Anti-CGRP monoclonal antibodies remained effective and safe for resistant migraine over 24 months, but patients who overuse acute medications responded worse.
61% responder rateMore than half of resistant migraine patients achieved at least 50% fewer monthly migraine days at 6 months on anti-CGRP therapy
What the researchers found
Anti-CGRP monoclonal antibodies reduced monthly migraine days, disability scores (MIDAS and HIT-6), and acute medication intake over a 24-month period in 120 resistant migraine patients. At 6 and 12 months, 61% and 57% of patients respectively achieved at least 50% reduction in monthly migraine days. Medication overuse at baseline was identified as a significant negative predictor of treatment response (OR 0.23, 95% CI 0.07–0.74, p = 0.014).
Why it matters
Most anti-CGRP clinical trials last 3–6 months. This study provides rare 2-year real-world data confirming these peptide-targeting antibodies maintain their effectiveness over time. The finding that medication overuse predicts poor response gives clinicians a practical screening tool before starting expensive biologic therapy.
The numbers in context
- 120 patients tracked over 24 months
- 61% were 50% responders at 6 months
- 57% were 50% responders at 12 months
- Medication overuse: OR 0.23 (95% CI 0.07-0.74, p = 0.014) for non-response
- Significant reductions in MIDAS, HIT-6, monthly migraine days, and monthly acute medication use across all time points
How the study worked
Single-center retrospective study conducted from December 2019 to June 2023. Patients completed headache diaries tracking monthly migraine days, acute medication intake, and adverse events. Patient-reported outcomes included MIDAS and HIT-6 questionnaires. Responders (≥50% reduction in monthly migraine days) were compared to non-responders using logistic regression.
Who was studied
120 adults with resistant migraine at a single center in Spain
What this study cannot tell us
Single-center retrospective design limits generalizability. No control group or placebo comparison. Relatively small sample (120 patients). The study did not compare the three antibodies head-to-head. Patient self-reporting of migraine days introduces recall bias.
How to read the evidence
Rated moderate: real-world retrospective study with 120 patients and 24-month follow-up, but lacks randomization and a control group.
When this study was published
Published in 2024 with data collected through June 2023. Reflects current clinical practice with all three available anti-CGRP antibodies.
The bigger picture
CGRP-targeting therapies represent a major advance in migraine treatment. Long-term real-world data like this helps confirm that the benefits seen in clinical trials translate to sustained relief in everyday practice, especially for patients without medication overuse.
Questions still open
- Would addressing medication overuse before starting anti-CGRP therapy improve response rates?
- Do the three anti-CGRP antibodies differ in long-term effectiveness?
- What happens to treatment response beyond two years?
Common questions
Do anti-CGRP migraine antibodies keep working long-term?
Who responds best to anti-CGRP therapy?
Read the original research
Anti‑CGRP monoclonal antibodies in resistant migraine: preliminary real-world effectiveness and clinical predictors of response at two years.
International journal of clinical pharmacy, 46(6), 1317-1326
Citation
Pons-Fuster, E; Lozano-Caballero, O; Martín-Balbuena, S; Lucas-Ródenas, C; Mancebo-González, A; De Gorostiza-Frías, I; González-Ponce, C M. (2024). Anti‑CGRP monoclonal antibodies in resistant migraine: preliminary real-world effectiveness and clinical predictors of response at two years.. International journal of clinical pharmacy, 46(6), 1317-1326. https://doi.org/10.1007/s11096-024-01758-2