4CPS-050 Multicentre evaluation of migraine preventive treatment with calcitonin gene-related peptide receptor antibodies efficacy after a therapeutic holiday
Year: 2025
Type: conference-paper
Study design: Observational Study
Abstract: Background and Importance Efficacy and tolerability of Calcitonin Gene-Related Peptide (CGRP) receptor monoclonal antibodies (mAbs) have been demonstrated and corroborated by numerous real-world studies. However, several questions remain regarding the management. One significant issue is determining the optimal treatment duration and whether treatment should be discontinued after a period of successful therapy. Aim and Objectives To evaluate the course of migraine after therapeutic holiday. Material and Methods Multicentre, observational retrospective cohort study that included patients diagnosed with episodic or chronic migraine according to International Classification of Headache Disorders (ICHD)-3 criteria. Patients received preventive treatment with anti-CGRP mAbs and attempted discontinuation after at least 8 months of therapy. Quantitative variables: age, year of diagnosis, monthly days of migraine and headaches, duration of treatment and therapeutic rest periods. Qualitative variables: sex, type of migraine, aura presence, first anti-CGRP received, treatment change and effectiveness post-therapeutic rest. Data were sourced from electronic prescription and electronic medical records and analysed using R Commander. Results A total of 47 patients were analysed, with 83% female and a median age of 47 years. Most patients (64.8%) had chronic migraine, and 52.8% experienced auras. Prior to treatment, patients had a median of 14(IQR 15–12) migraine days and 11(IQR 15–10)headache days per month. Erenumab was the most commonly used initial anti-CGRP medication (60.3%), followed by galcanezumab (22.6%) and fremanezumab (17.1%). The median treatment duration was 15.4(IQR 35.7–10,5) months, with 22.7% switching medications after a median of 9.3(IQR 20,6–3.9) months. Dose adjustments were necessary for 30.2% of patients, typically after 6.5(IQR 12–13,5) months. All patients took a therapeutic holiday lasting a median of 6.2(IQR 11,4–3,2) months, during which they had a median of 9.5(IQR 16–6) migraine days. After the break, 50.9% maintained treatment effectiveness, while 26.4% required a medication change, and 5.8% switched to a different anti-CGRP, primarily fremanezumab (53,3%), followed by erenumab (26.6%), eptinezumab (13.3%), and rimegepant (6.8%). Conclusion and Relevance A consistent response upon restarting would support temporarily stopping and then resuming treatment if needed. However, according to our results, it seems that a second treatment cycle might be less effective due to potential habituation. Thus, evaluating headache parameters during a second cycle is crucial for better migraine patient care. References and/or Acknowledgements Conflict of Interest No conflict of interest
Authors: A Martín Roldán, MDM Sánchez Suárez, B Cancela Díez, A Jimenez Morales, MDM García Valdés
Institution: Hospital Universitario Virgen de las Nieves
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4408376134