Efficacy and Tolerability of Anti-CGRP Monoclonal Antibodies in Patients Aged ≥ 65 Years With Daily or Nondaily Migraine

Amira Salim; Sudipa Biswas; Claire Sonneborn; Olivia Hogue; Elise Hennessy; Maryann Mays; Aarushi Suneja; Zubair Ahmed; Ignacio F Mata

doi:10.1212/CPJ.0000000000200373

Efficacy and Tolerability of Anti-CGRP Monoclonal Antibodies in Patients Aged ≥ 65 Years With Daily or Nondaily Migraine

Neurol Clin Pract. 2025 Feb;15(1):e200373. doi: 10.1212/CPJ.0000000000200373. Epub 2024 Oct 8.

Authors

Amira Salim¹, Sudipa Biswas¹, Claire Sonneborn¹, Olivia Hogue¹, Elise Hennessy¹, Maryann Mays¹, Aarushi Suneja¹, Zubair Ahmed¹, Ignacio F Mata¹

Affiliation

¹ Department of Molecular Medicine (A. Salim), Cleveland Clinic Lerner College of Medicine, Case Western Reserve University; Genomic Medicine Institute (A. Salim, IFM), Lerner Research Institute, Cleveland Clinic; Center for Neurological Restoration (SB, MM, A. Suneja, ZA), Cleveland Clinic Neurological Institute; Quantitative Health Sciences (CS, OH), Lerner Research Institute, Cleveland Clinic, OH; and Neuroscience Institute (EH), Penn State Health Milton S. Hershey Medical Center, Hershey, PA.

PMID: 39399553
PMCID: PMC11464238 (available on 2026-02-01)
DOI: 10.1212/CPJ.0000000000200373

Abstract

Background and objectives: Despite decreasing prevalence of migraine with advancing age, there remains a significant proportion of individuals aged ≥65 years with migraine. Treatment of this population is difficult and they are often excluded from clinical trials, limiting evidence regarding migraine treatment outcomes. Our objective is to assess the efficacy and tolerability of anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) therapies (erenumab, fremanezumab, and galcanezumab) in patients ≥65 years (O65) compared with patients <65 (U65) with daily or nondaily migraine.

Methods: This observational study uses retrospective data from the electronic medical records of patients who were treated with an anti-CGRP mAb between June 2018 and November 2021. Efficacy was determined through a reduction in monthly migraine days (MMDs) and Headache Impact Test (HIT-6) scores from baseline to posttreatment. Tolerability was examined through the number of adverse events reported per group. Mann-Whitney tests were used to compare the efficacy and tolerability of U65 and O65 patients overall and separated into daily and nondaily migraine groups.

Results: The dataset consisted of U65 (n = 2,707; median [interquartile range]; 45.4 [35.8-53.8] years) or O65 (n = 304; 69.5 [67.3-73.3] years) and further separated into daily (n = 1,303) and nondaily (n = 1,708) migraine. There was no difference (p = 0.57) in the median MMD reduction between U65 (10 days [0.0-17.0]) and O65 (10 days [0.0-16.5]). Similarly, no difference was found among patients with nondaily migraine (p = 0.82) and patients with daily migraine (p = 0.59). HIT-6 scores decreased from severe to moderate/substantial impact for all groups. The daily and nondaily groups showed differences in meeting the 50% improvement threshold (nondaily U65, 67% vs daily U65, 54%, p < 0.0001; nondaily O65, 65% vs daily O65, 49%, p = 0.008). Side effects were reported (829/3,011), with a higher incidence in the U65 (22% O65, 28% U65). The most common side effects for both groups were injection site reaction/rash (40%) and constipation (25%).

Discussion: This retrospective analysis provides real-world evidence that there is no difference in the efficacy and tolerability of treatment with erenumab, fremanezumab, and galcanezumab in patients O65 when compared with patients U65 both with daily or nondaily migraine. These data may help guide the choice of migraine treatment in older populations.