Evolution of Migraine After Discontinuation of Treatment with Anti-CGRP Monoclonal Antibodies: a Systematic Review and Single-Arm Meta-Analysis
Luana Makita1, Aishwarya Koppanatham2, Lucca Carpinelli1, Renata Montanarin1, Pedro Henrique Reginato1, Giovanna Morais1, Rafael Streit1, Rafael Kleimmann1, Andressa Rodrigues1
1Complex of the Clinical Hospital of the Federal University of Parana, Curitiba, Brazil, 2Andhra Medical College, Visakhapatnam, India
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.
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