Monoclonal antibodies have ‘good track record’ in treating migraine, expert says

DENVER — Monoclonal antibodies have shown promise as an emerging treatment for migraine, Stephanie J. Nahas, MD, MSEd, FAHS, FAAN, said at the American Headache Society annual scientific meeting.

“What we've learned from looking back at clinical trial data is that the monoclonal antibodies have very low numbers needed to treat, and very high numbers needed to harm — that’s what you want,” Nahas, Healio Neurology Peer Perspective Board Member and associate professor and director of the headache fellowship program at Thomas Jefferson University in Philadelphia, told Healio. “That's not the case for the older treatments. In essence, when we're told you have to use older treatments before newer ones, we're being told to put our patients at risk for harm.”

Nahas also discussed what would happen if the monoclonal antibody treatment worked but did not last for the full 4 weeks.

“What we've noticed is that just because you respond to one CGRP [calcitonin gene-related peptide]-targeted therapy doesn't mean you'll respond to them all,” she said. “So, it's about finding the right one for your patient.”

According to Nahas, monoclonal antibody treatments for migraine have had “good track records” in the real world, and most trials have shown them to be effective beyond the life of a clinical trial.

“What we're seeing in the real world is that when patients start responding to these, they tend to keep responding to these,” Nahas said. “We're not seeing it occur as often that the drug just stops working, which we would see all the time with other more traditional therapies.”

Although Nahas believes it is too early to predict where monoclonal antibodies stack up in terms of durability, she said tolerability is “certainly very good,” and that is what makes them “most attractive.”