Objective:

To assess the efficacy and tolerability of three anti-CGRP monoclonal antibody (mAb) therapies (erenumab, fremanezumab, galcanezumab) in patients ≥65 years (O65) compared to patients <65 (U65) with episodic migraine (EM) and chronic migraine (CM).

Background:

Despite decreasing prevalence of migraine with advancing age, there still remains a significant proportion of individuals aged ≥65 years with migraine. Treatment of this population is difficult given associated numerous comorbidities, polypharmacy, and altered pharmacokinetics. This age group is often excluded from clinical trials, limiting evidence regarding efficacy, safety, and tolerability of migraine treatments.

Design/Methods:

Patients who were treated with an anti-CGRP mAb between June 2018 and December 2021 had their electronic medical records extracted. The cohort was grouped into daily (n=1303) and non-daily (n=1708) migraines, then further separated between O65 (n=304, 70.81 ± 4.74 years) or U65 (n=2707, 44.33 ± 11.71 years) at their treatment start date. The groups were compared with a Mann-Whitney test.

Results:

There was no significant difference (p=0.8247) in the migraine days reduced for non-daily migraine patients O65 (8.44 ± 6.70 less MMD) or U65 (8.37 ± 6.76 less MMD). There was not a significant difference (p=0.5853) in the reduction of migraine days for daily migraineurs O65 (12.53 ± 12.18 less MMD) or U65 (13.35 ± 11.72 less MMD). There were adverse reactions noted (95/3012,1.6% O65, 3.3% U65) with the most common side effects being injection site pain/reactions (38/95) and constipation (35/95). No serious adverse events were noted in our cohort in the 6 months of anti-CGRP mAb use.

Conclusions:

This retrospective analysis provides real-world evidence that treatment with erenumab, fremanezumab, and galcanezumab is as efficacious and well-tolerated in patients O65 compared to patients U65 with EM or CM. This data may help guide choice of migraine treatment in older populations.