Real-World Effectiveness and Utilisation of Anti-CGRP Monoclonal Antibodies for Migraine Prevention in a Public Healthcare System

Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies represent an important therapeutic advance in migraine prevention. However, evidence on their effectiveness and use in routine clinical practice within public healthcare systems remains limited. To evaluate real-world effectiveness, utilisation patterns, and associated pharmaceutical expenditure of anti-CGRP monoclonal antibodies for migraine prevention in routine clinical practice within Catalan public healthcare system. A retrospective population-based cohort study was conducted using administrative and clinical registry data from the Catalan Health Service (2019–2023). Adult patients treated with erenumab, fremanezumab or galcanezumab were included. Clinical effectiveness was assessed based on reduction in monthly migraine days and acute medication use. Utilisation patterns and pharmaceutical expenditure were analysed using healthcare billing data. Between 2019 and 2023, 5438 patients received 7270 treatment episodes, with a marked increase in treatment initiation over time. Of the 4902 evaluable treatment episodes at 3 months, 48% of treatments achieved a ≥ 50% reduction in monthly migraine days, and 57.4% achieved ≥ 30% reduction. At 9 months, complete response was observed in 58.9% of the 2779 evaluable treatments episodes. Mean (SD) monthly migraine days decreased from 16.68 (7.47) at baseline to 9.09 (7.31) at 9 months. Acute medication use decreased by 40%. Treatment uptake increased substantially, with rising pharmaceutical expenditure and a 33% increase in mean annual cost per patient. Anti-CGRP monoclonal antibodies demonstrate sustained real-world effectiveness in migraine prevention and are associated with reduced migraine burden and acute medication use. Within a publicly funded healthcare system, their increasing uptake highlights the value of monitoring real-world outcomes, utilisation patterns and associated pharmaceutical expenditure to support appropriate and sustainable use in clinical practice.