A retrospective audit of the real‐world safety and effectiveness profile of eptinezumab for treatment‐resistant chronic migraine in Australia

Objective To describe the real‐world safety, tolerability, and effectiveness of eptinezumab for chronic migraine prevention in Australia. Background Eptinezumab is a relatively new medication for treatment‐resistant chronic migraine prevention. It was only introduced onto the Australian Pharmaceutical Benefits Scheme in August 2023, so there are limited real‐world Australian data regarding its tolerability and effectiveness. Methods This is a single center retrospective audit of patients receiving eptinezumab for chronic migraine prevention between 1 September 2023 and 31 December 2024. Headache characteristics were compared at baseline and 3 months after eptinezumab administration. Primary outcomes were mean reductions in monthly headache days (MHD) and monthly migraine days (MMD). Secondary outcomes were mean monthly reductions in acute abortive medications, and adverse events. Results Of the 60 patients who received eptinezumab during the study period, a total of 54 patients with complete medical records and headache diaries were used in the statistical analysis. The majority were female (43/54, 80%) with mean age 41.7 years (SD 11.4). Three months after eptinezumab infusion, MMD reduced from 23.0 to 15.4 days ( p value <0.001), and MHD reduced from 26.5 to 19.2 days ( p value <0.001). Acute analgesic use decreased from 16.2 to 11.1 days ( p value<0.001). The vast majority (94%, 51/54) had no immediate adverse events. Of 22 patients with 6‐month post infusion data, mean MMD and MHD decreased to 11.0 ( p < 0.001) and 17.8 days ( p < 0.001), respectively, from baseline. Statistically significant reductions to both co‐primary outcomes were achieved in those with pre‐existing medication‐overuse headache and those who had previously not responded to onabotulinumtoxinA, fremanezumab, and galcanezumab. Conclusions Our findings show that eptinezumab is a safe, well‐tolerated migraine prophylactic that decreases monthly migraine and headache days in a small sample of Australian patients with treatment‐resistant chronic migraine. Further prospective studies with larger sample sizes and longer follow‐up data are needed to confirm findings of this study.