All three CGRP-targeting antibodies (erenumab, galcanezumab, and fremanezumab) significantly improved migraine outcomes in 209 real-world patients, with only 2.4% stopping due to side effects.
2.4% stopped for AEsOnly 5 out of 209 patients discontinued CGRP antibody treatment due to side effects, demonstrating excellent real-world tolerability
What the researchers found
In 205 analyzed patients, erenumab and galcanezumab showed statistically significant improvements in MIDAS, HIT-6, monthly migraine days, and acute medication days. 17.5% reported adverse events (injection site pain, nausea, constipation, fatigue). Only 2.4% discontinued due to AEs, 7.3% for lack of efficacy.
Why it matters
Real-world effectiveness data complements clinical trial findings by showing how these drugs perform in typical clinical practice — with diverse patients, concomitant medications, and varying compliance patterns that clinical trials can't fully capture.
The numbers in context
209 patients. Three drugs: fremanezumab, galcanezumab, and erenumab. Prescribed between 2019 and 2022.
How the study worked
Retrospective observational study of 209 migraine patients prescribed subcutaneous CGRP antibodies (erenumab, galcanezumab, or fremanezumab) between 2019-2022. Outcomes: MIDAS, HIT-6, monthly migraine days (MMD), and monthly acute medication days (MAD). Could use concomitant acute or prophylactic medications.
Who was studied
Migraine patients prescribed CGRP antibodies between 2019-2022
What this study cannot tell us
Retrospective observational design without a control group. Fremanezumab's non-significant results likely due to small sample rather than true inferiority. No head-to-head statistical comparison between the three antibodies. Variable follow-up periods. Concomitant medication use may confound results.
How to read the evidence
Rated moderate: reasonable sample size (209 patients) with validated outcome measures, but limited by retrospective design without a control group.
When this study was published
Published in 2024. Covers 3 years of real-world prescribing (2019-2022).
The bigger picture
This study adds to the growing real-world evidence base for CGRP-targeting peptide antibodies, confirming that clinical trial benefits translate to routine practice and that all three currently available agents are effective options for migraine prevention.
Questions still open
- Are there patient characteristics that predict better response to one CGRP antibody over another?
- Does longer-term use (beyond this study period) show sustained or diminishing benefits?
- How do these real-world results compare to the clinical trial effect sizes?
Common questions
Do CGRP antibodies work for migraine in real life?
Which CGRP antibody is best for migraines?
Read the original research
Anti-CGRP and Anti-CGRP Receptor Monoclonal Antibodies for Migraine Prophylaxis: Retrospective Observational Study on 209 Patients.
Journal of clinical medicine, 13(4)
Citation
Schweiger, Vittorio; Bellamoli, Paola; Taus, Francesco; Gottin, Leonardo; Martini, Alvise; Nizzero, Marta; Bonora, Eleonora; Del Balzo, Giovanna; Donadello, Katia; Secchettin, Erica; Finco, Gabriele; Santis, Daniele De; Polati, Enrico. (2024). Anti-CGRP and Anti-CGRP Receptor Monoclonal Antibodies for Migraine Prophylaxis: Retrospective Observational Study on 209 Patients.. Journal of clinical medicine, 13(4). https://doi.org/10.3390/jcm13041130