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

  • Chronic Daily Headache (S-J Wang and S-P Chen, Section Editors)
  • Published:
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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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Authors and Affiliations

  1. Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea

    Soohyun Cho

  2. Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea

    Byung–Kun Kim

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Soohyun Cho and Byung-Kun Kim wrote the main manuscript text. All authors reviewed the manuscript

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Correspondence to Byung–Kun Kim.

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Conflict of Interest

Soohyun Cho received honoraria as a speaker from Celltrion Pharm, Daewoong Pharm, Boryung, Whan In Pharm, Teva and SK Pharm. He has been the principal investigator of clinical trials sponsored by Teva and SK Pharm. Byung–Kun Kim served on Lundbeck’s Advisory Board. He received honoraria as a moderator and speaker from Lundbeck, AbbVie, Pfizer, Eli Lilly, Teva, Yuyu Pharm, and SK Pharm. He has been the principal investigator of clinical trials sponsored by Eli–Lilly, Novartis, Lundbeck, Teva, AbbVie, and Ildong Pharm.

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Cho, S., Kim, B. Long–Term Outcome After Discontinuation of CGRP-Targeting Therapy for Migraine. Curr Pain Headache Rep (2024). https://doi.org/10.1007/s11916-024-01259-x

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