EAN 2026 | Optimizing outcomes for patients with migraine who have a partial response to eptinezumab
Alessandro Visentini, MD, IRCCS San Raffaele Scientific Institute, Milan, Italy, shares guidance for optimizing outcomes for patients with migraine who have a partial response to eptinezumab. Dr Visentini highlights the importance of defining “partial response” and approaches to improve responses or switch therapies. This interview took place at the 12th Congress of the European Academy of Neurology (EAN) in Geneva, Switzerland.
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Transcript
The first question is what we really consider a partial response because we know nowadays there is this idea of a migraine freedom where the idea that we can lower the number of monthly migraine days even to zero. This is certainly achievable in a subgroup of patients, but we also know from clinical practice that this is not achievable in everybody. For this reason, we usually don’t look at only one metric, like the monthly migraine days, but we usually look at different metrics, including the pain intensity, the disability, the consumption of acute medications and maybe most importantly the patient’s own impression...
The first question is what we really consider a partial response because we know nowadays there is this idea of a migraine freedom where the idea that we can lower the number of monthly migraine days even to zero. This is certainly achievable in a subgroup of patients, but we also know from clinical practice that this is not achievable in everybody. For this reason, we usually don’t look at only one metric, like the monthly migraine days, but we usually look at different metrics, including the pain intensity, the disability, the consumption of acute medications and maybe most importantly the patient’s own impression. When eptinezumab is, I said, one of the best treatments we have among the other monoclonal antibodies targeting CGRP. But not every patient responds and responds early even if eptinezumab is administered intravenously. This is why we usually don’t want to end the treatment too early. We usually start by increasing the dosage to 300 milligrams at the first time point possible. If later in the treatment course we can consider a combination therapy, maybe tailored to the patient’s comorbidities or even with botulinum toxin. Even if after this we still don’t have the response we want after usually nine or twelve months of treatment, if the treatment is well tolerated, we usually switch to a different monoclonal antibody or the new gepants that don’t work on the CGRP ligands but on its receptor.
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