A prospective real-world analysis of intravenous eptinezumab in migraine management: the first UK experience
Anna P. Andreou, Bethany Hill, Rand Al-Rawi, Madeleine Murphy, Isabel Soares, Jessica Briscoe, Rachael Kilner, Giorgio Lambru
Abstract
BACKGROUND: Clinical trials have shown the safety and statistical superiority of intravenous eptinezumab to placebo in migraine prevention in adults. However, data in real-world settings is sparse. METHODS: This is a prospective open-label single centre real-world analysis aiming to establish the effectiveness of intravenous eptinezumab 100 mg in patients with migraine who were treated for up to six months as per the National Institute of Care and Health Excellence (NICE) guidelines in the United Kingdom (UK). RESULTS: Of 130 patients treated between February 2023 and February 2025, 119 patients with migraine (chronic migraine: 112, 94%), who had completed a three month follow up and submitted their headache diary following the first eptinezumab infusion were analysed. Patients failed to respond/tolerate an average of 10.2 ± 4.5 preventive treatments and 80 patients (67%) did not respond or tolerate one or two calcitonin gene related peptide (CGRP) targeting therapies prior to Eptinezumab. After one eptinezumab infusion, 61 (51%), 41 (35%) and 15 (13%) of patients achieved at least a 30%, 50% and 75% reduction in their mean monthly migraine days (MMDs), respectively. The average reduction in MMD was 5.4 days (P < 0.001). Out the 76 patients who had the six-month review after the second infusion, 48 (63%), 33 (43%) and 14 (18%) of patients achieved at least a 30%, 50% and 75% reduction, respectively, in their MMD, with an average reduction in MMD of 6.3 days (P < 0.001). There was an average reduction of the Headache Impact Test 6 (HIT-6) score of 5.3 and 6.3 respectively at months 3 and 6 post-infusions (P < 0.001). Patients who were naive to any other anti-CGRP monoclonal antibodies (mAb) treatment were more likely to be eptinezumab responders (30% reduction in MMD) than those who failed to respond to previous anti-CGRP mAbs both at 3 and 6 months (3 month responders: 74% vs. 40; 6 months responders: 56% vs. 33%, p = 0.001). After the first treatment, 24 patients (20%) reported 34 treatment-related adverse events. After the second treatment, nine patients reported ten adverse events. Six patients (5%) discontinued eptinezumab because of side effects. CONCLUSION: In real world settings, intravenous eptinezumab may be an effective and well tolerated treatment option for patients with migraine who fail multiple treatments including other anti-CGRP mAbs.