Abstract Details

Title Evolution of Migraine After Discontinuation of Treatment with Anti-CGRP Monoclonal Antibodies: a Systematic Review and Single-Arm Meta-Analysis

Topic Headache

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 12-009

Objective This study aimed to assess the clinical responses of patients with migraine following discontinuation of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) treatment.

Background

Anti-CGRP mAbs offer a promising approach for migraine management, and their potential as disease-modifying agents has been a subject of debate. However, guidelines differ regarding treatment duration and planned discontinuation, and the benefits of treatment breaks remain unclear.

Design/Methods We systematically searched Embase, PubMed, and Cochrane databases for longitudinal studies evaluating mAbs treatment cessation in patients with migraine. Data were analyzed using mean difference (MD) and event proportions. Heterogeneity was assessed with I² statistics. The primary outcome was the change in monthly migraine days (MMD) between baseline and treatment discontinuation phases. Generative AI was used solely to enhance scientific writing and improve clarity. The authors critically evaluated each AI intervention to ensure accuracy.

Results One randomized controlled trial and seven real-world studies involving 1,009 patients were included. The mean change in MMD during the discontinuation phase compared to baseline was -3.74 days (95% CI: -4.89, -2.59; p < 0.05; I² = 61%). In chronic migraineurs, the effect was larger (MD: -6.53; 95% CI: -8.61, -4.44; p < 0.05; I² = 68%). The acute medication use during discontinuation was lower than pretreatment values (MD: -3.50; 95% CI: -5.70, -1.30; p < 0.05; I² = 71%). Compared to the intervention phase, MMD increased by 4.48 days (95% CI: 2.59, 6.37; p < 0.05; I² = 87%). The proportion of ≥50% responders was 63.11% during intervention and 25.37% during discontinuation.

Conclusions Discontinuation of CGRP mAbs led to worsened clinical outcomes compared to the intervention phase, but MMD and acute medication use remained lower than baseline. Assessing patient perceptions during mandatory treatment breaks would provide valuable insights for addressing this issue and refining treatment recommendations. Further research is needed to optimize treatment guidelines.

Authors/Disclosures
Aishwarya Koppanatham, MBBS PRESENTER	Ms. Koppanatham has nothing to disclose.
Luana M. Makita	Miss Makita has nothing to disclose.
Lucca P. Carpinelli, Medical Student	Mr. Carpinelli has nothing to disclose.
Renata T. Montanarin	Miss Montanarin has nothing to disclose.
Pedro Henrique Reginato	Mr. Reginato has nothing to disclose.
Giovanna d. Morais, Medical Student	Ms. Morais has nothing to disclose.
Rafael E. Streit	Mr. Streit has nothing to disclose.
Rafael d. Kleimmann, Medical Student	Mr. Kleimmann has nothing to disclose.
Andressa S. Rodrigues, Student	Miss Rodrigues has nothing to disclose.

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