{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:47:04Z","timestamp":1775148424830,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Objective: This retrospective, intention-to-treat real-world study, designed by the Greek Research Alliance for the Study of headache and Pain (GRASP) sought to compare the effectiveness and safety of anti-CGRP monoclonal antibodies (anti-CGRP Mabs) to topiramate in preventing migraine. Patients and methods: Patients received either fremanezumab, erenumab, galcanezumab, eptinezumab, or topiramate for at least six months. Outcomes included reductions in monthly headache days (MHDs), \u226550% and \u226575% responder rates, monthly acute medication intake (MAI), MHDs with peak headache intensity \u22655 on VAS, migraine-related disability (MIDAS, HIT-6), quality of life (EQ-VAS), discontinuation rates and safety. Results: We included 409 migraine patients (median age 45.2 years), predominantly female (80%) and mostly with long-standing disease and high baseline burden. After six months, all treatments reduced MHDs. Mean MHDs decreased by \u22127.8 days with anti-CGRP Mabs versus \u22123.8 days with topiramate (p &lt; 0.001). Higher \u226550% and \u226575% responder rates were observed across all anti-CGRP agents, compared to topiramate. Anti-CGRP Mabs also achieved greater reductions in moderate\/severe MHDs, MAI, disability metrics, and superior QOL gains. Among the CGRP-targeted therapies, slight differences in effectiveness outcomes were present, though failing to demonstrate any specific superiority. Safety was favorable for anti-CGRP Mabs, whereas topiramate showed substantially higher adverse events and discontinuations. Conclusions: Anti-CGRP Mabs were more effective, produced greater reductions in disability and higher improvements quality-of-life metrics and were better tolerated than topiramate. Differences among individual anti-CGRP agents were modest and unlikely to represent a clinically meaningful superiority, supporting a class-wide benefit vs. topiramate in migraine prevention both in terms of effectiveness and safety.<\/jats:p>","DOI":"10.3390\/neurolint18040067","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T15:14:43Z","timestamp":1775142883000},"page":"67","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing the Efficacy and Safety of Anti-CGRP Monoclonal Antibodies Versus Topiramate for Migraine Prophylaxis: Six-Month, Real-World, Intention-to-Treat Retrospective Evidence from the GRASP Study Group"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2715-7898","authenticated-orcid":false,"given":"Michail","family":"Vikelis","sequence":"first","affiliation":[{"name":"Glyfada Headache Clinic, 16675 Glyfada, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2346-5057","authenticated-orcid":false,"given":"Dimitrios","family":"Rikos","sequence":"additional","affiliation":[{"name":"Neurology Department, 404 Military Hospital, 41222 Larisa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2131-7114","authenticated-orcid":false,"given":"Andreas A.","family":"Argyriou","sequence":"additional","affiliation":[{"name":"Headache Outpatient Clinic, Neurology Department, Agios Andreas General Hospital of Patras, 26335 Patras, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiotis","family":"Soldatos","sequence":"additional","affiliation":[{"name":"Kalamata Headache Clinic, 24133 Kalamata, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9640-8728","authenticated-orcid":false,"given":"Christos","family":"Tsironis","sequence":"additional","affiliation":[{"name":"Headache Outpatient Clinic, Department of Neurology, University Hospital of Ioannina, 46100 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanouil","family":"Giakoumakis","sequence":"additional","affiliation":[{"name":"NeuroCrete Headache Clinic, 71303 Irakleio, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgia","family":"Xiromerisiou","sequence":"additional","affiliation":[{"name":"Private Institute of Preventive Neurology and Brain Health-Mindful Mind, 55133 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8315-5846","authenticated-orcid":false,"given":"Maria","family":"Chondrogianni","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, \u201cAttikon\u201d University Hospital, 12461 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aikaterini","family":"Foska","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, \u201cAttikon\u201d University Hospital, 12461 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Koutsokera","sequence":"additional","affiliation":[{"name":"Headache Outpatient Clinic, Neurology Department, Thriasion General Hospital, 19300 Elefsina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Notas","sequence":"additional","affiliation":[{"name":"Headache Outpatient Clinic, Saint Luke\u2019s Hospital, 55236 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8523-361X","authenticated-orcid":false,"given":"Eleni","family":"Mavraki","sequence":"additional","affiliation":[{"name":"Headache Outpatient Clinic, Department of Neurology, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9275-0076","authenticated-orcid":false,"given":"Emmanouil V.","family":"Dermitzakis","sequence":"additional","affiliation":[{"name":"Headache Outpatient Clinic, General Clinic, 54645 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1016\/S0140-6736(20)32162-0","article-title":"Migraine: Disease characterisation, biomarkers, and precision medicine","volume":"397","author":"Ashina","year":"2021","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s40120-023-00438-z","article-title":"Unmet Needs in Preventive Treatment of Migraine","volume":"12","author":"Bentivegna","year":"2023","journal-title":"Neurol. 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Res."}],"container-title":["Neurology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/4\/67\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T15:46:45Z","timestamp":1775144805000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/4\/67"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":32,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["neurolint18040067"],"URL":"https:\/\/doi.org\/10.3390\/neurolint18040067","relation":{},"ISSN":["2035-8377"],"issn-type":[{"value":"2035-8377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}