CGRP-Targeted Monoclonal Antibodies for Migraine Prevention: A Real-World Twelve Month Cohort: Effectiveness, Tolerability and Predictors of Response

Dr. Akshat Agarwal, Arif Chaudhary, Dr. Supriya Maitiy

Migraine; CGRP; Erenumab; Galcanezumab; Fremanezumab; Chronic Migraine; Preventive Therapy; Monoclonal Antibody.

Monoclonal antibodies targeting calcitonin gene-related peptide (CGRP) or its receptor have transformed migraine prevention, with multiple pivotal trials demonstrating substantial reductions in monthly migraine days for both chronic and high-frequency episodic migraine. Real-world data from South Asian populations remain limited. We prospectively followed 276 patients initiated on CGRP monoclonal antibodies at a tertiary headache clinic over 12 months: 92 on erenumab, 98 on galcanezumab, and 86 on fremanezumab. Mean monthly migraine days fell from 15.8 to 6.2 with erenumab, from 16.2 to 6.4 with galcanezumab, and from 16.4 to 5.8 with fremanezumab. Sustained response (≥50% reduction maintained over at least 2 consecutive months) was achieved by 64.1% of erenumab patients, 65.3% on galcanezumab, and 70.9% on fremanezumab. Discontinuation for any reason at 12 months was 18-22% across agents. Strongest independent predictors of response included fewer prior preventive failures, shorter disease duration, migraine without aura phenotype, and stable concurrent preventive regimen; medication overuse, depression, and comorbid fibromyalgia predicted poorer response. The findings support broad CGRP antibody utility with response rates matching international experience.

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