New data from the RESOLUTION trial indicates that Vyepti (eptinezumab) is effective in treating patients with both chronic migraine (CM) and medication-overuse headache (MOH). The Phase IV placebo-controlled trial showed that patients with these conditions experienced rapid benefits from Vyepti treatment when added to patient education.
The RESOLUTION trial, a multinational, randomized, double-blind study, involved 608 patients diagnosed with both chronic migraine and medication-overuse headache. Participants were randomized to receive either a 100 mg infusion of Vyepti or a placebo, in addition to a brief educational intervention (BEI). The primary endpoint was the change from baseline in monthly migraine days (MMD) over weeks 1-4. Results showed a statistically significant greater reduction in MMDs with Vyepti compared to placebo. Specifically, from a baseline average of 21 days, the change from baseline in MMDs was -6.9 days with Vyepti compared to -3.7 days with placebo (p<0.0001).
Key Findings from the RESOLUTION Trial
Beyond the primary endpoint, the study revealed that a significantly greater proportion of patients treated with Vyepti no longer met the diagnostic criteria for either chronic migraine or MOH after treatment, indicating a potential for disease modification. The trial also confirmed the early onset of Vyepti's efficacy, with significant reductions in pain severity and acute medication use, highlighting important benefits for patients with severe migraine.
Dr. Rigmor Højland Jensen, Professor at the University of Copenhagen and lead investigator of the RESOLUTION trial, noted the importance of these findings for patients whose migraines are complicated by medication overuse. She stated, "These results are good news for our patients with migraine complicated by medication overuse... These are among the patients in need of novel, migraine specific anti-CGRP treatments to prevent migraine attacks."
Trial Design and Patient Population
The RESOLUTION trial enrolled participants primarily from European countries. The brief educational intervention (BEI) involved a short screening followed by individual feedback on reducing acute migraine medication use, an approach previously shown to result in long-term medication reductions for patients with MOH. This study is the first randomized controlled trial to assess the efficacy of an anti-CGRP treatment in combination with structured patient education in chronic migraine and MOH.
Secondary and exploratory endpoints included monthly migraine days over weeks 1-12, MOH remission, transition from chronic to episodic migraine, health-related quality of life, work productivity, and the safety and tolerability of eptinezumab in this patient population.
About Vyepti (eptinezumab)
Vyepti is a humanized monoclonal antibody designed for intravenous (IV) administration that binds to calcitonin gene-related peptide (CGRP). Its efficacy and safety were previously established in the PROMISE-1 trial (episodic migraine) and PROMISE-2 trial (chronic migraine), where it met the primary endpoint of decreasing MMDs over weeks 1-12 in both episodic and chronic migraine. Clinical trials have demonstrated a treatment benefit over placebo as early as day 1 post-infusion. Vyepti was approved by the U.S. FDA in February 2020 and granted European marketing authorization in January 2022 and is available in over 30 markets globally. Common adverse reactions include nasopharyngitis and hypersensitivity.
