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EAN 2022 | The updated guidelines for treating migraines with CGRP-targeted monoclonal antibodies

Simona Sacco, MD, University of L’Aquila, L’Aquila, Italy, presents new guidelines from the European Headache Federation on the use of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway for migraine prevention. This was deemed essential in light of new data from randomized control trials and more practical experience. Major novelties included the incorporation of eptinezumab, the use of mAbs as a first-line treatment option compared to previously only being an option after failing at least two prior preventative treatments, and the recommended duration of mAb treatment. Regarding the duration of treatment, the guidelines suggest the approach should be flexible and personalized to the needs of the patient. In fact, some patients do not get worse after stopping mAbs, while others have residual migraine burden. The new guidelines also agree that some patients may benefit from antibody switching, especially switching from an antibody acting on the receptor to an antibody acting on the ligand, and vice versa. Although this is not supported with evidence, Prof. Sacco thinks it is reasonable to try switching if other options have failed. The hope is that the new guidelines will help patients with substantial migraine burden to get direct access to these new treatment options. This interview took place at the European Academy of Neurology (EAN) 2022 Congress in Vienna, Austria.


Lilly, Teva, Novartis, Allergan-Abbvie-Pfizer, AstraZeneca, NovoNordisk, Lundbeck