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      Impact on monthly migraine days of discontinuing anti-CGRP antibodies after one year of treatment – a real-life cohort study

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          Abstract

          Objective

          This study aims to analyse the effect of the discontinuation of anti-calcitonin gene-related peptide antibodies on monthly migraine days after 12 treatment months.

          Background

          Anti-calcitonin gene-related peptide antibodies have been a game changer in migraine prophylaxis. However, high treatment costs warrant reducing treatment duration to the essential minimum.

          Methods

          We collected data of patients with migraine who had received anti-calcitonin gene-related peptide antibodies and had received treatment for 12 months.

          Results

          We included 52 patients. The average number of monthly migraine days was 16 ± 7 days at baseline, 6 ± 6 in the third, and 5 ± 4 in the 12th treatment month. After treatment interruption, the number of monthly migraine days was 6 ± 4 days in the first month, 9 ± 4 days in the second, and 11 ± 5 days in the third month. Most patients (88.9%) restarted treatment.

          Conclusion

          Only little of the therapeutic effect of anti-calcitonin gene-related peptide antibodies outlasts their pharmacological effect. After treatment interruption, migraine frequency rose in most patients, and prophylaxis was required again in most cases.

          Limiting treatment to benefitting patients and confirming the need for prophylaxis periodically is reasonable. However, our data does not support the need for prescheduled treatment discontinuation after 12 months and a fixed duration of the treatment interruption of 3 months.

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          Most cited references14

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          Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase 2 trial.

          The calcitonin gene-related peptide (CGRP) pathway is important in migraine pathophysiology. We assessed the efficacy and safety of erenumab, a fully human monoclonal antibody against the CGRP receptor, in patients with chronic migraine.
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            The triggers or precipitants of the acute migraine attack.

            L. Kelman (2007)
            The aim of this study was to evaluate and define the triggers of the acute migraine attack. Patients rated triggers on a 0-3 scale for the average headache. Demographics, prodrome, aura, headache characteristics, postdrome, medication responsiveness, acute and chronic disability, sleep characteristics and social and personal characteristics were also recorded. One thousand two hundred and seven International Classification of Headache Disorders-2 (1.1-1.2, and 1.5.1) patients were evaluated, of whom 75.9% reported triggers (40.4% infrequently, 26.7% frequently and 8.8% very frequently). The trigger frequencies were stress (79.7%), hormones in women (65.1%), not eating (57.3%), weather (53.2%), sleep disturbance (49.8%), perfume or odour (43.7%), neck pain (38.4%), light(s) (38.1%), alcohol (37.8%), smoke (35.7%), sleeping late (32.0%), heat (30.3%), food (26.9%), exercise (22.1%) and sexual activity (5.2%). Triggers were more likely to be associated with a more florid acute migraine attack. Differences were seen between women and men, aura and no aura, episodic and chronic migraine, and between migraine and probable migraine.
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              • Record: found
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              • Article: not found

              A Controlled Trial of Erenumab for Episodic Migraine

              We tested erenumab, a fully human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor, for the prevention of episodic migraine.
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                Author and article information

                Journal
                Cephalalgia
                Cephalalgia
                CEP
                spcep
                Cephalalgia
                SAGE Publications (Sage UK: London, England )
                0333-1024
                1468-2982
                17 May 2021
                October 2021
                : 41
                : 11-12
                : 1181-1186
                Affiliations
                [1 ]Department of Neurology and Neurorehabilitation, RehaClinic group, Bad Zurzach, Switzerland
                [2 ]Department of Neurology, University Hospital Zurich, Zurich, Switzerland
                [3 ]Kopfwehzentrum Hirslanden, Zurich, Switzerland
                [4 ]Department of Neurology, Neurocenter of Southern Switzerland (NSI), Ospedale Regionale Lugano Civico, Lugano, Switzerland
                [5 ]Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
                [6 ]Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
                [7 ]Department of Neurology, Inselspital, Berne University Hospital, University of Berne, Berne, Switzerland
                [8 ]Centre Médical Montchoisi, Swiss Medical Network, Lausanne, Switzerland
                Author notes
                [*]Heiko Pohl, Department of Neurology, University Hospital Zurich, Switzerland, Frauenklinikstrasse 26, 8091 Zurich, Switzerland. Email: heiko.pohl@ 123456usz.ch
                Author information
                https://orcid.org/0000-0003-4668-6098
                https://orcid.org/0000-0002-2778-6790
                Article
                10.1177_03331024211014616
                10.1177/03331024211014616
                8504406
                34000847
                9479aad0-4f1b-48f1-9439-464c3caf64bb
                © International Headache Society 2021

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 22 February 2021
                : 27 March 2021
                : 11 April 2021
                Categories
                Original Articles
                Custom metadata
                ts2

                Neurology
                erenumab,galcanezumab,burden of disease,treatment interruption
                Neurology
                erenumab, galcanezumab, burden of disease, treatment interruption

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