Ultra-late response (> 24 weeks) to anti-CGRP monoclonal antibodies in migraine: a multicenter, prospective, observational study

• DOI: 10.1007/s00415-023-12103-4
• Publication Date: 2024-01-17T14:02:48Z
• Authors: Piero Barbanti; Cinzia Aurilia; Gabriella Egeo; Stefania Proietti; Florindo D’Onofrio; Paola Torelli; Marco Aguggia; Davide Bertuzzo; Cinzia Finocchi; Michele Trimboli; Sabina Cevoli; Giulia Fiorentini; Bianca Orlando; Maurizio Zucco; Laura Di Clemente; Ilaria Cetta; Bruno Colombo; Monica Laura Band...; Valentina Favoni; Licia Grazzi; Antonio Salerno; Antonio Carnevale; Micaela Robotti; Fabio Frediani; Claudia Altamura; Massimo Filippi; Fabrizio Vernieri; Stefano Bonassi
• Keywords: Chronic Migraine

Abstract Objective Nearly 60% of migraine patients treated with monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway experience a ≥ 50% reduction in monthly days (MMD) at 12 weeks compared to baseline (responders) . However, approximately half not responding anti-CGRP mAbs ≤ do respond 24 ( late responders) We assessed frequency and characteristics only > ultra-late responders ). Methods In this multicenter n = 16), prospective, observational, real-life study, we enrolled all consecutive adults affected by high-frequency episodic (HFEM: 8 days/month) or chronic (CM), 3 prior therapeutic failures, any for 48 weeks. defined response rate weeks, those achieving Results A total 572 completed treatment. Responders accounted 60.5% (346/572), 15% (86/572), 15.7% (90/572). Among , 7.3% (42/572) maintained across subsequent time intervals (weeks 28, 32, 36, 40, 44, 48) were considered persistent while 8.4% (48/572) missed 1 interval classified as fluctuating Fifty (8.7%) did Ultra-late differed from higher BMI p 0.033), longer duration medication overuse < 0.001), lower NRS 0.017) HIT-6 scores 0.002), dopaminergic symptoms less common unilateral pain—either alone 0.010) combination UAS 0.023), allodynia 0.043), 0.012)—a number comorbidities 0.012), psychiatric proportion comorbidity 0.020). Conclusion Two-thirds later, non-responders are quite rare (8.7%). These findings suggest rethink prophylaxis definition resistant refractory migraine, currently based on after 2–3 months