Emgality (galcanezumab-gnlm) / Eli Lilly, Daiichi Sankyo, AffaMed Therap, Organon - LARVOL DELTA

Increased integration and synergy in EEG- and fNIRS-based data in migraine patients after a three-month treatment with galcanezumab: relations with long-term clinical outcome. (PubMed, Sci Rep) - "Finally, for both EEG and fNIRS data, synergy and global efficiency at 3M correlated with clinical indicators at 1Y, including migraine-related disability and the number of acute medications/month [Formula: see text]. The results support central effects of galcanezumab associated with increased integration in functional and electrical brain connectivity, explaining its long-term efficacy and disease-modifying action."

Clinical data • Journal • CNS Disorders • Migraine • Pain

Prescription of Monoclonal Antibodies Against Calcitonin Gene-Related Peptide for the Prophylaxis of Migraine in Austria: A Retrospective, Longitudinal Analysis of Nationwide Insurance Data. (PubMed, Eur J Neurol) - "In this nationwide study persistence with CGRP-mAbs was excellent; dispensations of triptans and other preventatives decreased during CGRP-mAb therapy. Therapy breaks were common, but the majority resumed CGRP-mAbs, which indicates the need for long-term prophylaxis."

Journal • Reimbursement • Retrospective data • US reimbursement • CNS Disorders • Migraine • Pain

A retrospective audit of the real-world safety and effectiveness profile of eptinezumab for treatment-resistant chronic migraine in Australia. (PubMed, Headache) - "Our findings show that eptinezumab is a safe, well-tolerated migraine prophylactic that decreases monthly migraine and headache days in a small sample of Australian patients with treatment-resistant chronic migraine. Further prospective studies with larger sample sizes and longer follow-up data are needed to confirm findings of this study."

Journal • Real-world evidence • Retrospective data • CNS Disorders • Migraine • Pain

MIGRA-MS: A case series on chronic migraine and multiple sclerosis (EHF-EHC 2025) - "Prior treatments included interferons and glatiramer acetate; current therapies consisted of ocrelizumab, natalizumab, alemtuzumab, teriflunomide, or dimethyl fumarate...All received a median of three classic preventives (amitriptyline in all cases) and onabotulinumtoxinA (PREEMPT, 155 IU) with only one responder; two patients received an extended dose (195 IU) without benefit and later CGRP monoclonal antibodies (galcanezumab, erenumab, eptinezumab) with no response, and atogepant with only transient or partial benefit...In this case series of relapsing–remitting MS with chronic resistant migraine, response to onabotulinumtoxinA and anti-CGRP therapies was limited, with no drug interactions or adverse effects observed. An individualized approach and further studies are needed to assess emerging treatments in this subgroup."

Clinical • CNS Disorders • Migraine • Multiple Sclerosis • Pain

Is there an association between the effectiveness of anti-CGRP monoclonal antibodies in migraine and injection site reactions? (EHF-EHC 2025) - "The cohort included patients receiving erenumab (24.8%), galcanezumab (27.8%) and fremanezumab (47.4%). However, our findings suggest that the presence of these reactions does not compromise the clinical efficacy of the treatment. While ISRs may cause patient discomfort, they do not appear to influence therapeutic outcomes."

CNS Disorders • Dermatology • Migraine • Pain

Effectiveness and tolerability of anti-CGRP monoclonal antibodies for the prevention of migraine in pediatric patients in real world (EHF-EHC 2025) - "Types of mAbs: erenumab 140 mg (50.0%), fremanezumab 125 mg (30.0%), galcanezumab 120 mg (20.0%). Anti-CGRP mAbs in adolescents with resistant migraine in real world are well tolerated, with effectiveness similar to that observed in the adult population during the first 3 months of treatment. Our data support the use of anti-CGRP mAbs as a therapeutic option in the pediatric population."

Clinical • Real-world • Real-world evidence • CNS Disorders • Migraine • Pain • Pediatrics

Performance analysis of galcanezumab in the prophylaxis of cluster headache: A systematic review of clinical trials (EHF-EHC 2025) - "The use of immunotherapy represents great advance in the studies on treating cluster headaches. In the long term, however, additional studies, with a larger number of subjects, will be necessary to consolidate the findings and rectify the biases of the therapeutic approach."

Clinical • Review • Infectious Disease • Pain

Long-term efficacy and predictors of response of cgrp monoclonal antibodies in migraine prevention: A real-world service evaluation (EHF-EHC 2025) - "Most first received fremanezumab ( n =157, 70%) or erenumab ( n =65, 29%); one received galcanezumab. Response is more likely in triptan responders and those starting later. Poorer outcomes with longer migraine duration, more premonitory symptoms, and prior failure of preventives support early initiation of mAbs for a better outcome."

Clinical • Real-world • Real-world evidence • CNS Disorders • Migraine • Pain

Migraine worsening after excellent initial response to galcanezumab (EHF-EHC 2025) - "Several prophylactics were tried (topiramate, amitriptyline, and atogepant) with no improvement...However, in the last few months of treatment, she experienced recrudescence of symptoms – she's now awaiting treatment with eptinezumab...While he tried several preventive medications (topiramate, amitriptyline, venlafaxine and valproic acid), he was also medicated with corticosteroids...Recent literature and medical experience refer to Galcanezumab as a good sustained treatment to refractory migraine. However, these cases highlight the situations in which, despite the initial response being great, there's no prolonged effect on pain relief."

Cardiovascular • CNS Disorders • Complement-mediated Rare Disorders • Hepatology • Hereditary Angioedema • Migraine • Pain

People with migraine and two years treatment with anti-CGRP therapies. First results from the prospective national registry "Hercules" (EHF-EHC 2025) - "So far, 322 subjects with migraine and prior failure to at least 3 repurposed anti-migraine prophylactic treatments attending 7 headache centers in Greece have been recorded, of whom 141 (43.7%) completed the 2-year treatment with anti-CGRP agents [17/141 (12%) subjects with erenumab; 18/141 (12.7%) with galcanezumab; and 106/141 (75.2%) with fremanezumab] while 51/322 (15.8%) participants discontinued treatment [fremanezumab 26/322 (8%); galcanezumab 17/322 (5.3%); 7/322 (2.2%) erenumab; eptinezumab 1/322 (0.3%)], due to failure [40/322 (12.4%)], adverse events (AE) [9/322 (2.8%)], or complete remission of migraine [2/51 (0.6%)]. More than 75% or 100% reduction in MMDs were recorderd in 38/141 (26.9%) and 9/141 (6.4%) subjects. Anti-CGRP mAbs are effective, safe, and well tolerated after long-term administration and should be considered as a first-line prophylactic treatment for migraine."

Clinical • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Migraine • Pain

Four‑year real‑world efficacy and tolerability of anti‑CGRP therapies in a tertiary headache centre in England (EHF-EHC 2025) - "A total of 548 treatments were initiated in 415 patients (rimegepant: n=57; atogepant: n=60; erenumab: n=283; fremanezumab: n=136; galcanezumab: n=12). Atogepant was associated with the most adverse effects, with constipation, dizziness, and "brain fog" reported. Fremanezumab was associated with a higher treatment success rate than erenumab, rimegepant, and atogepant in our cohort."

Clinical • Real-world • Real-world effectiveness • Real-world evidence • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Migraine • Pain

Satisfaction rates and self-reported adverse events of antiCGRP therapies for migraine prevention – Focus on patient perspectives (EHF-EHC 2025) - "4% of questionnaires corresponded to patients on Atogepant, 9.3% on Erenumab , 24.4% on Eptinezumab, 29% on Galcanezumab and 32% on Fremanezumab. Most frequent, were gastrointestinal symptoms and local skin reactions. Nevertheless, some other complaints were not expected such as weight gain, dizziness, palpitations and chest pain arising in more than 10% of patients, showing the need for maintaning recent therapies adverse events surveillance"

Adverse events • Clinical • Cardiovascular • CNS Disorders • Hypertension • Migraine • Pain

Chronology of response to Anti-CGRP mAbs in migraine: The CRONOS-CGRP study (EHF-EHC 2025) - "We conducted a single-center prospective cohort study including 462 patients with episodic or chronic migraine treated with erenumab, galcanezumab, or fremanezumab between February 2021 and November 2024. Switching may be most beneficial around month 4 in non-responders. Baseline clinical features may help predict early response."

CNS Disorders • Migraine • Pain

Clinical characteristics and treatment outcomes in resistant and refractory migraine: Application of the European Headache Federation (EHF) 2020 criteria in a UK tertiary headache cohort (EHF-EHC 2025) - "Galcanezumab looked to be significantly less effective compared with Erenumab (p=0.02). RM accounted more than one-quarter of our patients with a high proportion of migraine aura, depression, high BMI. Older rM patients seem to respond better to Erenumab compared to ligand antiCGRP."

Clinical • CNS Disorders • Depression • Migraine • Mood Disorders • Pain

Local cutaneous complications of CGRP monoclonal antibodies: A case series (EHF-EHC 2025) - "Nine women treated with subcutaneous anti-CGRP monoclonal antibodies developed mild/moderate local cutaneous reactions (mainly erythema, induration, edema, and pruritus) representing 5% of all treated patients (n=190; fremanezumab 88, galcanezumab 75, erenumab 27)...Two continued therapy with supportive measures (local cooling, topical corticosteroid cream, pre/post-injection antihistamines, and rotation of injection site to abdominal area), while five required switching due to persistent reactions with or without lack of efficacy: two to atogepant, one to erenumab then eptinezumab, and one directly to eptinezumab; one discontinued...Supportive measures allowed continuation in some cases, but most required switching to another monoclonal antibody or a gepant. Monitoring and proactive management are essential to minimize treatment discontinuation."

Clinical • CNS Disorders • Dermatology • Immunology • Migraine • Pruritus

Discontinuation of anti-calcitonin Gene-Related Peptide (CGRP) monoclonal Antibodies (mAbs) in migraine patients after 12 months of good response: Are there any predictors of restarting mAbs need? Real-world cohort of 103 patients (EHF-EHC 2025) - "They received fremanezumab (n=77) or galcanezumab (n=26) for a median of 25.9 months (IQR 15.6–39.7). In this real-world cohort, nearly half of the patients who discontinued anti-CGRP monoclonal antibodies after a sustained good response eventually required resuming treatment. No clinical or demographic predictors were identified, supporting individualized decisions and close follow-up."

Clinical • Real-world • Real-world evidence • CNS Disorders • Migraine • Pain

Long-term effectiveness of monoclonal antibodies targeting CGRP in migraine patients (EHF-EHC 2025) - "We aim to evaluate the effectiveness of 3 anti-CGRP subcutaneous monoclonal treatments (erenumab, galcanezumab and fremanezumab) over 2 to 3 years. Monoclonal antibodies showed a remarkable decrease in the frequency of headaches and migraine, as well as the score in MIDAS and HIT-6 scales, not being influenced by the mentioned confusion factors. This improvement is more noticeable during the first 6 months of treatment, but is stable over time until 36 months."

Clinical • Cardiovascular • CNS Disorders • Fibromyalgia • Inflammation • Migraine • Musculoskeletal Pain • Pain • Rheumatology

CGRP, VIP and PACAP plasmatic levels in migraine patients before and after anti-CGRP(R) monoclonal antibodies prophylaxis (EHF-EHC 2025) - "From Feb 2022 to Feb 2023, we enrolled 56 migraineurs who began prophylaxis with erenumab (n=26), galcanezumab (n=16), or fremanezumab (n=14). VIP and PACAP levels remained unaffected by treatment. Further studies are needed to clarify their interplay with CGRP in migraine pathogenesis."

Clinical • CNS Disorders • Migraine • Pain • ADCYAP1

Efficacy of pharmacological and non-pharmacological interventions in the prophylaxis cluster headache: A systematic review (EHF-EHC 2025) - "Objectives include assessing pharmacological treatments like galcanezumab, verapamil, lithium, and non-pharmacological options such as non-invasive vagus nerve stimulation (nVNS). Galcanezumab and nVNS have the strongest evidence for reducing attack frequency and severity. More long-term, large-scale studies are needed to confirm findings and tailor treatments."

Clinical • Review • Pain

Does Fibromyalgia improve with CGRP targeting therapy? (EHF-EHC 2025) - "The most commonly used CGRP monoclonal antibody was fremanezumab (63%), followed by erenumab (30%) and galcanezumab (7%). Our study showed that a minority of patients with migraine and fibromyalgia will experience improvement in their fibromyalgia symptoms with CGRP mAbs. This may suggest the underlying biology of fibromyalgia in patients with migraine is largely driven by mechanisms other than CGRP."

CNS Disorders • Fibromyalgia • Migraine • Musculoskeletal Pain • Otorhinolaryngology • Pain • Rheumatology • Vertigo

Failure of CGRP inhibition as a treatment for complex regional pain syndrome (EHF-EHC 2025) - "She was started on galcanezumab (anti-CGRP monoclonal antibody), resulting in a rapid and sustained reduction in migraine frequency (from 16 to 4 days/month) and severity, with significant improvement in quality of life. Rimegepant (a CGRP receptor antagonist) was also effective for acute attacks...While migraine predominantly involves CGRP-mediated trigeminovascular pathways, CRPS may involve more complex and multifactorial mechanisms, including central sensitization, neurogenic inflammation, and autonomic dysfunction. This example underscores the importance of a differentiated approach to chronic pain conditions, even in the presence of shared biomarkers."

CNS Disorders • Inflammation • Migraine • Musculoskeletal Pain • Pain

Eptinezumab for migraine prevention: Initial experience from a Portuguese tertiary hospital (EHF-EHC 2025) - "Prior anti-CGRP monoclonal antibody use was documented in 14 patients (78%), all of whom had previously received galcanezumab. Among them, 4 were also treated with fremanezumab, and 1 of these had additionally received erenumab...Nonetheless, in this cohort, it was not frequently selected as a first-line option, being primarily used in patients with highly refractory migraine. Treatment adherence was high and further data are needed to assess long-term effectiveness and better define its role in clinical practice."

Clinical • CNS Disorders • Migraine • Pain

Reporting of lack of efficacy of anti-CGRP monoclonal antibodies in migraine patients treated with other concomitant monoclonal antibodies: A VigiBase disproportionality analysis (EHF-EHC 2025) - "Reports listing erenumab, galcanezumab, fremanezumab, or eptinezumab as suspected or interacting drugs and collected in VigiBase up to March 9th, 2025 were included and classified as cases (reporting lack of efficacy) or non-cases (reporting other adverse drug reactions). The concomitant use of other mAbs in patients receiving anti-CGRP mAbs for migraine is not associated with increased reporting of lack of efficacy in VigiBase. These findings offer preliminary reassurance regarding the real-world effectiveness of anti-CGRP mAbs when administered in combinations with mAbs for other indications."

Clinical • CNS Disorders • Migraine • Pain

Comparative effects of anti-CGRP monoclonal antibodies and atogepant on migraine disability, sleep quality, and attack frequency: A 12-month observational study (EHF-EHC 2025) - "This retrospective observational study included patients with chronic migraine refractory to first-line preventives, treated with erenumab, galcanezumab, fremanezumab, or atogepant. Atogepant showed promising early improvements in sleep in selected patients. These findings support multidimensional monitoring—including disability and sleep quality—in migraine care."

Clinical • Observational data • CNS Disorders • Migraine • Pain • Sleep Disorder

Combining anti-CGRP antibodies with atogepant: Safety and efficacy in a patient cohort (EHF-EHC 2025) - "Treatments included erenumab (n=1), fremanezumab (n=11), galcanezumab (n=6), and eptinezumab (n=9). No serious adverse events were reported. In this real-world cohort, combining anti-CGRP mAbs with atogepant appears to be safe and may offer additional benefit."

Clinical • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Insomnia • Migraine • Sleep Disorder