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29-04-2024 | Migraine | Chronic Daily Headache (S-J Wang and S-P Chen, Section Editors)

Long–Term Outcome After Discontinuation of CGRP-Targeting Therapy for Migraine

Authors: Soohyun Cho, Byung–Kun Kim

Published in: Current Pain and Headache Reports

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Abstract

Purpose of review

Calcitonin gene-related peptide (CGRP)-targeting agents are potential candidates for disease-modifying migraine drugs. However, most studies on CGRP-targeting agents have assessed efficacy outcomes rather than long-term effects after discontinuation. This review aimed to synthesize and scrutinize the latest clinical data on the outcomes after the discontinuation of CGRP-targeting therapy in patients with episodic and chronic migraine, with a particular focus on chronic migraine.

Recent findings

Real-world studies involving patients with migraine have reported consistent findings of worsened headache frequency and quality of life after the discontinuation of CGRP monoclonal antibodies (CGRP mAbs). Although many patients maintain improvements for up to 4 months after discontinuation compared to baseline (before starting CGRP mAbs), no studies have evaluated the effects of stopping treatment for > 5 months, which is the five-half-life of CGRP mAbs. Several studies have suggested that patients treated with CGRP receptor mAbs experience more rapid deterioration than those treated with CGRP ligand mAbs after discontinuing CGRP mAbs.

Summary

The results of real-world studies suggest that for many patients with migraine, the benefits of CGRP mAbs diminish months after discontinuation. Therefore, anti-CGRP therapies may not be considered disease-modifying. However, the comprehensive assessment of the disease-modifying potential of these drugs requires studies with extended treatment and cessation durations.
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Metadata
Title
Long–Term Outcome After Discontinuation of CGRP-Targeting Therapy for Migraine
Authors
Soohyun Cho
Byung–Kun Kim
Publication date
29-04-2024
Publisher
Springer US
Published in
Current Pain and Headache Reports
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-024-01259-x