Highlights from

AAN 2019

American Academy of Neurology annual meeting

Philadelphia, USA 4-10 May 2019

Galcanezumab reduces cluster headache frequency

In a placebo-controlled trial, the anti-calcitonin gene-related peptide antibody galcanezumab reduced the weekly episodic cluster headache attack frequency from week 1 to 3, and resulted in a greater percentage achieving a reduction in the weekly cluster headache attack frequency at week 3 of at least 50%. The safety profile of galcanezumab was similar to that seen previously in patients with episodic or chronic migraine [1].

Dr David Dodick (Mayo Clinic, Phoenix, USA) stressed that there is underrecognition of cluster headache and a high rate of misdiagnosis that delays the correct diagnosis an average of 5 to 7 years. “Effective acute treatments are underused, and there are no approved medications for prevention.” Presenting results from the double-blind treatment period of this trial, Dr Dodick said participants were randomised to subcutaneous galcanezumab 300 mg (n=49) or placebo (n=57) once monthly. The primary endpoint was the overall mean change from baseline in weekly attack frequency across weeks 1 to 3. A significant difference was found: -8.7 for galcanezumab versus -5.2 for placebo (P=0.036). The key secondary endpoint, the proportion achieving a ≥50% reduction in weekly attack frequency at week 3, was also significantly higher (76% vs 57%; P=0.04).

Dr Dodick pointed out that the Patient Global Impression of Improvement (PGI-I) was significantly better after 4 weeks in the active treatment group, but not after 8 weeks. “This likely reflects the typical spontaneous resolution of cyclic cluster headache after some weeks.” Galcanezumab was generally well-tolerated. There was a low incidence of discontinuation due to adverse events, with no clinically meaningful differences between galcanezumab and placebo in safety parameters except for a higher incidence of injection site pain (4 patients in the galcanezumab arm versus 0 in the placebo arm). He could not say if any of the other available anti-calcitonin gene-related peptide antibodies may be effective in cluster headache.

  1. Bardos JN, et al. AAN 2019, Plen02.004.

The content and interpretation of these conference highlights are the views and comments of the speakers/authors.