{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T14:25:35Z","timestamp":1781533535215,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study, designed by the Greek Research Alliance for Studying headache and Pain (GRASP), aimed to (i) prospectively evaluate the effects of treatment cessation in fremanezumab\u2010responsive patients after 2\u2009years exposure and (ii) assess variations in response rates after migraine worsening and treatment re\u2010initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed 149 patients with high\u2010frequency episodic (HFEM) or chronic migraine (CM), who completed 24\u2009months of fremanezumab, and mandatorily paused fremanezumab and re\u2010initiated it after their migraine worsened. To assess longitudinal variations mostly in monthly migraine\/headache days (MMD\/MHD) and other efficacy variables, patients were interviewed at baseline (T0), at month 3 (T1), month 24 (T2), treatment pause period (T3), and at month 3 after fremanezumab re\u2010initiation (T4). The primary objective was to assess the \u2265\u200950% and\u2009\u2265\u200975% response rates at T4, compared to T3 and T2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Migraine relapsed in previous responders at T3, while fremanezumab re\u2010initiation was not equally effective, as evidenced by lower \u2265\u200950% response rates, mostly in CM. At T4, 6 (9.7%) previously responsive HFEM patients and 27 (31%) previously responsive CM patients failed to obtain \u2265\u200950% MMD\/MHD reduction, compared to T3. The rate of both HFEM and CM super\u2010responders, obtaining a\u2009\u2265\u200975% response at T3, also dropped at T4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Discontinuation of fremanezumab after month 24 leads to rising MMD\/MHDs. After fremanezumab re\u2010initiation, a relatively reduced effectiveness in the first 3 months might occur, compared with the pre\u2010fremanezumab cessation. Overall, our findings doubt the rationale behind mandated anti\u2010CGRP treatment pauses in migraine prophylaxis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.70327","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T07:44:06Z","timestamp":1755157446000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effects of Pausing and Re\u2010Initiating Fremanezumab After Continuous 24\u2010Month Treatment for Preventing Difficult\u2010To\u2010Treat Migraine: Prospective, Multicenter, Real\u2010World Data From the <scp>GRASP<\/scp> Study Group"],"prefix":"10.1111","volume":"32","author":[{"given":"Andreas A.","family":"Argyriou","sequence":"first","affiliation":[{"name":"Headache Outpatient Clinic; Neurology Department Agios Andreas General Hospital of Patras  Patras Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil V.","family":"Dermitzakis","sequence":"additional","affiliation":[{"name":"Headache Clinic Euromedica General Clinic  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Xiromerisiou","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine University of Thessaly  Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Chondrogianni","sequence":"additional","affiliation":[{"name":"Second Department of Neurology National and Kapodistrian University of Athens, School of Medicine, \u2018Attikon\u2019 University Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Foska","sequence":"additional","affiliation":[{"name":"Second Department of Neurology National and Kapodistrian University of Athens, School of Medicine, \u2018Attikon\u2019 University Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Soldatos","sequence":"additional","affiliation":[{"name":"Kalamata Headache Clinic  Kalamata Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Mavraki","sequence":"additional","affiliation":[{"name":"Neurology Department Democritus University of Thrace  Alexandroupolis Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Rikos","sequence":"additional","affiliation":[{"name":"404 Military Hospital  Larisa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pantelis","family":"Litsardopoulos","sequence":"additional","affiliation":[{"name":"Headache Outpatient Clinic; Neurology Department Agios Andreas General Hospital of Patras  Patras Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0640-3797","authenticated-orcid":false,"given":"Georgios","family":"Tsivgoulis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology National and Kapodistrian University of Athens, School of Medicine, \u2018Attikon\u2019 University Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Vikelis","sequence":"additional","affiliation":[{"name":"Glyfada Headache Clinic  Glyfada Greece"},{"name":"Greek Society of Migraine and Headache Patients  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.2002.00310.x"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12618"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00059.2021"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/6420425"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12179"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102418821662"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-018-0955-y"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709038"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.4853"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31946-4"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.15740"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12134526"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13020386"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-025-12911-w"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-022-01431-x"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-021-01363-y"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024211046617"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16203"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417738202"},{"key":"e_1_2_11_21_1","unstructured":"Teva Pharmaceuticals USA Inc. \u201cHighlights for Prescribing Information. 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