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.

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Reference

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