Impact on monthly migraine days of discontinuing anti-CGRP antibodies after one year of treatment - a real-life cohort study

Abstract

Objective: This study aims to analyse the effect of the discontinuation of anti-calcitonin gene-related peptide antibodies on monthly migraine days after 12 treatment months.

Background: Anti-calcitonin gene-related peptide antibodies have been a game changer in migraine prophylaxis. However, high treatment costs warrant reducing treatment duration to the essential minimum.

Methods: We collected data of patients with migraine who had received anti-calcitonin gene-related peptide antibodies and had received treatment for 12 months.

Results: We included 52 patients. The average number of monthly migraine days was 16 ± 7 days at baseline, 6 ± 6 in the third, and 5 ± 4 in the 12th treatment month. After treatment interruption, the number of monthly migraine days was 6 ± 4 days in the first month, 9 ± 4 days in the second, and 11 ± 5 days in the third month. Most patients (88.9%) restarted treatment.

Conclusion: Only little of the therapeutic effect of anti-calcitonin gene-related peptide antibodies outlasts their pharmacological effect. After treatment interruption, migraine frequency rose in most patients, and prophylaxis was required again in most cases.Limiting treatment to benefitting patients and confirming the need for prophylaxis periodically is reasonable. However, our data does not support the need for prescheduled treatment discontinuation after 12 months and a fixed duration of the treatment interruption of 3 months.

Keywords: Erenumab; burden of disease; galcanezumab; treatment interruption.

Conflict of interest statement

Declaration of conflicting interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AG received financial support for speaking, consultancies, education, research or travel grants from Allergan, Almirall, Amgen, Curatis, Eli Lilly, Grünenthal, Novartis, Teva Pharma. The submitted work is not related to these agreements.

CG receives financial support for speaking, educational, research or travel grants from Abbvie, Almirall, Biogen Idec, Celgene, Merck, Novartis, Sanofi, Roche and Teva Pharma. The submitted work is not related to these agreements.

CJS reports personal fees from Novartis, Eli Lilly, Allergan, Almirall, Amgen, MindMed and Grünenthal, and personal fees and other from Teva Pharmaceuticals. The submitted work is not related to these agreements.

DV received financial support for consultancies and research from Eli Lilly, Novartis and Teva Pharma. The submitted work is not related to these agreements.

CZ receives financial support for speaking, educational, research or travel grants from Abbvie, Almirall, Biogen Idec, Celgene, Merck, Novartis, Sanofi, Roche and Teva Pharma. The submitted work is not related to these agreements.

HP was funded by the Werner Dessauer Stiftung. The submitted work is not related to these agreements.

Figures

Figure 1.

Monthly migraine days at different time points.