{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:40:35Z","timestamp":1784025635972,"version":"3.55.0"},"reference-count":13,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Real-world persistence of traditional oral migraine preventive medications is low in routine care. Prior large claims-based analyses demonstrated early discontinuation of oral prophylaxis, but such datasets neither included modern preventive options such as monoclonal antibodies (mAB) against calcitonin-gene-related peptide (CGRP), nor were able to capture clinically validated reasons for discontinuation. The primary aim was to compare real-world treatment persistence and discontinuation reasons due to adverse drug reactions (ADRs) or insufficient efficacy among three preventive therapy classes: subcutaneous CGRP mAB and oral high- (HEVP) and low-evidence preventive medications (LEVP). A secondary aim was to examine persistence patterns of individual substances within the HEVP cohort. Methods: This exploratory observational study used depersonalized real-world data from the German Pain e-Registry (GPeR), a national multicenter clinical registry. Persistence trajectories were evaluated over six months, together with cumulative proportions of ADR-related and inefficacy-related discontinuations. Pairwise comparisons across the three cohorts based on chi-square analyses, odds ratios, relative risks, effect sizes, and numbers needed to harm. Results: At six months, persistence was highest for CGRP monoclonal antibodies at 89.4%, compared with 43.0% for LEVP and 34.0% for HEVP (all p &lt; 0.001). ADR-related discontinuation occurred in 7.0% with CGRP vs. 35.7\/44.5% with LEVP\/HEVP, and discontinuations due to insufficient efficacy occurred in 3.6% with CGRP vs. 21.3\/21.5% with LEVP\/HEVP, without influence of sex or migraine frequency. Substance-level analysis within HEVP showed the steepest early attrition for tricyclic antidepressants, followed by beta-blockers, with comparatively more favorable though still suboptimal persistence for topiramate and flunarizine. Conclusions: Real-world treatment persistence is markedly higher with CGRP mAB than with HEVP\/LEVP. Oral preventives show high discontinuation rates due to both ADR and insufficient efficacy, indicating substantial limitations in real-world applicability. These findings highlight the clinical relevance of a modern mechanism-based migraine prevention with CGRP mAB.<\/jats:p>","DOI":"10.3390\/jcm15051985","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T10:31:14Z","timestamp":1772706674000},"page":"1985","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Treatment Persistence in Migraine Prophylaxis Comparing CGRP Monoclonal Antibodies vs. High-\/Low-Evidence Conventional Oral Preventives\u2014A Comparative Real-World Evidence Study of Depersonalized Data of the German Pain e-Registry"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7165-9492","authenticated-orcid":false,"given":"Michael A.","family":"\u00dcberall","sequence":"first","affiliation":[{"name":"IFNAP\u2014Private Institute of Neurological Sciences, O. Meany-MDPM GmbH, Nordostpark 51, 90411 N\u00fcrnberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8619-2433","authenticated-orcid":false,"given":"Philipp C. G.","family":"M\u00fcller-Schwefe","sequence":"additional","affiliation":[{"name":"Interdisciplinary Center for Pain & Palliative Care Medicine, Schillerplatz 8\/1, 73033 G\u00f6ppingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"K\u00fcster","sequence":"additional","affiliation":[{"name":"Interdisciplinary Center for Pain & Palliative Care Medicine, 53177 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Peter","family":"Jansen","sequence":"additional","affiliation":[{"name":"Pain Medicine Center Berlin, Sch\u00f6nhauser Allee 172 a, 10435 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1212\/01.wnl.0000252808.97649.21","article-title":"Migraine prevalence, disease burden, and the need for preventive therapy","volume":"68","author":"Lipton","year":"2007","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/S0140-6736(18)30478-1","article-title":"Migraine","volume":"391","author":"Dodick","year":"2018","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1212\/WNL.0b013e3182535d20","article-title":"Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society","volume":"78","author":"Silberstein","year":"2012","journal-title":"Neurology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1177\/0333102416678382","article-title":"Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: A retrospective claims analysis","volume":"37","author":"Hepp","year":"2017","journal-title":"Cephalalgia"},{"key":"ref_5","first-page":"22","article-title":"Systematic review of migraine prophylaxis adherence and persistence","volume":"20","author":"Hepp","year":"2014","journal-title":"J. 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