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The increasing use of anti-CGRP therapies in patients with migraine and other comorbidities raises the question whether the potential use of anti-CGRP monoclonal antibodies (CGRP-mAbs) therapies in combination with other immunological therapies is effective and safe.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This multicenter study included patients with migraine receiving CGRP-mAbs combined with immunosuppressive and immunomodulatory treatments. Clinical and demographic data, treatment history, laboratory markers and treatment-emergent adverse events (TEAEs) were analyzed. Effectiveness outcomes included the change in monthly migraine days (MMD) and monthly headache days (MHD) at 3, 6, 9 and 12\u00a0months, alongside the\u2009&gt;\u200950% response rate. Moreover, autoimmune disease progression was also evaluated. We explored differences between patients with and without autoimmune disease activation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Among 89 patients, there were 80 (90%) females with a mean age of 50\u00a0years (SD: 11), who had a high prevalence of psychiatric comorbidities (anxiety 44%, depression 49%) and medication overuse (68%). Patients receiving immunological treatments experienced significant reductions in MMD and MHD, with MMD decreasing from 16 (SD: 7) at baseline to 9 (SD: 8) at 6\u00a0months, and MHD dropping from 23 (SD: 8) to 17 (SD: 11). A 50% response in MMD was achieved by 46% at 6\u00a0months. TEAEs were reported in 28%, most commonly constipation (16%) and dizziness (9%).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>CGRP-mAbs therapies combined with immunological treatments appear effective and safe in patients with autoimmune diseases. Larger prospective studies are necessary to confirm these findings and optimize management strategies.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00415-025-13177-y","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T19:00:39Z","timestamp":1748977239000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Concomitant anti-CGRP and immunomodulatory treatments in patients with migraine: towards integrated management strategies"],"prefix":"10.1007","volume":"272","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4905-4186","authenticated-orcid":false,"given":"Mar\u00eda 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EC has received honoraria from Novartis, Chiesi, Lundbeck, MedScape, Lilly, TEVA, Dr Reddy\u2019s; his salary has been partially funded by R\u00edo Hortega grant Acci\u00f3n Estrat\u00e9gica en Salud 2017\u20132020 from Instituto de Salud Carlos III (CM20\/00217) and Juan Rod\u00e9s fellowship, Subprograma Estatal de Incorporaci\u00f3n de la Acci\u00f3n Estrat\u00e9gica en Salud 2023 (JR23\/00065). He is a junior editor for Cephalalgia. AJ has received honoraria from Lilly, TEVA, Lundbeck and Abbvie. AMV has received honoraria for advisory board participation, consultancy, scientific communications, research support, and funding for travel and congress attendance from Teva, Lilly, Roche, UCB, Bial, Chiesi, Abbvie, Esai, Zambon, Kern Pharma, Pfizer, Janssen, Biogen Idec, BMS, Novartis, TEVA, Merck, Neuraxpharm, Genzyme, Sanofi, Bayer, Almirall and\/or Celgene.\u00a0A. S\u2013S has received fees from TEVA for sponsored lectures. ABG-V has received speaker honoraria and\/or clinical advisor from Novartis, Lilly, TEVA, Exeltis, Chiesi, Abbvie, Pfizer, Dr. Reddy\u00b4s and Lundbeck. SC received honoraria for participating on advisory boards and for collaborations as consultants and scientific communications; they also received research support as well as funding for travel and congress-attending expenses from Teva, Lilly, Roche, UCB, Kern Pharma, Pfizer, Biogen Idec, Novartis, TEVA, Merck, Genzyme, Sanofi, Bayer, Almirall, and Celgene. M-L. C has been involved as a consultant or lecturer for Novartis, Lundbeck and Teva. AL. GP has participated in Advisory Boards: Abbvie, Elly Lilly, Lundbeck, Organon, Pfizer, TEVA. Speaker boards: Abbvie, Elly Lilly, Exeltis, Lundbeck, TEVA. MHV received honoraria for participating on advisory boards and for collaborations as consultant, scientific communications, speaker, research support as well as funding for travel and congress attending expenses from AbbVie, Novartis, Lilly, TEVA, Lundbeck, Dr Reddy's, Pfizer, Almirall, Chiesi, Esai, Kern Pharma and Zambon. PP-R has received, in the last 3\u00a0years, honoraria as a consultant and speaker from AbbVie, Amgen, Dr Reddy\u2019s, Eli Lilly, Lundbeck, Medscape, Novartis, Organon, Pfizer and Teva Pharmaceuticals. Her research group has received research grants from AbbVie, AGAUR, EraNet Neuron, FEDER RIS3CAT, Instituto Investigaci\u00f3n Carlos III, MICINN, Novartis, and Teva Pharmaceuticals, and has received funding for clinical trials from AbbVie, Amgen, Biohaven, Eli Lilly, Lundbeck, Novartis, Pfizer and Teva Pharmaceuticals. She is the Honorary Secretary of the International Headache Society, is an associate editor for Cephalalgia and Neurologia. She is a member of the Clinical Trials Guidelines Committee of the International Headache Society. PJG reports, over the last 36\u00a0months, grants from Kallyope, and personal fees from Aeon Biopharma, Abbvie, Amgen, Aurene, CoolTech LLC, Eli-Lilly and Company, Linpharma, Lundbeck, Pfizer, PureTech Health LLC, Satsuma, Shiratronics, Teva Pharmaceuticals, Tremeau, and Vial; personal fees for advice through Gerson Lehrman Group, Guidepoint, SAI Med Partners and Vector Metric; fees for educational materials from CME Outfitters and WebMD; publishing royalties or fees from Massachusetts Medical Society, Oxford University Press, UptoDate and Wolters Kluwer; and a patent magnetic stimulation for headache (No. WO2016090333 A1) assigned to eNeura without fee. A.G.M has received speaker honoraria from TEVA, Lilly and Altermedica. Her salary has been partially funded by R\u00edo Hortega grant Acci\u00f3n Estrat\u00e9gica en Salud from Instituto de Salud Carlos III (CM21\/00178) and Juan Rod\u00e9s fellowship, Subprograma Estatal de Incorporaci\u00f3n de la Acci\u00f3n Estrat\u00e9gica en Salud 2023 (JR23\/00005). She is the principal investigator of the Research Project funded by Instituto de Salud Carlos III (grant number PI24\/01085)\u00a0and co-funded by FEDER and\u00a0FSE. She is board member of the Future Headache Experts of the European Headache Federation, secretary of the Residents and Research Fellows (RRFS) of the European Academy of Neurology (EAN) and coordinator of the junior Headache Group of the Spanish Society of Neurology (jGECSEN).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}},{"value":"Consent for publication was obtained from patients participating in the present study. Details that might disclose the identity of the subjects under study should be omitted.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Ethics approval and consent to participate was obtained from the institutional ethics committee of Hospital Universitario de la Princesa (Number: 4563) and the project has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"443"}}