Eptinezumab showed meaningful response in 30% of treatment-refractory migraine patients who had previously failed multiple subcutaneous CGRP antibodies, with over half achieving clinically meaningful disability improvement.
29.7% respondedof patients who had failed all prior subcutaneous CGRP antibodies
What the researchers found
29.7% of patients who failed multiple subcutaneous CGRP antibodies achieved ≥30% reduction in monthly migraine days with eptinezumab by week 24, with 52.4% showing clinically meaningful MIDAS improvement.
Why it matters
Treatment-refractory migraine patients have exhausted most options. This study suggests that the different delivery mechanism (IV vs subcutaneous) and pharmacology of eptinezumab may reach patients who don't respond to other CGRP antibodies.
The numbers in context
Patients had previously failed erenumab plus at least one other subcutaneous CGRP mAb (fremanezumab and/or galcanezumab) before switching to eptinezumab.
How the study worked
Retrospective cohort study of 41 migraine patients who failed erenumab plus at least one other CGRP(-R) mAb, treated with eptinezumab 100 mg IV (most escalated to 300 mg), with headache diary and patient-reported outcomes at baseline, weeks 12 and 24.
Who was studied
Migraine patients who failed erenumab and at least one other subcutaneous CGRP monoclonal antibody
What this study cannot tell us
Retrospective design without placebo control; small sample (41 patients); regression to the mean possible; patients may have improved regardless of treatment change; 24-week follow-up may be insufficient; no formal statistical significance achieved for primary outcomes.
How to read the evidence
Preliminary evidence from a small retrospective cohort without controls. Clinically relevant for a truly refractory population, but formal efficacy conclusions require controlled trials.
When this study was published
Published in 2024, addressing the practical clinical question of what to do when multiple CGRP antibodies fail.
The bigger picture
This fills a critical gap in migraine treatment — showing there's still hope for patients who've cycled through multiple anti-CGRP antibodies. Eptinezumab's IV delivery provides 100% bioavailability, potentially explaining why some patients respond after subcutaneous failures.
Questions still open
- What makes eptinezumab effective in patients who failed other CGRP antibodies — the IV route, the higher bioavailability, or the specific antibody characteristics?
- Would a longer treatment course show continued improvement?
- Can we predict which CGRP antibody non-responders will benefit from eptinezumab?
Common questions
If anti-CGRP shots don't work for my migraine, is there still hope?
How is eptinezumab different from other anti-CGRP antibodies?
Read the original research
Efficacy of eptinezumab in non-responders to subcutaneous monoclonal antibodies against CGRP and the CGRP receptor: A retrospective cohort study.
Cephalalgia : an international journal of headache, 44(10), 3331024241288875
Citation
Triller, Paul; Blessing, Virginia N; Overeem, Lucas H; Fitzek, Mira P; Hong, Ja Bin; Lange, Kristin S; Reuter, Uwe; Raffaelli, Bianca. (2024). Efficacy of eptinezumab in non-responders to subcutaneous monoclonal antibodies against CGRP and the CGRP receptor: A retrospective cohort study.. Cephalalgia : an international journal of headache, 44(10), 3331024241288875. https://doi.org/10.1177/03331024241288875