Real-world effectiveness of eptinezumab in chronic migraine—increase in good days in three subgroups: psychiatric comorbidities, prior subcutaneous anti-calcitonin gene-related peptide therapy, and migraine-associated brain fog

Background The REVIEW study evaluated the real-world experiences of individuals treated with eptinezumab for chronic migraine (CM) in the outpatient setting. This post hoc analysis explored eptinezumab effectiveness in three participant subgroups: those who had self-reported psychiatric comorbidities, those previously treated with subcutaneous anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAbs) for migraine prevention, or those who had reported ever experiencing symptoms of brain fog. Methods Adults with a CM diagnosis who completed ≥ 2 eptinezumab infusion cycles provided survey responses that included the number of good days (participant-defined) per month before and after initiating eptinezumab, the presence/absence of comorbid psychiatric conditions, the number and type of subcutaneous anti-CGRP mAbs used prior to initiating eptinezumab, and the presence/absence of brain fog (feeling confused, difficulty learning/remembering, or trouble speaking/reading) and its improvement after initiating eptinezumab. Results Among 94 participants, 61 (65%) reported psychiatric comorbidities, and 84 (89%) had previously used a subcutaneous anti-CGRP mAb. Average increase from baseline in participant-reported total number of good days per month after initiating eptinezumab were 9.8 and 10.1 days for those with the presence or absence of psychiatric conditions at baseline, respectively; based on the type of subcutaneous anti-CGRP mAb, average increase from baseline were, 9.2 days (erenumab), 10.6 days (fremanezumab), and 10.0 days (galcanezumab); and based on the number of prior mAbs, 9.9 days (0 prior), 8.9 days (1 prior), 11.7 days (2 prior), and 8.6 days (3 prior). Participants reporting complete/very much improvement in brain fog had an average 15-day increase in the number of good days per month, while in participants that reported brain fog did not improve, there was a 1-day increase. Conclusions This post hoc analysis of REVIEW showed that eptinezumab treatment can provide patient-perceived benefits across a spectrum of individuals with CM, including those with psychiatric comorbidities, in real-world settings. A greater number of good days regardless of number of prior mAb therapy supports the use of eptinezumab earlier for individuals with CM, rather than cycling through multiple anti-CGRP therapies. Furthermore, good days can provide a meaningful and measurable endpoint to assess preventive treatment and is correlated with improvements in brain fog.