Predictors of remission maintenance after discontinuation of anti-CGRP monoclonal antibody therapy in migraine
https://doi.org/10.33667/2078-5631-2025-32-25-29
Abstract
Monoclonal antibodies targeting CGRP or its receptor have marked a new era in the preventive treatment of migraine, demonstrating high efficacy and good tolerability. However, the optimal duration of such therapy and the factors influencing the maintenance of remission after its discontinuation remain insufficiently studied. The aim of our study was to identify predictors of sustained remission following the cessation of anti-CGRP monoclonal antibody therapy in migraine. The study included 96 patients with migraine who received three or more injections of anti-CGRP mAb and experienced at least a 30 % reduction in headache frequency. The results allowed us to identify key factors associated with maintenance of remission after the end of treatment. The principal predictors were: rapid and sustained onset of therapeutic effect, a lower number of headache days at the end of therapy, a lower level of depression, less marked central sensitization, and minimal impact of headache on daily activities. This study emphasizes the importance of comprehensive patient assessment before discontinuing therapy and highlights opportunities for an individualized approach in the management of migraine, aimed at maintaining long-term remission and improving quality of life.
About the Authors
A. A. Garmanova
Polyclinic No. 1 Department of the President of the Russian Federation
Russian Federation
Russian Federation
Garmanova Anna A., neurologist
Moscow
V. D. Kotenev
I. M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Kotenev Vladimir D., resident physician at Dept of Nervous Diseases, Institute of Postgraduate Education No. 2
Moscow
A. V. Berdnikova
I. M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Berdnikova Anna V., PhD Med, assistant professor at Dept of Nervous Diseases, Institute for Professional Education
Moscow
N. V. Latysheva
I. M. Sechenov First Moscow State Medical University (Sechenov University); Alexander Vein Headache Clinic
Russian Federation
Russian Federation
Latysheva Nina V., Dr Med Sci (habil.), professor at Dept of Nervous Diseases, Institute for Professional Education, neurologist
Moscow
References
1. Osipova V. V., Filatova E. G., Artemenko A. R. et al. Diagnosis and treatment of migraine: Recommendations of the Russian experts. S. S. Korsakov Journal of Neurology and Psychiatry. 2017; 117 (1–2): 28–42. (In Russ.). https://doi.org/10.17116/jnevro20171171228-42
2. Ailani J. et al. The American Headache Society Consensus Statement: update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain. 2021; 61 (7): 1021–1039. DOI: 10.1111/head.14153
3. Sacco S. et al. European headache federation guideline on the use of monoclonal antibodies acting on the calcitonin gene related peptide or its receptor for migraine prevention. The journal of headache and pain. 2019; 20 (1): 6. DOI: 10.1186/s10194-018-0955-y
4. Dodick D. W. et al. Effect of fremanezumab compared with placebo for prevention of episodic migraine: a randomized clinical trial. Jama. 2018; 319 (19): 1999–2008. DOI: 10.1001/jama.2018.4853
5. Silberstein S. D. et al. Fremanezumab for the preventive treatment of chronic migraine. New England Journal of Medicine. 2017; 377 (22): 2113–2122. DOI: 10.1056/NEJMoa1709038
6. Goadsby P. J. et al. A controlled trial of erenumab for episodic migraine. New England Journal of Medicine. 2017; 377 (22): 2123–2132. DOI: 10.1056/NEJMoa1705848
7. Dodick D. W. et al. ARISE: a phase 3 randomized trial of erenumab for episodic migraine. Cephalalgia. 2018; 38 (6): 1026–1037. DOI: 10.1177/0333102418759786
8. Tepper S. J. et al. Long-term safety and efficacy of erenumab in patients with chronic migraine: results from a 52-week, open-label extension study. Cephalalgia. 2020; 40 (6): 543–553. DOI: 10.1177/0333102420912726
9. Silberstein S. D. et al. Adverse events reported with therapies targeting the CGRP pathway during the first 6 months post-launch: a retrospective analysis using the FDA adverse events reporting system. Advances in Therapy. 2023; 40 (2): 445–459. DOI: 10.1007/s12325‑022‑02346‑4
10. Do T. P., Guo S., Ashina M. Therapeutic novelties in migraine: new drugs, new hope? The journal of headache and pain. 2019; 20; (1); 37. https://doi.org/10.1186/s10194‑019‑0974‑3
11. Goadsby P. J. et al. Long-term safety, tolerability, and efficacy of fremanezumab in migraine: a randomized study. Neurology. 2020; 95 (18): e2487–e2499. DOI: 10.1212/WNL.0000000000010600
12. Caronna E. et al. Redefining migraine prevention: early treatment with anti-CGRP monoclonal antibodies enhances response in the real world. Journal of Neurology, Neurosurgery & Psychiatry. 2024; 95 (10): 927–937. DOI: 10.1136/jnnp‑2023-333295
13. Mitsikostas DD. et al. European Headache Federation consensus on long-term use of monoclonal antibodies acting on the calcitonin gene related peptide or its receptor for migraine prevention. The journal of headache and pain. 2022; 23 (1): 49. https://doi.org/10.1186/s10194-018-0955-y
14. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38 (1): 1–211. DOI: 10.1177/0333102417738202
15. Kuruppu D. K. et al. Onset, maintenance, and cessation of effect of galcanezumab for prevention of migraine: a narrative review of three randomized placebo-controlled trials. Advances in Therapy. 2021; 38 (3): 1614–1626. https://doi.org/10.1007/s12325-021-01632-x
16. Raffaelli B. et al. Erenumab and galcanezumab in chronic migraine prevention: effects after treatment termination. The Journal of Headache and Pain. 2019; 20 (1): 66. DOI: 10.1186/s10194‑019‑1018‑8
17. De Matteis E. et al. Early outcomes of migraine after erenumab discontinuation: data from a real-life setting. Neurological Sciences. 2021; 42 (8): 3297–3303. https://doi.org/10.1007/s10072-020-05022-z
18. De Matteis E. et al. Early outcomes of migraine after erenumab discontinuation: data from a real-life setting. Neurological Sciences. 2021; 42 (8): 3297–3303. https://doi.org/10.1007/s10072-020-05022-z
19. Gantenbein A. R. et al. Impact on monthly migraine days of discontinuing anti-CGRP antibodies after one year of treatment–a real-life cohort study. Cephalalgia. 2021; 41 (11–12): 1181–1186. DOI: 10.1177/03331024211014616
20. Vernieri F. et al. Discontinuing monoclonal antibodies targeting CGRP pathway after one-year treatment: an observational longitudinal cohort study. The Journal of Headache and Pain. 2021; 22 (1): 154. DOI: 10.1186/s10194-021-01363-y
21. Iannone L. F. et al. Predictors of sustained response and effects of the discontinuation of ant-calcitonin gene related peptide antibodies and reinitiation in resistant chronic migraine. European Journal of Neurology. 2022; 29 (5): 1505–1513. https://doi.org/10.1111/ene.15260
22. Edvinsson L. CGRP receptor antagonists and antibodies against CGRP and its receptor in migraine treatment. British journal of clinical pharmacology. 2015; 80 (2): 193–199. https://doi. org/10.1111/bcp.12618
Review
For citations:
Garmanova A.A., Kotenev V.D., Berdnikova A.V., Latysheva N.V. Predictors of remission maintenance after discontinuation of anti-CGRP monoclonal antibody therapy in migraine. Medical alphabet. 2025;(32):25-29. (In Russ.) https://doi.org/10.33667/2078-5631-2025-32-25-29
Views:
30
Email this article 