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Abstract Details

The Safety and Efficacy of Dual Calcitonin Gene-related Peptide Therapies for Migraine Treatment
Headache
P9 - Poster Session 9 (8:00 AM-9:00 AM)
12-002
Although singular regimens of calcitonin gene-related peptide (CGRP) medications are shown to be effective in treating migraines, a considerable number of patients continue to experience suboptimal outcomes. Adding a second CGRP inhibitor could provide increased relief; however, limited research is available to support this practice.
To assess the safety and efficacy of dual CGRP therapies.
This retrospective chart review analyzed 67 patients diagnosed with episodic or chronic migraine and treated with two CGRP medications simultaneously between May 2018 and July 2023. The prescribed CGRP inhibitors were receptor monoclonal antibodies (erenumab), ligand monoclonal antibodies (fremanezumab, galcanezumab, and eptinezumab), or receptor small molecule antagonist (ubrogepant, rimegepant, and atogepant). Variables, including age of onset, current age, sex, race, ethnicity, baseline symptoms, and adverse events, were collected. Pre-treatment severity was reported by patients on a scale of 1-10, along with monthly headache frequency. They were compared to post-treatment results evaluated for 1 to 8 months.
Of the 67 patients, 33 patients experienced a 14% average reduction in headache severity (p = 4.4 x 10-6), while 37 patients showed an average reduction of 5 days in monthly headache frequency (p = 1.4 x 10-6). No major adverse events were reported even when considering different mechanisms of action or whether the medications were used acutely or prophylactically. While statistically insignificant, dual-CGRP therapies involving small molecule antagonists are consistently associated with a lower incidence of adverse events compared to combinations with monoclonal antibodies only.
The observed reduction in headache severity and frequency suggests a dual blockade is beneficial for migraine symptom control in selected patients. Safety regarding this treatment option is also supported by these findings; specifically, the small molecule antagonists appear to be the safest option to include in dual regimens.
Authors/Disclosures
Ho Hyun Lee
PRESENTER
Mr. Lee has nothing to disclose.
Reyn Yoshioka (Hawaii Pacific Neuroscience) No disclosure on file
Man Ian Woo No disclosure on file
Lana Liquard No disclosure on file
Julia Jahansooz No disclosure on file
Edward Weldon (John A. Burns School of Medicine) No disclosure on file
Anson Lee (University of Hawaii John A. Burns School of Medicine) No disclosure on file
Kyle Ishikawa (University of Hawai'i) No disclosure on file
Lydia Nicole Little, PhD, PA (Hawaii Pacific Neuroscience) Dr. Little has nothing to disclose.
Enrique Carrazana Enrique Carrazana has received personal compensation for serving as an employee of Neurelis. Enrique Carrazana has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Neurelis, Alexza, Zogenix. Enrique Carrazana has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Hawaii-Biotech, CND Life Sciences. Enrique Carrazana has stock in Neurelis, Marinus, .
Jason Viereck, MD, PhD (Adventist Health Castle Hospital) Dr. Viereck has nothing to disclose.
Kore K. Liow, MD, FACP (University of Hawaii, John Burns School of Medicine) The institution of Dr. Liow has received research support from UCB. The institution of Dr. Liow has received research support from Livanova. The institution of Dr. Liow has received research support from Biogen. The institution of Dr. Liow has received research support from Novartis. The institution of Dr. Liow has received research support from Eisai. The institution of Dr. Liow has received research support from Engage Therapeutics. The institution of Dr. Liow has received research support from SK Lifescience. The institution of Dr. Liow has received research support from Cerevel. The institution of Dr. Liow has received research support from Xenon. The institution of Dr. Liow has received research support from NeuroDerm. The institution of Dr. Liow has received research support from Avanir. The institution of Dr. Liow has received research support from Annovis. The institution of Dr. Liow has received research support from Acadia. The institution of Dr. Liow has received research support from Prothena. The institution of Dr. Liow has received research support from SAGE. The institution of Dr. Liow has received research support from Annovis. The institution of Dr. Liow has received research support from Cyclerion.