4CPS-050 Multicentre evaluation of migraine preventive treatment with calcitonin gene-related peptide receptor antibodies efficacy after a therapeutic holiday

<h3>Background and Importance</h3> Efficacy and tolerability of Calcitonin Gene-Related Peptide (CGRP) receptor monoclonal antibodies (mAbs) have been demonstrated and corroborated by numerous real-world studies. However, several questions remain regarding the management. One significant issue is determining the optimal treatment duration and whether treatment should be discontinued after a period of successful therapy. <h3>Aim and Objectives</h3> To evaluate the course of migraine after therapeutic holiday. <h3>Material and Methods</h3> Multicentre, observational retrospective cohort study that included patients diagnosed with episodic or chronic migraine according to International Classification of Headache Disorders (ICHD)-3 criteria. Patients received preventive treatment with anti-CGRP mAbs and attempted discontinuation after at least 8 months of therapy. Quantitative variables: age, year of diagnosis, monthly days of migraine and headaches, duration of treatment and therapeutic rest periods. Qualitative variables: sex, type of migraine, aura presence, first anti-CGRP received, treatment change and effectiveness post-therapeutic rest. Data were sourced from electronic prescription and electronic medical records and analysed using R Commander. <h3>Results</h3> A total of 47 patients were analysed, with 83% female and a median age of 47 years. Most patients (64.8%) had chronic migraine, and 52.8% experienced auras. Prior to treatment, patients had a median of 14(IQR 15–12) migraine days and 11(IQR 15–10)headache days per month. Erenumab was the most commonly used initial anti-CGRP medication (60.3%), followed by galcanezumab (22.6%) and fremanezumab (17.1%). The median treatment duration was 15.4(IQR 35.7–10,5) months, with 22.7% switching medications after a median of 9.3(IQR 20,6–3.9) months. Dose adjustments were necessary for 30.2% of patients, typically after 6.5(IQR 12–13,5) months. All patients took a therapeutic holiday lasting a median of 6.2(IQR 11,4–3,2) months, during which they had a median of 9.5(IQR 16–6) migraine days. After the break, 50.9% maintained treatment effectiveness, while 26.4% required a medication change, and 5.8% switched to a different anti-CGRP, primarily fremanezumab (53,3%), followed by erenumab (26.6%), eptinezumab (13.3%), and rimegepant (6.8%). <h3>Conclusion and Relevance</h3> A consistent response upon restarting would support temporarily stopping and then resuming treatment if needed. However, according to our results, it seems that a second treatment cycle might be less effective due to potential habituation. Thus, evaluating headache parameters during a second cycle is crucial for better migraine patient care. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest