Similar efficacy of anti-CGRP mAbs in short- and long-term migraine prevention

After 2 years of treatment, the effectiveness of monoclonal antibodies targeting calcitonin gene-related peptide (anti-CGRP mAbs) remains comparable to that seen after the first 6 months. The most important factors associated with treatment withdrawal were greater baseline headache frequency, depression, and obesity.

 

Since anti-CGRP mAbs are indicated for the prevention of chronic migraine, there is a need for data on their long-term tolerability and safety. However, real-world data are very limited, said Dr Edoardo Caronna (Vall d’Hebron Hospital, Barcelona, Spain). He presented 2-year results from EUREkA, a European multicentre, prospective, real-world study of adult migraine with participants from 35 centres in 7 European countries [1]. The study cohort includes adult patients with high-frequency episodic (EM) or chronic (CM) migraine treated with anti-CGRP mAbs. Results of the first 6 months were published in 2024 [2]. For the present study, Dr Caronna and colleagues compared participants who completed 24 months of treatment (ON group) with those who discontinued treatment due to lack of effectiveness (OFF group).

The ON group consisted of 1340 participants. Median age was 48 years, and 82% were female. The median monthly headache days decreased from 20 to 10 (p<0.001); the median monthly migraine days from 15 to 5 (p<0.001); and the number of acute medication days from 15 to 6 (p<0.001). In all, 60.4% had a ≥50% response. At baseline, 70% had CM; of this group, 20.3% had converted to EM at month 24.

The OFF group counted 1057 participants. Compared to the ON group, the OFF group had significantly higher proportions of CM (ON: 69.9% vs OFF: 82.9%), depression (ON: 24.0% vs OFF: 38.0%), anxiety (ON: 30.7% vs OFF: 41.0%) and obesity (ON: 7.2% vs OFF: 19.1%) (p<0.001).

Dr Caronna concluded that a sustained response over time may help more precisely characterise CGRP-dependent individuals for future studies. He also noted that obesity is a predictor of therapy discontinuation, highlighting the need to better understand how body weight affects migraine and the pharmacokinetics of anti-CGRP mAbs.

1. Caronna E, et al. European multicenter study on the use of anti-CGRP monoclonal antibodies in migraine: The 2-year follow-up. OPR-008, EAN Congress 2025, 21-24 June 2025, Helsinki, Finland.
2. Caronna E, et al. J Neurol Neurosurg Psychiatry. 2024;95(10):927-37.

 

Medical writing support was provided by Michiel Tent.

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Posted on 26 June 20253 September 2025