4CPS-168 Results of the use of galcanezumab in routine clinical practice

Background and ImportanceMigraine is a highly disabling neurovascular disorder characterised by a severe headache and trigeminovascular system activation, involving the release of calcitonin-gene related peptide (CGRP). Galcanezumab is a humanised monoclonal antibody blocking the CGRP.Aim and ObjectivesAnalyze:The effectiveness of galcanezumab in the prophylaxis of chronic migraineResponse to other anti-CGRP monoclonal antibodies after galcanezumab failureMaterial and MethodsObservational-retrospective study from January 2020 to September 2022. Patients in whom at least one year had passed since the start of galcanezumab treatment were included.Variables analysed: demographics, baseline migraine days/month (MDM), three months later, objective response rate (ORR) >50%, duration, reason for suspension, and action. The headache impact test (HIT-6) was performed at baseline vs after three months of treatment. This score presents a range between 36 and 78 (60= very severe impact).Quantitative variables were expressed as median (interquartile range).Results56 patients were included.Age 50(43-58) years Gender (woman) 77% Galcanezumab duration 6(6-9) months MDM month 0 15(14-17) MDM month 3 5(3-6) ORR>50% 84% HIT6 month 0 72(68-76) HIT6 month 3 49(48-57) - 9%(5) of the patients continue with active treatment, 100% maintain effectiveness, median MDM: 3(2-6).- 91% (51) discontinued treatment: Reason for suspension 67%Neurologist's decision (34 ) 29%lack of effectiveness (15 ) 4%Toxicity (2 ) Medical action Reset Galcanezumab No required reset* Change to Erenumab Change to Fremanezumab NªPatients 19 15 4 7 MDM month 0 15(12-16) 15(15-17) 15(15-20) MDM month 3 4(3-5) 15(12-17) 15(7-20) ORR >50% 89% 25% 43% HIT-6 month 0 73(68-76) 73(68-78) 66(59-70) HIT-6 month 3 57(50-68) 72(64-78) 57(55-67) *Median months without treatment after suspension: 7(5-11).Conclusion and RelevanceA high percentage of patients presented a good response to galcanezumab, with an improvement in the HIT-6 score.A large number of patients who received temporary prophylaxis with galcanezumab did not require another visit to the neurologist. Most of the patients who required reintroduction of galcanezumab reached an ORR>50%.Less than half of the patients who restarted therapy with a different anti-CGRP after galcanezumab failure, achieved an ORR>50%.All patients who continued with galcanezumab from the start, maintained effe