The (NNT) for achieving a ≥ 50% reduction in monthly migraine days (MMDs) with anti-CGRP monoclonal antibodies ranges from 2.7 to 6.0.
All anti-CGRP monoclonal antibodies showed significantly higher rates of ≥ 50% and ≥ 75% MMD reduction compared to placebo.
NNT for a ≥ 50% MMD reduction varied from 2.7 for eptinezumab 300 mg to 6.0 for erenumab 140 mg.
For a ≥ 75% MMD reduction, NNT ranged from 6.0 for eptinezumab 300 mg to 16.2 for fremanezumab 675 mg/q.
The quarterly (CPR) for achieving a ≥ 50% reduction varied from £4647 for eptinezumab 100 mg to £7009 for erenumab 140 mg.
For achieving a ≥ 75% reduction, CPR ranged from £9850 for eptinezumab 100 mg to £21,862 for fremanezumab 675 mg/q.
Simplified
INTRODUCTION: Four monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) signaling are approved for migraine prevention and commonly prescribed/reimbursed after the failure of repurposed anti-migraine medications. Participants achieving clinical response [e.g., ≥ 50% monthly migraine days (MMDs) reduction] during an anti-CGRP mAb trial are likely to continue treatment. We calculated (NNT) and quarterly (CPR) across four anti-CGRP mAbs.
METHODS: Data were from randomized, double-blind, placebo-controlled phase 3b clinical trials that evaluated anti-CGRP mAbs (eptinezumab, fremanezumab, galcanezumab, erenumab) for migraine prevention in adults with episodic or chronic migraine for whom 2-4 prior preventive treatments have failed. NNT was calculated as 1 divided by absolute risk reduction (difference between active treatment and placebo in the proportion of participants with ≥ 50% or ≥ 75% MMD reduction over Weeks 1-12). CPR was calculated by multiplying NNT by the quarterly (3-month) drug acquisition CPR (£), based on the reimbursed list price in the United Kingdom (CPR could not be calculated for eptinezumab 300 mg). Statistical comparisons were not made.
RESULTS: All anti-CGRP mAbs demonstrated higher rates of ≥ 50% and ≥ 75% MMD reduction than their respective placebo (p < 0.05). The NNT to achieve ≥ 50% MMD reduction ranged from 2.7 (eptinezumab 300 mg) to 6.0 (erenumab 140 mg), and for ≥ 75%, 6.0 (eptinezumab 300 mg) to 16.2 (fremanezumab 675 mg/q). The cost per ≥ 50% responder ranged from £4647 (eptinezumab 100 mg) to £7009 (erenumab 140 mg), and for ≥ 75%, £9850 (eptinezumab 100 mg) to £21,862 (fremanezumab 675 mg/q).
CONCLUSIONS: These results show that, for most anti-CGRP mAbs, a low number of participants (< 10) with migraine need to be treated to achieve one person with a ≥ 50% or ≥ 75% reduction in MMDs over Weeks 1-12, with CPR ranging from £4647 (eptinezumab 100 mg) to £21,862 (fremanezumab 675 mg/q).
Key numbers
2.7
for ≥ 50% Reduction
for eptinezumab 300 mg to achieve a ≥ 50% reduction in monthly migraine days.
£4,647
Cost per ≥ 50% Responder
Cost for eptinezumab 100 mg per responder achieving ≥ 50% reduction.
6.0
for ≥ 75% Reduction
for eptinezumab 300 mg to achieve a ≥ 75% reduction in monthly migraine days.
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Declarations. Conflict of Interest: Dimos D. Mitsikostas has received consulting fees from AstraZeneca, Bristol Mayers Squibb, Eli Lilly, Lundbeck, Novartis, Pfizer, Roche, and Teva; payment or honoraria for presentations from Allergan/AbbVie, AstraZeneca, Bristol Mayers Squibb, Eli Lilly, Genesis Pharma, Lundbeck, Merck, Novartis, Roche, and Teva; support for attending meetings or travel from Allergan/AbbVie, Eli Lilly, Genesis Pharma, Lundbeck, Novartis, and Teva; has performed clinical trials as Principal Investigator for Amgen, Eli Lily, Lundbeck, Novartis, and Pfizer; is the member of the Management Group of Headache Scientific Panel and of Coordinating Panel for Functional Disorder at European Academy of Neurology; and is the president of Hellenic Headache Society. Susanne F. Awad, Rikke Kongerslev, Line Pickering Boserup, and Ravinder Phul are full-time employees of H. Lundbeck A/S or one of its subsidiary companies. Xin Ying Lee was a full-time employee of H. Lundbeck A/S during data analysis and initial manuscript stages. She is currently an employee of Novo Nordisk, which was not involved in nor has competing interest with this study. Simona Sacco has received grants or contracts from Novartis and Uriach; has received consulting fees and payment or honoraria for presentations from Abbot, Allergan/AbbVie, AstraZeneca, Eli Lilly, Lundbeck, Novartis, Novo Nordisk, and Pfizer; support for attending meetings or travel from Eli Lilly, Lundbeck, Novartis, and Teva; equipment or services from Allergan/AbbVie and Novo Nordisk; is the second vice-president for European Headache Federation; and is the president-elect for European Stroke Organization. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. As such, no direct ethical approval or informed consent was required.
