Abstract Details

Title Desensitization Protocol in Patients with Immediate Eptinezumab Hypersensitivity: A Case Series

Topic Headache

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 15-013

Objective To describe a desensitization protocol for patients with immediate eptinezumab hypersensitivity.

Background Eptinezumab is a humanized monoclonal antibody targeting calcitonin gene-related peptide (CGRP), approved for migraine prevention. While generally well-tolerated, hypersensitivity reactions have been documented.

Design/Methods Case series and review of the Food and Drug Administration (FDA) Adverse Events Reporting System (FAERS).

Results Patient 1 is a 33-year-old female with chronic migraine, on eptinezumab for four years, who developed cough, throat swelling, and urticaria within ten minutes of her last eptinezumab 300 mg infusion. She was treated in the emergency department (ED), requiring epinephrine, and discharged on prednisone and anti-histamines, but returned the following day with recurrent throat swelling and urticaria. She was switched to rimegepant 75 mg every other day but also experienced shortness of breath and urticaria. Her headache severity worsened off eptinezumab. She had previously trialed multiple anti-seizure medications, anti-depressants, anti-hypertensives, other anti-CGRP medications, memantine, cyproheptadine, nerve blocks, and neuromodulation. As eptinezumab 300 mg was the only effective treatment for this patient with severe, treatment-experienced, chronic migraine, eptinezumab desensitization was planned. She tolerated a three-bag 12-step eptinezumab desensitization with only subjective symptoms, managed with diphenhydramine. A localized port-site rash developed after the second two-bag, eight-step desensitization; a third is planned. Patient 2 is a 24-year-old female with chronic migraine on eptinezumab for the preceding three years, who developed recurrent sneezing, flushing, throat tightness, voice changes, and shortness of breath after her most recent eptinezumab 300 mg infusion, requiring epinephrine in the ED. She is currently undergoing eptinezumab desensitization protocol. A review of FAERS revealed 259 cases of hypersensitivity reaction to eptinezumab, with 39 classified specifically as an anaphylactic reaction, although no deaths.

Conclusions Eptinezumab can induce hypersensitivity reactions in 1-4% of patients. Desensitization may allow patients to receive eptinezumab when no equally effective alternatives are available.

Authors/Disclosures
Aimen Vanood, MD (Mayo Clinic Arizona) PRESENTER	Dr. Vanood has nothing to disclose.
Emily Gansert, MD	Dr. Gansert has nothing to disclose.
Victoria Hough	Miss Hough has nothing to disclose.
Aimee R. Itaaehau, PharmD	Dr. Itaaehau has nothing to disclose.
Alex Wonnaparhown, MD	Dr. Wonnaparhown has nothing to disclose.
Juliana VanderPluym, MD (Mayo Clinic)	Dr. VanderPluym has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Neurology and Neuroscience Reports. The institution of Dr. VanderPluym has received research support from Amgen.
Amaal J. Starling, MD, FAAN (Mayo Clinic)	Dr. Starling has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Axsome Therapeutics. Dr. Starling has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Starling has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medscape. Dr. Starling has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Satsuma. Dr. Starling has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Miller Medical. Dr. Starling has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Starling has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Salvia. Dr. Starling has received personal compensation in the range of $0-$499 for serving as a Consultant for Abbvie. Dr. Starling has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Starling has received personal compensation in the range of $500-$4,999 for serving as a Consultant for eNeura. Dr. Starling has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Woodberry Associates .
Alexei Gonzalez-Estrada, MD	Dr. Gonzalez-Estrada has nothing to disclose.

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