Research report: Real-world treatment patterns of galcanezumab versus traditional oral migraine preventives: 12-month results from the TRIUMPH study

Patients with migraine who started or switched to the CGRP-targeting antibody galcanezumab discontinued their preventive treatment less often and cut down more on migraine headache days requiring acute medication over 12 months than patients who began traditional oral migraine preventives, according to 12-month results from the prospective, real-world TRIUMPH study published in BMC Neurology. The multi-country observational study followed 2,486 patients in routine clinical practice, including 973 who initiated or switched to galcanezumab and 1,138 who started a traditional oral migraine preventive, or TOMP.

The two cohorts differed markedly at baseline, which the researchers addressed through statistical weighting. Roughly 70.0% of the galcanezumab group had chronic migraine compared with 59.8% of the TOMP group, and 37.3% of galcanezumab patients had already tried three or more preventive medications, against just 4.5% in the oral preventive cohort. Mean age was 45.2 years in the galcanezumab group and 40.4 years in the TOMP group. This pattern of greater treatment refractoriness among galcanezumab users means the comparison reflects how the drugs perform in the patients who typically receive them, rather than a randomized head-to-head trial.

Discontinuation was the study’s central outcome. At 12 months, 12.7% of galcanezumab patients had stopped their index drug for what the investigators called negative reasons—lack of efficacy, intolerability, or drug unavailability—versus 17.4% of TOMP patients, a difference that was statistically significant. All-cause discontinuation followed the same direction, at 17.8% versus 23.2%. Using weighted Cox proportional hazards models, the hazard ratio for discontinuation due to negative reasons was 0.53 (95% CI 0.41–0.68) and for all-cause discontinuation 0.57 (95% CI 0.46–0.70), both with P less than 0.0001.

Reductions in migraine headache days requiring acute medication were observed in both groups, but were larger with galcanezumab. The weighted mean change from baseline was −5.1 days in the galcanezumab cohort versus −3.4 in the TOMP cohort at 3 months (P<0.0001), −5.1 versus −4.2 at 6 months (P=0.0234), and −5.3 versus −4.3 at 12 months (P=0.0168). Despite these differences in discontinuation and migraine day reduction, persistence rates were similar between the cohorts, with mean exposure of 9.3 months for galcanezumab and 9.4 months for oral preventives.

Treatment patterns also diverged in ways that may matter clinically. The galcanezumab cohort had fewer combination treatments with other preventives and fewer switches, and more often moved to a subsequent line of other CGRP monoclonal antibodies compared with the TOMP cohort. The authors conclude that in this prospective real-world study, discontinuation of and combination with other preventive medications were less frequent among galcanezumab patients, and that patients initiating or switching to galcanezumab experienced a larger reduction in migraine headache days requiring acute medication. As an observational study rather than a randomized trial, its findings describe associations in routine practice and cannot by themselves establish causal superiority, particularly given the baseline differences in disease severity and prior treatment history between the two cohorts.

Subject of Research: Twelve-month real-world treatment patterns and outcomes of galcanezumab compared with traditional oral migraine preventive medications

Article Title: Real-world treatment patterns of galcanezumab versus traditional oral migraine preventives: 12-month results from the TRIUMPH study

Article References: Ashina, S., Matharu, M., Sakai, F., Vincent, M., Viktrup, L., Martimianaki, G., & Robinson, R. L. (2026). Real-world treatment patterns of galcanezumab versus traditional oral migraine preventives: 12-month results from the TRIUMPH study. BMC Neurology. https://doi.org/10.1186/s12883-026-05552-7

Image Credits: AI Generated

DOI: 10.1186/s12883-026-05552-7

Keywords: migraine, galcanezumab, CGRP monoclonal antibody, oral migraine preventives, TRIUMPH study, treatment discontinuation, migraine headache days, real-world evidence, observational study, BMC Neurology, Real-world, treatment