CGRP-monoclonal antibodies in Japan: insights from an online survey of physician members of the Japanese headache society

• Published in: Journal of headache and pain Vol. 25; no. 1; p. 39
• Main Authors: Takizawa, Tsubasa, Ihara, Keiko, Watanabe, Narumi, Takemura, Ryo, Takahashi, Nobuyuki, Miyazaki, Naoki, Shibata, Mamoru, Suzuki, Keisuke, Imai, Noboru, Suzuki, Norihiro, Hirata, Koichi, Takeshima, Takao, Nakahara, Jin
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 15.03.2024; Springer Nature B.V; BMC
• Subjects: Antibodies, Monoclonal - therapeutic use; Calcitonin; Calcitonin Gene-Related Peptide; CGRP monoclonal antibody; Cost; Guideline; Headache; Headache - drug therapy; Headaches; Humans; Internal Medicine; Japan; Japanese Headache Society; Medicine; Medicine & Public Health; Migraine; Migraine Disorders - drug therapy; Migraine Disorders - prevention & control; Monoclonal antibodies; Neurology; Online survey; Pain Medicine; Physicians; Surveys; Japan; CGRP monoclonal antibody; Guideline; Cost; Migraine; Japanese Headache Society; Online survey
• ISSN: 1129-2377; 1129-2369; 1129-2377
• DOI: 10.1186/s10194-024-01737-y

Background Anti-calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs) have greatly changed migraine treatment options. In Japan, although CGRPmAb guidelines (≥ 4 monthly migraine days (MMDs) and ≥ 1 previous preventive failure) are well-acknowledged, the actual use of CGRPmAbs and the circumstances of the related headache care are unknown. Methods We conducted an online survey of Japanese Headache Society members, inquiring about the physicians' experience with CGRPmAbs and how they make decisions related to their use. Results Of the 397 respondents, 320 had prescribed CGRPmAbs. The threshold number of previous preventive failures for recommending a CGRPmAb was two for the majority of the respondents ( n  = 170, 54.5%), followed by one ( n  = 64, 20.5%). The MMD threshold was ≥ 4 for 71 respondents (22.8%), ≥ 6 for 68 (21.8%), ≥ 8 for 76 (24.4%), and ≥ 10 for 81 (26.0%). The respondents tended to assess treatment efficacy after 3 months (episodic migraine: n  = 217, 69.6%, chronic migraine: n  = 188, 60.3%). The cost of CGRPmAbs was described by many respondents in two questions: ( i ) any request for a CGRPmAb (27.7%), and ( ii ) the most frequently reported reason for responders to discontinue CGRPmAbs (24.4%). Conclusions Most of the respondents recommended CGRPmAbs to patients with ≥ 2 preventive failures, followed by ≥ 1. The MMD threshold ranged mostly from ≥ 4 to ≥ 10. The concern for costs was raised as a major limiting factor for prescribing CGRPmAbs.