilized in clinical practice. Real-world studies review clinician’s experience with treatments that are either new to market, or new to an indication, reviewing efficacy, side effects, and nuances to use in practice (1).

This study from Dr. Pham and colleagues highlights the experience of a tertiary headache center with the first two CGRP monoclonal antibodies (mab) that were FDA approved for prevention of migraine; erenumab and galcanezumab. They discuss their experience with patients who switched from one CGRP mab to another and reviewed side effects and tolerability seen with both medications. Patients in this study treated with erenumab had a higher rate of constipation, and those treated with galcanezumab had a higher rate of injection site reactions. Reasons for switching CGRP mabs included lack of efficacy, side effects, and insurance issues. A similar number of patients responded to erenumab and galcanezumab, a similar number of patients responded to neither agent, and a similar number of patients responded to one CGRP mab and not the other. 

These findings suggest that a switch from erenumab to galcanezumab produced similar improvement in migraine symptoms.

This study was not designed to provide further safety information on switching CGRP mabs. Results from this study can provide assurance to patients who need to change CGRP mabs due to side effects or insurance issues that response may be present with a switch in product.

 

 

References:

1.  Blonde L, Khunti K, Harris SB, Meizinger C, Skolnik NS. Interpretation and Impact of Real-World Clinical Data for the Practicing Clinician. Adv Ther. 2018;35(11):1763-1774. doi:10.1007/s12325-018-0805-y