Despite growing interest in switching between CGRP monoclonal antibodies after discontinuation, available evidence remains insufficient to determine whether this strategy is effective for migraine prevention.
~50% discontinuation rateApproximately half of patients receiving CGRP monoclonal antibodies for migraine prevention are expected to discontinue therapy, making the switching question clinically urgent
What the researchers found
Available data is insufficient to determine the efficacy of switching between CGRP receptor monoclonal antibodies following discontinuation of initial therapy, according to expert review aligned with European Headache Federation guidelines.
Why it matters
With ~50% of CGRP antibody users discontinuing treatment, the question of whether to try a different CGRP antibody is extremely common in clinical practice. Clarifying what the evidence says — and doesn't say — helps patients and doctors make informed decisions rather than operating on assumptions.
The numbers in context
Approximately 50% of patients receiving CGRP antibodies discontinue therapy. Available switching data comes from small studies and case series.
How the study worked
Database search for 'CGRP monoclonal antibody switch OR CGRP monoclonal antibody switching' to identify all available data on switching efficacy after CGRP MoAb discontinuation.
Who was studied
Migraine patients who discontinued initial CGRP antibody therapy
What this study cannot tell us
Limited by the scarcity of available switching data — the review can only synthesize what exists. Expert opinion fills gaps where evidence is absent. The field is evolving rapidly, so conclusions may change as new studies are published.
How to read the evidence
Preliminary — the review concludes that available evidence is insufficient to determine switching efficacy, reflecting the scarcity of published data rather than negative results.
When this study was published
Published in 2024, reflecting the current state of a rapidly evolving field where CGRP antibodies have only been available since 2018.
The bigger picture
CGRP antibodies have revolutionized migraine prevention, but they don't work for everyone. The question of what to do after a first CGRP antibody fails is one of the biggest unanswered questions in headache medicine. Whether to switch antibodies, try a gepant, or pursue entirely different treatments remains a clinical judgment call rather than an evidence-based decision.
Questions still open
- Do different CGRP antibody mechanisms (anti-CGRP vs. anti-CGRP receptor) make switching between them more or less likely to succeed?
- Would switching to a gepant (oral CGRP blocker) be more effective than switching between injectable CGRP antibodies?
- What patient characteristics predict success when switching CGRP-targeted therapies?
Common questions
If my CGRP injection didn't work, should I try a different one?
What options do I have if CGRP antibodies don't work for my migraines?
Read the original research
Switching CGRP(r) MoAbs in migraine: what evidence?
Expert opinion on biological therapy, 24(5), 327-333
Citation
Wells-Gatnik, William David; Martelletti, Paolo. (2024). Switching CGRP(r) MoAbs in migraine: what evidence?. Expert opinion on biological therapy, 24(5), 327-333. https://doi.org/10.1080/14712598.2024.2354386