Long‑term effectiveness of three anti‑CGRP monoclonal antibodies in resistant migraine patients: a real-world study

Aim: To assess the long-term effectiveness, clinical predictors, safety, and treatment persistence of three anti-CGRP mAbs (erenumab, galcanezumab, fremanezumab) in RM patients. Methods: A single-center retrospective study was conducted from December 2019 to June 2023 involving 126 RM patients who received anti-CGRP mAbs treatment for at least 6 months. Demographic and clinical data were collected, and assessments were conducted at 6, 12, and 24 months. Effectiveness was evaluated using clinical burden parameters, acute medication usage, and monthly migraine days (MMD). Patients achieving a ≥ 50% reduction in MMD were classified as responders, and baseline parameters and logistic regression between groups were analyzed. Adverse effects and treatment discontinuation were documented. Results: Treatment with anti-CGRP mAbs led to significant reductions in disability, MMD and acute medication usage, with sustained improvements observed up to 24 months. Responders exhibited lower baseline MMD and medication overuse. Medication overuse was identified as a negative predictor of treatment efficacy. Safety profiles were favorable, with few adverse events and minimal treatment discontinuations. Conclusion: Anti-CGRP mAbs prove effective in reducing migraine-related disability and headache frequency in RM patients over a 24-month period with favorable safety profiles. However, controlled studies with larger populations are warranted for further validation.