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For managed care organizations developing step-therapy and prior-authorization protocols for anti-calcitonin gene-related peptide (anti-CGRP) therapies, new real-world data presented at the 2026 AAN Annual Meeting add a dimension to the conversation about the migraine burden that frequency-based metrics alone do not capture.
Lundbeck presented six-month interim results from the INFUSE study, a real-world, ongoing one-year study of eptinezumab (Vyepti) in patients with migraine who had experienced at least one prior anti-CGRP preventive treatment failure. The analysis focused specifically on patient-reported cognitive symptoms, a domain that has rarely been studied systematically despite its prominence in patients' descriptions of their disease experience.
Migraine-related cognitive symptoms were highly prevalent and bothersome at baseline, with brain fog reported as moderately to extremely bothersome by 82.1% of participants, and difficulty with complex tasks, difficulty making decisions, and difficulty with reading comprehension reported by 62.6%, 64.7%, and 60.0% of participants, respectively.
Following treatment with eptinezumab, the outcomes shifted meaningfully. More than 50% of participants reported improvements across individual cognitive symptoms at six months after two doses of eptinezumab compared to baseline, with improvements observed as early as Day 7 post-treatment.
The managed care implications extend beyond the clinical findings. This population, characterized by prior anti-CGRP failure, represents a cohort where plans are already absorbing the cost of one failed branded agent. The INFUSE data support the argument that switching within class can produce functional gains beyond headache frequency reduction, a consideration relevant to formulary tiering decisions and utilization management criteria for sequential anti-CGRP prescribing.
