EAN 2026 | Characteristics that are predictive of response to eptinezumab in migraine treatment
Alessandro Visentini, MD, IRCCS San Raffaele Scientific Institute, Milan, Italy, discusses characteristics that are predictive of response to eptinezumab in migraine treatment. Dr Visentini highlights that previous failure of anti-CGRP monoclonal antibodies and a high number of preventive treatment failures are associated with a lower probability of having a good response. This interview took place at the 12th Congress of the European Academy of Neurology (EAN) in Geneva, Switzerland.
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Transcript
As we always like to say, the best positive predictive characteristic of having a good response is having the right diagnosis. This is because eptinezumab is right now among the best treatment we have for migraine prophylaxis. So we focus more on trying to identify the best characteristics associated with not having a good response. Among these, clearly, having tried and having failed a different monoclonal antibody targeted at CGRP and more in general, having a high number of preventive treatments failed is associated with a lower probability of having a good response...
As we always like to say, the best positive predictive characteristic of having a good response is having the right diagnosis. This is because eptinezumab is right now among the best treatment we have for migraine prophylaxis. So we focus more on trying to identify the best characteristics associated with not having a good response. Among these, clearly, having tried and having failed a different monoclonal antibody targeted at CGRP and more in general, having a high number of preventive treatments failed is associated with a lower probability of having a good response. This may reflect a more refractory phenotype or at least in a subgroup of patients can be a sign of an underlying biology that is at least partially independent from the CGRP pathway. Another thing I really want to say is about the baseline migraine burden because patients who start with a chronic migraine or a daily migraine or in general a high number of monthly migraine days can still achieve a good response but this improvement is not always associated with a meaningful improvement in the quality of life of the patient. We can think of someone who starts with 30 monthly migraine days and after three or six months still have 13 or 14 monthly migraine days that maybe he cannot treat well with his acute medication. This is why in migraine, as maybe in other diseases, chronification is a bad thing and an early diagnosis and an early effective treatment can be really beneficial for our population of patients. At the present moment, there aren’t biomarkers that can be used. I hope that future research will clarify if dosing the CGRP in the blood, in the saliva, or maybe other peptides like PACAP or maybe even functional MRI can help us identify the best treatment for our patients. Possibly when there will be treatments that target other pathways other than the CGRP.
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