Pharmacological Differences and Switching Among Anti-CGRP Monoclonal Antibodies: A Narrative Review

Abstract

Antibodies targeting either the calcitonin gene–related peptide (CGRP), such as galcanezumab, fremanezumab, and eptinezumab, or the receptor (erenumab) have been approved for the prevention of episodic and chronic migraine. Although widely used and generally effective, a proportion of patients discontinue treatment due to lack of efficacy. In both randomized controlled trials and observational studies, all anti-CGRP monoclonal antibodies (mAbs) have consistently demonstrated comparable efficacy and tolerability, suggesting a pharmacological class effect. However, differences in therapeutic targets, structure, and pharmacokinetic characteristics may influence their efficacy and safety differently. Therefore, in patients not achieving a clinically meaningful response with one anti-CGRP antibody, switching to a different antibody may be a viable option. This review examines the pharmacological characteristics and distinctions among anti-CGRP mAbs, highlighting their mechanisms of action and pharmacokinetic profiles, along with the clinical observational data of switching. Finally, we summarize suggestions from international guidelines.

Target Audience

Healthcare Professionals 

Learning Objectives

To understand the differences between anti-CGRP monoclonal antibodies and when to consider switching

Activity Disclosure

No commercial support has been accepted related to the development or publication of this activity.

Course summary

Available credit: 
  • 1.00 ABPN-approved Self-Assessment credit(s)
  • 1.00 AMA PRA Category 1 Credit(s)™
Course opens: 
08/29/2025
Course expires: 
08/28/2027
Cost:
$0.00
Rating: 
0

Faculty disclose no financial relationships. This activity underwent peer review in line with standards of editorial integrity and publication ethics. Conflicts of interest have been identified and resolved in accordance with John Wiley and Sons, Inc.’s Policy on Activity Disclosure and Conflict of Interest.

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John Wiley and Sons, Inc. designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. For information on applicability and acceptance of continuing medical education credit for this activity, please consult your professional licensing board.

The American Board of Psychiatry and Neurology has reviewed Behavior and Migraine and has approved this activity as part of a comprehensive Self-Assessment activity, which is mandated by the ABMS as a necessary component of Continuing Certification.

This activity is designed to be completed within 1 hour. To successfully earn credit, participants must access and complete the activity during the valid credit period, which is up to two years from initial publication.

Available Credit

  • 1.00 ABPN-approved Self-Assessment credit(s)
  • 1.00 AMA PRA Category 1 Credit(s)™

Price

Cost:
$0.00
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