In real-world use, about half of migraine patients discontinued CGRP antibodies within 12 months, but those who stayed on treatment reduced their triptan use by about 5 doses per month.
~5 fewer triptans per monthMigraine patients on anti-CGRP antibodies reduced their monthly triptan consumption by approximately 5 dosage units, sustained over 15 months of follow-up.
What the researchers found
Among 624 new users of anti-CGRP mAbs (erenumab n=295, galcanezumab n=223, fremanezumab n=106), treatment persistence declined progressively: 69% at 6 months, 48% at 12 months, and only 6% at 15 months. Treatment switching between antibodies occurred in about 6% of patients at 15 months.
For patients with regular triptan use at baseline, mean monthly triptan consumption decreased by 4.4 dosage units at 3 months, 5.2 at 6 months, 5.5 at 9 months, 5.4 at 12 months, and 4.5 at 15 months. The patient population was predominantly female (78%) with a mean age of 49.2 years.
Why it matters
Clinical trials paint an optimistic picture of CGRP antibodies, but real-world use often tells a different story. The finding that half of patients discontinue within a year — despite these drugs being well-tolerated in trials — highlights the gap between trial settings and real clinical practice. At the same time, the consistent 5-dose reduction in monthly triptan use confirms these drugs do reduce migraine burden for those who stay on treatment.
How the study worked
This was a retrospective descriptive cohort study using the population-based administrative healthcare database of the Tuscany region, Italy. Patients with at least one anti-CGRP mAb dispensing between April 2019 and September 2021 were identified. Treatment persistence was analyzed using Kaplan-Meier curves over 15 months. Triptan consumption was measured as mean monthly dosage units in five consecutive 3-month windows and compared to the 6-month baseline period.
What this study cannot tell us
Administrative database studies cannot capture clinical outcomes like migraine frequency, severity, or patient satisfaction — only medication dispensing patterns. The low 15-month persistence rate (6%) may partly reflect Italian prescribing regulations that require treatment reassessment rather than true discontinuation for lack of efficacy. The study did not assess reasons for discontinuation. Triptan dispensing is a proxy for acute migraine episodes but may not perfectly correlate with headache frequency.
How to read the evidence
This is a retrospective population-based drug utilization study using administrative data. While it provides valuable real-world evidence on prescribing patterns, it cannot assess clinical outcomes directly. The study is descriptive rather than comparative and has no control group.
When this study was published
Published in 2023 with data from 2019–2021, this study captures the early real-world adoption period of CGRP antibodies in Italy. Prescribing patterns may have evolved since then.
The bigger picture
Real-world evidence studies like this one are essential for understanding how CGRP antibodies perform outside of carefully controlled clinical trials. The relatively high discontinuation rate observed in Italy may reflect prescribing policies (treatment reassessment requirements), cost, or unmet expectations. Understanding these patterns helps payers, clinicians, and patients set realistic expectations and identify factors that predict long-term treatment success.
Questions still open
- What are the primary reasons migraine patients discontinue CGRP antibodies within the first year — lack of efficacy, side effects, or administrative/cost barriers?
- Would persistence rates be higher in healthcare systems without mandatory reassessment requirements?
- Do patients who reduce triptan consumption on CGRP antibodies also experience improved quality of life and functional outcomes?
Common questions
How long do most migraine patients stay on CGRP antibodies?
Do CGRP antibodies reduce the need for other migraine medications?
Read the original research
Patterns of anti-CGRP mAbs use and variation of triptan consumption following treatment initiation: A descriptive drug utilization study in the Tuscany region, Italy.
Headache, 63(10), 1391-1402
Citation
Hyeraci, Giulia; Paoletti, Olga; Iannone, Luigi Francesco; Gini, Rosa; De Cesaris, Francesco; Geppetti, Pierangelo; Roberto, Giuseppe. (2023). Patterns of anti-CGRP mAbs use and variation of triptan consumption following treatment initiation: A descriptive drug utilization study in the Tuscany region, Italy.. Headache, 63(10), 1391-1402. https://doi.org/10.1111/head.14639