For patients with episodic or chronic migraine who are initially unresponsive to galcanezumab, continued treatment may be associated with improvement, according to a study published in Headache.
In this post hoc analysis, data from patients with episodic (n=879) or chronic (n=555) migraine who continued treatment with galcanezumab despite the absence of “good” early improvement (ie, ≥50% and ≥30% reduction in the number of baseline migraine headache days [MHD] for patients with episodic and chronic migraine, respectively) after 1 month of dosing (NR-1; n=450 and n=306 for patients with episodic and chronic migraine, respectively) were examined.
Study participants were divided according to the level of reduction in MHD during the first month of treatment: modest (>30% to <50% fewer MHD for episodic migraine, and >10% to <30% fewer MHD for chronic migraine), limited (episodic only; >10% to ≤30% fewer MHD), minimal/no early improvement (≤10% fewer MHD to ≤10% more MHD), or worsening (>10% more MHD). The percentages of participants who had better (≥75% fewer MHD for episodic migraine and ≥50% for chronic migraine), good, or little-to-no (≤10% fewer MHD) response during the remaining treatment period were calculated.
Of the 155 NR-1 participants with episodic migraine and modest early improvement, 96 (62%) and 31 (20%) achieved good and better responses with continued treatment, respectively. Participants in other improvement categories also achieved a good response after continued treatment, including 46 (43%) of those with limited early improvement, 29 (34%) of those with minimal to no early improvement, and 20 (20%) of those with worsening early response.
Of 116 NR-1 participants with chronic migraine, 44 (38%) of those with modest early improvement achieved a good response after continued treatment and 15 (13%) achieved a better response. Of participants who had minimal to no early improvement, 23 (17%) achieved a good response after continued treatment.
“Factors contributing to response/nonresponse have yet to be elucidated and clinical judgment should be exercised when deciding whether to discontinue treatment,” the researchers wrote.
Nichols R, Doty E, Sacco S, Ruff D, Pearlman E, Aurora SK. Analysis of initial nonresponders to galcanezumab in patients with episodic or chronic migraine: results from the EVOLVE-1, EVOLVE-2, and REGAIN randomized, double-blind, placebo-controlled studies [published online November 21, 2018]. Headache. doi:10.1111/head.13443