Preventative treatment of chronic migraine will continue to evolve in short-term with anti-CGRP mAbs effectiveness

OnabotulinumtoxinA (BoNT-A) and monoclonal antibodies against the calcitonin gene-related protein (anti-CGRP mAbs) have emerged as the first disease-specific preventative treatments to be approved for chronic migraine. At the 10th Congress of the European Academy of Neurology (EAN) 2024, Danilo Antonio Montisano, MD, presented real-world evidence findings from a retrospective, observational multicenter cohort study (RAMO) comparing the effectiveness of anti-CGRP mAbs and BoNT-A for chronic migraine prevention. The positive results from the study indicate that the treatment for chronic disease prevention will continue to evolve in the short term, says GlobalData.

Erela Dana, Director of Neurology at GlobalData, comments: “The results of the observational real-world evidence study demonstrate a superior reduction across efficacy outcomes for anti-CGPR mAbs versus BoNT-A.”

The primary study endpoint of the difference in improvement of mean headache days (MHD) at six and 12 months between the two treatments demonstrated a statistically significant difference. There were also key differences at both time intervals for a reduction in migraine acute medications (MAM) days and migraine disability assessment test (MIDAS) scores.

Key opinion leaders (KOLs) recently interviewed by GlobalData support this view and have reported a preference for prescribing of mAbs over BoNT-A in recent years due to a perceived higher efficacy and availability of a larger breadth of outcomes data for the former.

Dana adds, “In March 2024, the American Headache Society published updated guidelines for chronic migraine treatment, where they recommended that CGRP-targeting therapies be considered first-line for migraine prevention without a requirement for prior failure of other classes of migraine preventive treatment. The real-world evidence presented by Montisano supports the potential earlier prescribing of mAbs due to their superior efficacy compared with neurotoxin treatment.”

GlobalData’s upcoming Migraine Global Drug Forecast and Market Analysis to 2033 report will explore the shifting dynamics in the preventative treatment of migraine.

“The preventative treatment of chronic migraine will advance in the near future, seeing a shift in the positioning of anti-CGRP mAbs as they mature in the market and real-world evidence becomes more prevalent, but the advent of the gepant class, also targeting CGRP, introduces new competition beyond BoNT-A to the migraine-specific treatment landscape,” concludes Dana.

Edits made by EP News Bureau