| Sumario: | Antibodies targeting either the calcitonin gene–related peptide (CGRP), such as galcanezumab, fremanezumab, and eptinezumab, or the receptor (erenumab) have been approved for the prevention of episodic and chronic migraine. Although widely used and generally effective, a proportion of patients discontinue treatment due to lack of efficacy. In both randomized controlled trials and observational studies, all anti‐CGRP monoclonal antibodies (mAbs) have consistently demonstrated comparable efficacy and tolerability, suggesting a pharmacological class effect. However, differences in therapeutic targets, structure, and pharmacokinetic characteristics may influence their efficacy and safety differently. Therefore, in patients not achieving a clinically meaningful response with one anti‐CGRP antibody, switching to a different antibody may be a viable option. This review examines the pharmacological characteristics and distinctions among anti‐CGRP mAbs, highlighting their mechanisms of action and pharmacokinetic profiles, along with the clinical observational data of switching. Finally, we summarize suggestions from international guidelines. Plain Language Summary: Optimizing anti‐calcitonin gene–related peptide (CGRP) monoclonal antibody (mAb) treatments and offering options to patients who do not respond adequately to these drugs is essential. We explored the potential benefits of switching between different anti‐CGRP mAbs in patients who have received prior preventive treatments, including a first anti‐CGRP mAb. Findings suggest that switching mAb medicines may improve outcomes in patients with multiple prior ineffective treatments, but further studies are needed to determine the clinical effectiveness of switching between anti‐CGRP mAbs and to enhance our understanding of the pharmacological differences among them.
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