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Improvement of migraine using CGRP mAbs in a real-world setting

Presented by
Prof. Robert E. Shapiro, University of Vermont, VT, USA
MTIS 2020


Most patients taking a calcitonin gene-related peptide (CGRP)-targeted monoclonal antibody (mAb) for the preventive treatment of migraine reported their migraine condition as better since starting the medication. This improvement appears relatively consistent across monthly headache day categories.

Real-world patient-reported outcome data is limited for patients who use a CGRP mAb for the preventive treatment of migraine. The current study, presented by Dr Robert Shapiro (University of Vermont, USA), assessed patient characteristics and patient-reported improvement among current users of CGRP mAbs [1].

Data was obtained in the last quarter of 2019 as part of the OVERCOME study via a web-based survey conducted in a representative US sample. Over 20,000 respondents were selected via a validated migraine diagnostic screener for International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria (95.1% of respondents) or via a self-reported healthcare professional migraine diagnosis (59.0% of respondents).

The current analysis evaluated a specific subpopulation of the respondents, namely those who had used a CGRP mAb for the preventive treatment of migraine within the past 3 months. A total of 950 patients (4.6%) reported ever using a CGRP mAb. The 586 patients (2.8%) currently using a CGRP mAb (mean age 38.9 years, 64.0% female, and 73.5% White) were asked to complete the Patient Global Impression of Improvement (PGI-I), which assessed the perceived improvement in their migraine condition since starting the current CGRP mAb. These patients had a mean monthly headache days of 7.6. Over half of the current CGRP mAb-users initiated their current treatment within the previous 3 months (55.1%). In addition, 62.6% of these patients reported use of an additional recommended migraine preventive medication (concomitant or switching) at some point during the same period.

Participants were also asked to complete the Migraine Disability Assessment (MIDAS) scale. Nearly half (49.5%) had severe migraine-related disability (MIDAS score ≥21), 22.9% moderate (11-20), 15.0% mild (6-10), and 12.6% little to none (≤5).

Unadjusted percentages of patients with PGI-I scores were reported overall and by monthly headache day categories (0-3, 4-7, 8-14, ≥15). Most respondents (79.2%, 95% CI 75.7-82.4%) reported their migraine condition as better since starting the CGRP mAb. These results were consistent across a range of monthly headache day categories.

These results are among the first real-world population-based patient-reported outcomes from those using CGRP mAbs for migraine prevention and suggest that these novel medications may positively impact patient-perceived improvement.

Future analyses should consider how other factors may influence patient-reported outcomes when using CGPR mAbs, including:

  • migraine-related factors (e.g. baseline headache frequency, symptom severity, and cyclic disease fluctuations);

  • medication-related factors (e.g. therapy duration, other preventive medication use, acute treatment optimisation, and switching between CGRP mAbs); and

  • healthcare-related factors (e.g. location of care and access to medication).


  1. Shapiro RE. CGRP monoclonal antibody use and patient-reported improvement of migraine: results of the OVERCOME study. MTIS 2020 Virtual Symposium, abstract MTV20-DP-002.

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