Eptinezumab Improves Migraine-Related Cognitive Symptoms in INFUSE Study
Key Clinical Summary
- Real-world INFUSE study (6-month interim) shows >50% of patients reported improvement in migraine-related cognitive symptoms after eptinezumab.
- Baseline cognitive burden was high, with patients reporting brain fog (82.1%), decision difficulty (64.7%), reading issues (60.0%), complex task difficulty (62.6%).
- Improvements were observed as early as day 7 in patients with prior anti-calcitonin gene-related peptide (anti-CGRP) treatment failure.
New real-world data presented at the American Academy of Neurology (AAN) 2026 Annual Meeting reported improvements in migraine-related cognitive symptoms with eptinezumab (VYEPTI). The 6-month interim analysis of the INFUSE study focuses on patient-reported outcomes in individuals with prior anti-calcitonin gene-related peptide (anti-CGRP) treatment failure, emphasizing the broader burden of migraine beyond headache frequency.
Study Findings
The INFUSE study is a 12-month, prospective, observational study evaluating intravenous eptinezumab (100 mg or 300 mg) in adults with migraine who previously failed at least 1 anti-CGRP preventive therapy. Data are collected using the Patient Global Impression of Change (PGIC) at baseline, day 7, and months 3, 6, 9, and 12.
An interim analysis of 6-month data demonstrated that cognitive symptoms are highly prevalent and burdensome at baseline. Participants reported moderate-to-extreme impairment in brain fog (82.1%), difficulty making decisions (64.7%), difficulty with complex tasks (62.6%), and reading comprehension issues (60.0%).
Following treatment with eptinezumab, more than 50% of patients reported improvements across these domains at 6 months. Improvements were observed as early as day 7 after treatment initiation.
Clinical Implications
The findings suggest that preventive migraine treatment with eptinezumab may address cognitive symptoms, commonly described as “brain fog”, which significantly impact daily functioning. Traditional migraine endpoints, such as monthly migraine days, may not fully capture the disease burden experienced by patients.
For clinicians, the data reinforce the importance of incorporating patient-reported outcomes into routine care. Cognitive symptoms such as impaired concentration, decision-making difficulty, and reduced task performance can affect work productivity and quality of life.
The early onset of improvement may also be clinically relevant when counseling patients about treatment expectations. Furthermore, the study’s population, which included patients with prior anti-CGRP treatment failure, suggests potential utility of eptinezumab in refractory migraine cases.
Expert Commentary
“Migraine is a highly individualized neurological disease characterized by fluctuating symptoms, disability, and quality-of-life impairment,” said study author Amaal Starling, MD, neurologist, Mayo Clinic, in a press release. “Patients often describe ‘brain fog’ as profoundly disruptive, hindering their ability to perform at work, engage with family, or simply enjoy daily life. The INFUSE study findings are meaningful as patients report improvements in cognitive symptoms associated with migraine after starting eptinezumab.”
