In a real-world US study, patients initiating galcanezumab for migraine prevention showed higher persistence and lower discontinuation rates compared to those starting fremanezumab or erenumab.
248 vs 237 days persistenceGalcanezumab users stayed on treatment 11 days longer than fremanezumab users (p=0.001)
What the researchers found
Galcanezumab initiators showed higher treatment persistence (248 days vs 237-242 days), lower discontinuation rates, and slightly better adherence compared to fremanezumab and erenumab initiators at 12 months.
Why it matters
Treatment adherence is critical for migraine prevention — patients who stay on therapy longer get better results. Understanding which CGRP antibody patients are most likely to stick with helps guide prescribing decisions and patient counseling.
The numbers in context
Three CGRP mAbs compared: galcanezumab, fremanezumab, and erenumab; US claims database; continuous enrollment required.
How the study worked
Retrospective claims-based study using Merative MarketScan Commercial and Medicare databases (May 2017 - March 2021). Propensity-score matched cohorts: 2,674 galcanezumab-fremanezumab pairs and 3,503 galcanezumab-erenumab pairs. Outcomes: PDC, MPR, persistence, discontinuation, switching.
Who was studied
US adults with migraine starting self-injectable CGRP monoclonal antibody treatment
What this study cannot tell us
Claims-based study — cannot determine reasons for discontinuation or switching. Propensity-score matching reduces but doesn't eliminate confounding. Cannot assess clinical outcomes (headache frequency, severity). Data period (2017-2021) may not reflect current prescribing patterns. Funded by Eli Lilly (manufacturer of galcanezumab).
How to read the evidence
Moderate evidence — large propensity-matched real-world study, but retrospective claims data with inherent limitations. Industry-funded (Eli Lilly).
When this study was published
Published in 2024 using 2017-2021 data. Reflects early to mid-adoption patterns for CGRP antibodies in the US.
The bigger picture
As the CGRP antibody market matures, real-world evidence on treatment patterns helps differentiate these therapies beyond clinical trial efficacy. Persistence and adherence may be driven by factors like dosing frequency, injection experience, and patient-perceived efficacy — insights that clinical trials alone can't capture.
Questions still open
- Why do galcanezumab users persist longer — is it the drug, the dosing schedule, or patient characteristics?
- Would persistence differences change with eptinezumab (IV-administered CGRP mAb) included?
- Does higher persistence translate to better migraine control outcomes?
Common questions
Which CGRP antibody for migraine do patients stick with longest?
Does it matter which CGRP antibody I choose for migraine prevention?
Read the original research
Comparison of Treatment Patterns in Patients with Migraine Initiating Calcitonin Gene-Related Peptide Monoclonal Antibodies: A Retrospective Real-World US Study.
Patient preference and adherence, 18, 69-88
Citation
Varnado, Oralee J; Brady, Brenna L; Zagar, Anthony J; Robles, Yvonne P; Hoyt, Margaret. (2024). Comparison of Treatment Patterns in Patients with Migraine Initiating Calcitonin Gene-Related Peptide Monoclonal Antibodies: A Retrospective Real-World US Study.. Patient preference and adherence, 18, 69-88. https://doi.org/10.2147/PPA.S437396