AAN 2025 | A study investigating the evolution of migraine after the discontinuation of anti-CGRP antibodies

We conducted a systematic review and meta-analysis that explores what happens clinically when patients with migraine stop using the anti-CGRP monoclonal antibodies. CGRP is a neurotransmitter that has potential, that has strong vasodilatory properties. And they have emerged in the recent years as a promising approach for patients with migraine for preventive treatment. They have shown a very good safety and efficacy profile for treating in real-world settings. These treatments have shown strong effectiveness in many countries, but we have some situations where they are high-cost medications. So stopping therapy is often mandatory due to reimbursement conditions, rules, or national guidelines. Despite this, we still don’t know if we have clear answers on how long patients should stay on treatment or what’s the real impact of stopping it. So we aim to conduct a systematic review and meta-analysis regarding this clinical question to better understand the clinical profile of the patients when they stop this medication. Here we need to think that these medications are in the healthcare systems. They are delivered for patients with difficult-to-treat migraines, with refractory migraines to most conventional migraine drugs. So we’re looking at a high-burdened subgroup of migraineurs. We conducted searches in PubMed, Embase, and Cochrane for randomized control trials or longitudinal studies that looked at the effects of this treatment’s continuation. And we found that compared to baseline, the monthly migraine days, the rate of migraine attacks per month, it remains lower in the three months after stopping migraine treatment. And this difference was even greater in one month post-continuation. We also compared the post-continuation phase of the final month of active treatment. And we found that the monthly migraine days increased by about 4.4 days. We also found that around 42% of patients who were previously responders to this migraine treatment, they maintained this response rate three months after stopping this treatment. So we can say that its continuation outcomes, they showed a worsening in migraine burden, but they showed still a sustained improvement from baseline. And they suggest for sure the need for research into optimizing the treatment duration, exploring tapering strategies and identifying biomarkers for individualized continuation protocols and reimbursement conditions, which can inform more flexible and broad reimbursement policies to enhance these long-term treatment approaches.

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