Effectiveness of eptinezumab 300 mg dose escalation in partial responders to 100 mg among patients with difficult-to-treat migraine: A prospective, real-world study by the GRASP study group.

AimThis prospective real-world study aimed to evaluate the effectiveness of escalating eptinezumab to 300 mg in difficult-to-treat migraine patients with a partial response after two 100 mg cycles.MethodsWe included adults with high-frequency episodic or chronic migraine who achieved a partial response (30% to < 50% reduction in monthly headache days (MHD)) after two 100 mg eptinezumab cycles and escalated to 300 mg for two consecutive quarterly cycles. The primary outcome was the proportion of patients achieving a ≥ 50% MHD reduction from baseline after each 300 mg cycle. Secondary outcomes evaluated changes in MHDs with peak intensity > 4, monthly acute medication intake, Migraine Disability Assessment (i.e. MIDAS), and Headache Impact Test-6 (i.e. HIT-6) scores. Logistic regression assessed predictors of response.ResultsWe analyzed 57 patients (87.7% female, mean ± SD age of 48.2 ± 10.8 years). Following dose escalation, 57.9% and 64.9% of partial responders achieved ≥ 50% MHD reduction after the first and second 300 mg cycles, respectively. Using generalized estimating equations models, estimated marginal mean MHDs (95% confidence interval) dropped from a baseline of 18.65 (16.93-20.37) days/month to 13.33 (11.76-14.91) days/month after two 100 mg cycles, 10.02 (8.15-11.88) days/month after one 300 mg cycle, and 8.84 (6.77-10.91) days/month after two 300 mg cycles (all p < 0.05 vs baseline). Across all secondary outcomes, significant cumulative improvements occurred. Multivariable analysis showed that greater MHD reduction during the 100 mg phase (odds ratio = 0.920, p = 0.008) and no prior erenumab exposure (odds ratio = 0.145, p = 0.012) independently predicted a ≥ 50% response.ConclusionsEscalation to eptinezumab 300 mg was associated with improved population-averaged outcomes in this selected cohort of difficult-to-treat partial responders to 100 mg, supporting, as such, dose escalation over switching therapy.