{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T19:16:21Z","timestamp":1780600581750,"version":"3.54.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T00:00:00Z","timestamp":1707696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T00:00:00Z","timestamp":1707696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"This work was partially supported by the Italian Ministry of Health (Institutional Funding Ricerca Corrente) IRCCS San Raffaele Roma and by Fondazione Italiana Cefalee (FICEF)."}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>While a single 12-month treatment cycle (TrC) with anti-CGRP mAbs is not disease-modifying for most patients, there is limited understanding of the effects of multiple TrCs on migraine course. We evaluated whether a second TrC might modify the migraine course by comparing the occurrence of migraine relapse after discontinuation of the second TrC to that following the cessation of the first TrC.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In a real-life, multicenter, prospective study we considered all consecutive patients diagnosed with high-frequency episodic migraine (HFEM) or chronic migraine (CM) with\u2009&gt;\u20093 treatment failures and treated with any anti-CGRP mAbs for\u2009\u2265\u20092 consecutive 12-month TrCs who were responders at week 12. The primary endpoint was the change in monthly migraine days (MMD) for HFEM or monthly headache days (MHD) for CM at the first month of treatment discontinuation after the second TrC (D2) compared to the first TrC (D1). Secondary endpoints included variations in monthly analgesic medications (MAM), Numeric Rating Scale (NRS), and Headache Impact Test (HIT-6) scores,\u2009\u2265\u200950%,\u2009\u2265\u200975%, and 100% response rates, and relapse from episodic migraine to CM and from no-medication overuse (MO) to MO at D2 vs. D1.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>One-hundred-seventy-eight patients completed two 12-month TrCs with anti-CGRP mAbs. At D2, patients experienced a significant reduction in MMD (\u2013\u00a00.6, <jats:italic>p<\/jats:italic>\u2009=\u20090.028), MHD (\u2013\u00a02.6, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), monthly analgesic medications (\u2013\u00a02.0, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and HIT-6 score (\u2013\u00a02.2, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) compared to D1, indicating improved effectiveness. The\u2009\u2265\u200950% response rate at weeks 45\u201348 during the first TrC was 95.5%, while at weeks 45\u201348 of the second TrC was 99.4%. Corresponding rates at D1 was 20.2% whereas at D2 was 51.6% (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). No statistical difference emerged in\u2009\u2265\u200975% and 100% responders. The relapse rate from episodic migraine to CM at D2 was lower than at D1 (12.3% vs 30.4%; <jats:italic>p<\/jats:italic>\u2009=\u20090.0002) Fewer patients experienced relapse from no-MO to MO at D2 compared to D1 (29.5% vs 68.7%; <jats:italic>p<\/jats:italic>\u2009=\u20090.00001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>A second TrC with anti-CGRP mAbs demonstrated clinical improvements compared to the first one, as indicated by a milder migraine relapse at D2 compared to D1. Multiple TrCs with anti-CGRP mAbs could progressively modify migraine evolution by reducing CGRP-dependent neuroinflammatory nociceptive inputs to the brain.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-024-12192-9","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T04:14:30Z","timestamp":1707711270000},"page":"2605-2614","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Impact of multiple treatment cycles with anti-CGRP monoclonal antibodies on migraine course: focus on discontinuation periods. 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Cinzia Aurilia received travel grants from Eli-Lilly, FB-Health, Lusofarmaco and Teva, honoraria from Novartis, Eli-Lilly, and Teva; Gabriella Egeo received travel grants and honoraria from Eli-Lilly, Novartis, New Penta and Ecupharma; Paola Torelli received a travel grant, honoraria as a speaker, or for participating in advisory boards from Novartis, Teva, Eli Lilly, and Allergan; Florindo d\u2019Onofrio received a travel grant, and honoraria as a speaker or for participating in advisory boards from Novartis, Teva, Neopharmed Gentili, Qbgroup srl, K link srl and Eli-Lilly; Bruno Colombo received travel grants, honoraria for advisory boards, speaker panels or investigation studies from Novartis, Teva, Lilly e Lusofarmaco; Massimo Filippi is Editor-in-Chief of the Journal of Neurology; received compensation for consulting services and\/or speaking activities from Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva; and receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA); Sabina Cevoli received honoraria for speaker panels from Teva and Novartis; Stefania Proietti, Giulia Fiorentini, Bianca Orlando, Antonio Carnevale, Sofia Tavani and Stefano Bonassi have no disclosures to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}