Background and Importance Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway are recommended by European Headache Federation for migraine prevention. They are considerate effective and safe in the long-term.

In individuals with episodic or chronic migraine (EM, CM) the duration of preventive treatment is not defined. Some experts recommend a pause after 12–18 months of continuous treatment. Restarting the treatment is suggested when migraine worsen after treatment withdrawal.

Aim and Objectives To evaluate the course of migraine after anti-CGRP treatment withdrawal and the prevalence of restart treatment in our population.

Material and Methods Descriptive, retrospective and observational study of patients treated with erenumab, galcanezumab and fremanezumab from January 2020 to September 2022 who required restarting anti-CGRP therapy after 12 months of treatment.

Electronic medical history was used to record following variables: demographic data (sex, age) and clinical data (migraine type, months without anti-CGRP, biological drug, monthly migraine days (MMD), Headache Impact Test-6 score (HIT-6)) at two visits: before the initial biological treatment (baseline); before resumption of biological treatment.

The Shapiro-Wilk normality test and the Student’s t-test were used for statistical analysis. Results with p-values <0.05 were considered significant.

Results 44 patients were included (13 erenumab, 25 galcanezumab, 6 fremanezumab). 84% (37/44) were women and average age was 49 years [26–77]. 52% (23/44) were CM and 48% (21/44) high frequency EM (≥8 MMD). All patients completed 12 months of anti-CGRP treatment due a good response (≥50% MMD reduction).

55% (24/44) patients restarted treatment due to clinical worsening. Months without treatment were 6,3 ± 3,0.

17% (4/24) patients restarted treatment with a different initial anti-CGRP by medical decision (tolerance or improvement of response).

Baseline data were 14,0 ± 4,6 average MMD and 68,3 ± 3,7 on the HIT-6 score and when restarting biological treatment were 12 ± 3,0 and 67,7 ± 6,1, respectively.

The reduction the MMD at the time of restarting treatment compared to baseline is statistically significant (p<0,01), while the HIT-6 score not (p>0,05).

Conclusion and Relevance Restart of treatment is not required in all patients. Follow-up of them is necessary to assess the long-term benefit after treatment discontinuation. Despite treatment is restarted, a reduction in MMD compared to baseline is observed.

References and/or Acknowledgements 1. https://doi.org/10.1186/s10194-022-01431-x

Conflict of Interest No conflict of interest