Introduction. Migraine is one of the most common and disabling neurological disorders, with a significant socioeconomic impact. Calcitonin Gene-Related Peptide Receptor Antagonists monoclonal antibodies represent a major innovation in preventive migraine treatment. This study analyzed adherence, persistence, and therapy switching in patients treated with erenumab, fremanezumab, and galcanezumab at an ASL, along with a cost-minimization analysis. Materials and methods. A retrospective analysis on databases administrative, single-center study has been performed on naïve patients treated with anti-CGRP antibodies between 01/01/2023 and 31/01/ 2025. Adherence was calculated as the ratio between Received Daily Dose (RDD) and Prescribed Daily Dose (PDD), while persistence was defined as the time elapsed between the first and last dispensation of therapy. Cost-minimization analysis was performed using ex-factory drug prices, assessing costs at one and five years of treatment. Results. A total of 93 patients were identified: 18 on erenumab, 46 on fremanezumab, and 29 on galcanezumab. Adherence was high for all drugs (≥0.8), with the highest value for erenumab (0.8978). One-year persistence rates were 22.22% for erenumab, 32.60% for fremanezumab, and 34.48% for galcanezumab, with no statistically significant differences. Therapy switching was limited (6 out of 93 patients). The 5-year economic analysis showed that galcanezumab is the most cost-effective option, followed by erenumab (+1,23%) and fremanezumab (+3,54%). Conclusions. Galcanezumab was found to be the most economically sustainable option while maintaining good adherence and comparable persistence to other anti-CGRP monoclonal antibodies. However, the overall low persistence rate highlights the need for strategies to improve long-term treatment retention. Further studies with longer follow-up periods could provide more robust data for optimizing chronic migraine management.
Aderenza, persistenza, switch e analisi di minimizzazione dei costi in pazienti in trattamento con anticorpi anti-CGRP
Tiziano Lupi
Primo
;Fiorenzo SantoleriUltimo
2025-01-01
Abstract
Introduction. Migraine is one of the most common and disabling neurological disorders, with a significant socioeconomic impact. Calcitonin Gene-Related Peptide Receptor Antagonists monoclonal antibodies represent a major innovation in preventive migraine treatment. This study analyzed adherence, persistence, and therapy switching in patients treated with erenumab, fremanezumab, and galcanezumab at an ASL, along with a cost-minimization analysis. Materials and methods. A retrospective analysis on databases administrative, single-center study has been performed on naïve patients treated with anti-CGRP antibodies between 01/01/2023 and 31/01/ 2025. Adherence was calculated as the ratio between Received Daily Dose (RDD) and Prescribed Daily Dose (PDD), while persistence was defined as the time elapsed between the first and last dispensation of therapy. Cost-minimization analysis was performed using ex-factory drug prices, assessing costs at one and five years of treatment. Results. A total of 93 patients were identified: 18 on erenumab, 46 on fremanezumab, and 29 on galcanezumab. Adherence was high for all drugs (≥0.8), with the highest value for erenumab (0.8978). One-year persistence rates were 22.22% for erenumab, 32.60% for fremanezumab, and 34.48% for galcanezumab, with no statistically significant differences. Therapy switching was limited (6 out of 93 patients). The 5-year economic analysis showed that galcanezumab is the most cost-effective option, followed by erenumab (+1,23%) and fremanezumab (+3,54%). Conclusions. Galcanezumab was found to be the most economically sustainable option while maintaining good adherence and comparable persistence to other anti-CGRP monoclonal antibodies. However, the overall low persistence rate highlights the need for strategies to improve long-term treatment retention. Further studies with longer follow-up periods could provide more robust data for optimizing chronic migraine management.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
