Retrospective Review of Dual CGRP-Targeted Regimens for Acute and Preventive Treatment of Migraines in a Veteran Population.

BACKGROUND: Medications targeting calcitonin gene-related peptide (CGRP) have been approved for both acute treatment and prevention of migraines. Controversy surrounds the concomitant use of these agents for these 2 purposes, given their similar mechanisms of action and the limited data available to support concurrent use. METHODS: A medication use evaluation was performed using electronic health record prescription records. The primary objective was to assess the safety of dual CGRP-targeting therapies when used for both the prevention and acute treatment of migraines. A secondary exploratory objective was to assess the efficacy of combination treatment regimens. Patients were included if they had a documented diagnosis of migraine and were concomitantly using a preventive CGRP-targeting regimen and a gepant for acute migraine treatment between April 1, 2023, and January 31, 2025. RESULTS: The analysis included 89 patients. Most were female (60.7%), with a mean age of 46.8 years and a diagnosis of chronic migraines (76.4%). There were 149 unique dual CGRP-targeting regimens identified and included in the safety analysis, 59 of which were eligible for the exploratory efficacy analysis. No new or concerning adverse effects were identified. Only 7 adverse drug reactions were reported by patients and documented. The efficacy analysis revealed no median change in migraine intensity (0.0, P = .18) or duration (0.0, P = .92). Ten patients receiving dual CGRP therapy reported that the addition of a gepant for acute treatment was effective, and 20 reported that it was ineffective. There was a lack of documentation for the remaining 29 patients. CONCLUSIONS: The use of concomitant dual CGRP-targeting agents for migraine treatment and prevention appears to be safe and well tolerated. Efficacy data were limited in this study; randomized controlled trials are needed to fully assess this endpoint.