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Review
. 2024 Apr 29.
doi: 10.1007/s11916-024-01259-x. Online ahead of print.

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

Soohyun Cho  1 , Byung-Kun Kim  2
Affiliations
Review

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

Soohyun Cho et al. Curr Pain Headache Rep. .

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. 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.

Keywords: CGRP-targeting therapy; Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs); Chronic migraine; Discontinuation; Disease-modifying migraine drug (DMMD).

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