Anti-CGRP drugs show high initial persistence in Japan but only 36.5% of migraine patients continue at 12 months | Research

The takeaway

Japanese claims analysis shows CGRP mAb persistence starts high (85.6% at 3 months) but declines to 36.5% at 12 months, while oral migraine preventives persist at only 21.7%, with substantial unmet needs across all treatment classes.

36.5% CGRP mAb persistence at 1 year
Despite high initial persistence (85.6%), nearly two-thirds of Japanese migraine patients discontinue CGRP mAbs within 12 months—highlighting unmet treatment needs

What the researchers found

CGRP mAb persistence: 85.6% (3m) → 36.5% (12m). OMPM persistence: 49.7% (3m) → 21.7% (12m). Antiepileptics: highest OMPM persistence (27.0%). Switching: 22.9% OMPM, 19.7% CGRP mAb at 12m. Only 20% OMPM switchers → CGRP mAb. Comorbidities: ~50% non-migraine headache, 26-31% mental health, 29% sleep.

Why it matters

Low 12-month persistence across all migraine preventives—including CGRP mAbs—highlights that current treatments do not adequately meet patient needs. New approaches are needed to improve long-term migraine management.

How the study worked

Retrospective JMDC claims analysis (April 2021-January 2024). Treatment-naïve OMPM (12,750) and CGRP mAb (3,280) initiators. 60-day gap = discontinuation.

What this study cannot tell us

Claims data cannot capture reasons for discontinuation. Japanese healthcare system may differ from others. 60-day gap definition may misclassify some patients. Short post-CGRP-mAb era in Japan.

How to read the evidence

Large retrospective claims analysis with 16,030 patients. Good real-world persistence data.

When this study was published

Published in 2025; data April 2021-January 2024.

The bigger picture

Despite being the most effective migraine preventives available, CGRP mAbs still lose nearly two-thirds of patients within a year. This persistence gap drives the need for even better migraine treatments and improved patient support.

Questions still open

Why do patients stop CGRP mAbs despite initial effectiveness?
Would CGRP mAb persistence improve with better patient support?
Should CGRP mAbs be offered earlier to prevent OMPM treatment failure?

Common questions

Do people stay on CGRP migraine drugs long-term?

In Japan, 85.6% of patients on CGRP antibodies were still taking them at 3 months, but this dropped to only 36.5% at 1 year. For oral migraine preventives, persistence was even lower (21.7% at 1 year). This shows most migraine patients do not stay on their initial preventive treatment.

Why do patients stop migraine preventives?

This study could not determine specific reasons (it used insurance claims data), but possible factors include insufficient effectiveness, side effects, cost, injection burden for CGRP mAbs, or migraine improvement leading patients to stop. The high comorbidity rates (50% with other headaches, 30% with mental health/sleep issues) suggest many patients have complex needs.

Read the original research

Real world treatment patterns and unmet needs of migraine preventive treatments in Japan: JMDC claims analysis.

Current medical research and opinion, 41(8), 1559-1571

View on PubMed ↗Publisher’s paper ↗

Citation

Takeshima, Takao; Ahmadyar, Gina; Duan, Molly; Yamazaki, Toru; Inoue, Shoko; Nishimura, Chiori. (2025). Real world treatment patterns and unmet needs of migraine preventive treatments in Japan: JMDC claims analysis.. Current medical research and opinion, 41(8), 1559-1571. https://doi.org/10.1080/03007995.2025.2552277