From the Guidelines
Galcanezumab can be used for migraine prevention for as long as it remains effective and the patient tolerates it, with the most recent guideline recommending its use without specifying a maximum duration 1. The decision to continue or stop galcanezumab should be based on periodic assessments of its effectiveness and the patient's tolerance to the medication. According to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1, galcanezumab is recommended for the prevention of episodic or chronic migraine, indicating its long-term use is supported by strong evidence. Key points to consider when using galcanezumab for migraine prevention include:
- The standard dosing regimen, which typically starts with a loading dose followed by regular monthly injections 1.
- The importance of regular follow-up to assess the ongoing effectiveness and safety of the treatment.
- The potential for attempting a drug holiday after a period of successful treatment to evaluate the persistence of migraine prevention without medication.
- The mechanism of action, which involves blocking the calcitonin gene-related peptide (CGRP) pathway, a key component in migraine pathophysiology 1. Given the strong recommendation for galcanezumab in migraine prevention 1, its use can be considered a valuable option for patients suffering from episodic or chronic migraines, offering a potentially long-term solution with a favorable side effect profile compared to some traditional preventive treatments.
From the Research
Duration of Galcanezumab Use for Migraine Prevention
- Galcanezumab can be used for up to 12 months for the preventive treatment of chronic migraine, as shown in the open-label extension of the REGAIN study 2.
- The study found that galcanezumab was effective, safe, and well-tolerated, with high adherence, for up to 12 months of treatment in patients with chronic migraine 2.
- Another study, a 12-month open-label study, demonstrated the continued efficacy of galcanezumab for up to 12 months 3.
- The EVOLVE-2 Phase 3 randomized controlled clinical trial showed that galcanezumab was efficacious, safe, and well tolerated for 6 months in patients with episodic migraine 4.
- A review of the current literature on the usage of galcanezumab for migraine treatment found that galcanezumab can decrease the frequency and length of migraines, and is well tolerated and safe 5.
- A retrospective US claims study found that patients on galcanezumab showed higher adherence and persistence than patients on standard-of-care migraine preventive treatments, with a mean persistence of 212.5 days and a proportion of days covered (PDC) of 55.1% 6.
Key Findings
- Galcanezumab can be used for up to 12 months for migraine prevention.
- The treatment is effective, safe, and well-tolerated, with high adherence.
- Galcanezumab can decrease the frequency and length of migraines.
- Patients on galcanezumab show higher adherence and persistence than patients on standard-of-care migraine preventive treatments.