2025 Southeastern Residency Conference

Title: Blood Pressure Trajectory Post-Initiation of Eptinezumab Infusions For Migraines


Authors: Ashleigh Neese, Rachel Renwick


Introduction: Calcitonin gene-related peptide (CGRP) is a vasodilatory neuropeptide involved in the pathway responsible for onset of migraines. There are several injectable monoclonal CGRP antagonists approved by the FDA for prevention and treatment of migraines. Post-marketing safety monitoring data for erenumab suggests that CGRP antagonists may place patients at risk for increased blood pressure. Eptinezumab was approved for prevention of migraine in 2020 for the prevention of both episodic as well as chronic migraine. However, it has not undergone evaluation for its effect on blood pressure trajectory post-infusion.


Methods: This retrospective, single-center, multi-site study was performed to determine blood pressure trajectory post-infusion for eptinezumab. Patients selected for inclusion were those who received at least 1 dose of eptinezumab at an infusion center within the VUMC Enterprise. The primary outcome of the study was to assess the incidence of significant blood pressure increases immediately following eptinezumab infusion which was defined as an increase greater than or equal to 20 mmHg or 10 mmHg for systolic or diastolic blood pressure, respectively. The incidence of long-term blood pressure increases at 6 months after eptinezumab infusion and a comparison of increases in blood pressure for the 100 mg versus the 300 mg dose of eptinezumab were investigated.


Results: There were 130 patients who received a total of 512 administrations of eptinezumab during the selected time period. Of these administrations, only 35 (7%), met the criteria for a significant increase in blood pressure immediately following infusion for the primary outcome. The average change in blood pressure was -7.48 mmHg for systolic blood pressure and -4.35 mmHg for diastolic blood pressure immediately following administration. When comparing eptinezumab 100 mg versus 300 mg, 20 (9.1%) and 13 (6.1%) of patients experienced a significant increase in blood pressure, respectively. At six months following infusion, 31 (23.8%) of all patients receiving eptinezumab met the criteria for a significant increase in blood pressure. For patients receiving eptinezumab 100 mg, 28 (25.0%) of patients met criteria for a significant increase in blood pressure at 6 months while 15 (26.3%) of patients receiving eptinezumab 300 mg met criteria.


Conclusions: Many patients were previously on other CGRP agents which may have confounded patients experiencing significant blood pressure increases. Additionally, patients had their blood pressure checked post-infusion which resulted in a more accurate blood pressure reading at rest versus when a patient initially presents for their infusion. There were a limited number of patients with eptinezumab as their original infusion which introduced confounding with the 100 mg patient group. Additionally, there was variability in where the patient's 6-month blood pressure was taken. Overall, it was found that eptinezumab causes low incidences of significant blood pressure increases immediately following infusion but can cause increases over a longer period. Therefore, more research should be performed to compare blood pressure increases in patients undergoing treatment with other CGRP agents to eptinezumab.