In 53 migraine patients in the UAE who switched between CGRP antibody classes (ligand-targeting to receptor-targeting or vice versa) due to lack of efficacy or poor tolerability, both switch directions showed some clinical improvement with no new safety concerns.
53 patients switched classesMigraine patients who failed one CGRP antibody showed improvement when switched to a different class — suggesting the mechanism of CGRP targeting (peptide vs receptor) matters for individual response
What the researchers found
53 migraine patients switched between CGRP mAb classes (CGRP/R to CGRP/L or CGRP/L to CGRP/R). Both switch cohorts showed some clinical improvements. Safety was maintained — adverse events from the first antibody did not recur or worsen after switching classes. Fremanezumab was not included due to UAE unavailability.
Why it matters
Up to 30-50% of migraine patients don't respond adequately to their first CGRP antibody. Clinicians face uncertainty about whether switching to a different CGRP antibody — particularly one from a different class — can help. This study provides early real-world evidence that class switching is both safe and potentially effective.
The numbers in context
53 patients switched between CGRP antibody classes. Studied in a UAE clinical setting.
How the study worked
Retrospective real-world study of 53 migraine patients at a UAE center who switched between CGRP mAb classes (eptinezumab, erenumab, galcanezumab) due to lack of efficacy or poor tolerability. Efficacy assessed by clinical improvement measures. Safety evaluated by adverse event monitoring.
Who was studied
Migraine patients in the UAE who switched between CGRP antibody classes
What this study cannot tell us
Small sample size (53 patients) limits statistical power. Retrospective design without a control group. No standardized outcome measures described. Single-center UAE study — population may not be representative. Fremanezumab excluded. Preliminary designation by the authors themselves.
How to read the evidence
Rated preliminary: small retrospective study (53 patients) without standardized outcomes or control group. Provides initial real-world signal but needs larger prospective validation.
When this study was published
Published in 2024. Addresses a current clinical question as CGRP antibodies become widely used.
The bigger picture
As CGRP antibodies become standard migraine prevention therapy, managing non-responders is increasingly important. This study supports the hypothesis that failing one CGRP antibody doesn't mean CGRP biology is irrelevant — the difference between targeting the peptide versus its receptor may matter for individual patients.
Questions still open
- Are there predictive biomarkers for which patients will benefit from switching CGRP antibody classes versus trying a different preventive approach entirely?
- Does the direction of switch (ligand→receptor vs receptor→ligand) matter for outcomes?
- Would results differ with fremanezumab included as a switching option?
Common questions
If one CGRP migraine drug doesn't work, should I try another one?
What's the difference between CGRP ligand and receptor antibodies?
Read the original research
Effectiveness of Switching CGRP Monoclonal Antibodies in Non-Responder Patients in the UAE: A Retrospective Study.
Neurology international, 16(1), 274-288
Citation
Suliman, Reem; Santos, Vanessa; Al Qaisi, Ibrahim; Aldaher, Batool; Al Fardan, Ahmed; Al Barrawy, Hajir; Bader, Yazan; Supena, Jonna Lyn; Alejandro, Kathrina; Alsaadi, Taoufik. (2024). Effectiveness of Switching CGRP Monoclonal Antibodies in Non-Responder Patients in the UAE: A Retrospective Study.. Neurology international, 16(1), 274-288. https://doi.org/10.3390/neurolint16010019