4CPS-223 Compared real-life persistence between fremanezumab, erenumab and galcanezumab

<h3>Background and Importance</h3> Monoclonal antibodies targeting calcitonin gene-related peptide (CGRP) represents an effective choice in preventing migraine crises. Nevertheless, data on their persistence is limited. <h3>Aim and Objectives</h3> This study compares the persistence between fremanezumab, erenumab and galcanezumab and identifies the main reasons for treatment discontinuation. <h3>Material and Methods</h3> An ambispective, observational study was conducted at a tertiary hospital, including patients who started treatment with fremanezumab, erenumab or galcanezumab between December 2019 and February 2024. Follow-up carried out until August 2024. Women who discontinued treatment due to pregnancy were excluded. Temporary medication interruption was not considered if the discontinuation was ≤6 months and the patient restarted the same drug. Demographic and clinical data were obtained from electronic medical records. Variables collected were age, gender, diagnosis (chronic or episodic migraine), monthly migraine days (MMD) and previous preventive treatments (PPT) including botulinum toxin. Persistence was defined as the time from the first medication dispensation to treatment discontinuation or end of the study. Kaplan-Meier survival analyses and log-rank test were carried out with R-4.4.1. <h3>Results</h3> 266 patients were included, of whom 224 (84.2%) were women. Mean age was 48±12 years. 119 (44.7%) patients had chronic migraine, whereas 147 (55.3%) had episodic migraine. Median MMD were 10 (IQ 8–15). Mean number of PPT before starting anti-CGRP was 5±2. 68 patients were treated with fremanezumab, 94 with erenumab and 104 with galcanezumab. Median persistence was 714 days (CI 95% 409–1130) for fremanezumab, 907 days (CI 95% 588–1316) for erenumab, and 798 days (CI 95% 715–1143) for galcanezumab. Hazard ratio (HR) of fremanezumab versus erenumab is 1.47 (p=0.124). HR of galcanezumab is 1.09 (p=0.877) versus erenumab. HR of galcanezumab versus fremanezumab is 0.74 (p=0.258). There were no statistically significant differences between persistence of treatments. 70% of patients discontinued treatment. Reasons for treatment discontinuation were: clinical deterioration (56.5% of patients who discontinued), followed by favourable clinical outcome (17.7%), safety reasons added to clinical deterioration (8.6%), inadequate adherence to treatment (7%), safety (4.3%) and other minority reasons: loss of patient at follow-up, generalised allergic reaction or breast cancer. 30% of patients continued treatment at the end of the study. <h3>Conclusion and Relevance</h3> Although trends indicated that galcanezumab may have the longest persistence and fremanezumab the shortest, no significant differences in persistence were found. Main reason for discontinuation was clinical deterioration. Further studies are needed to confirm these findings. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest