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Romero Del Rincón C, Gonzalez-Martinez A, Quintas S, García-Azorín D, Fernández Lázaro I, Guerrero-Peral AL, Gonzalez Osorio Y, Santos-Lasaosa S, González Oria C, Sánchez Rodríguez N, Iglesias Díez F, Echavarría Íñiguez A, Gil Luque S, Huerta-Villanueva M, Campoy Díaz S, Muñoz-Vendrell A, Lozano Ros A, Sánchez-Soblechero A, Velasco Juanes F, Kortazar-Zubizarreta I, Echeverría A, Rodríguez-Vico J, Jaimes Sánchez A, Gómez García A, Morollón Sánchez-Mateos N, Belvis R, Navarro Pérez MP, García-Moncó JC, Álvarez Escudero MR, Montes N, Gago-Veiga AB. RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine. Eur J Neurol 2024; 31:e16203. [PMID: 38270379 DOI: 10.1111/ene.16203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND PURPOSE According to the latest European guidelines, discontinuation of monoclonal antibodies against calcitonin gene-related peptide (anti-CGRP MAb) may be considered after 12-18 months of treatment. However, some patients may worsen after discontinuation. In this study, we assessed the response following treatment resumption. METHODS This was a prospective study conducted in 14 Headache Units in Spain. We included patients with response to anti-CGRP MAb with clinical worsening after withdrawal and resumption of treatment. Numbers of monthly migraine days (MMD) and monthly headache days (MHD) were obtained at four time points: before starting anti-CGRP MAb (T-baseline); last month of first treatment period (T-suspension); month of restart due to worsening (T-worsening); and 3 months after resumption (T-reintroduction). The response rate to resumption was calculated. Possible differences among periods were analysed according to MMD and MHD. RESULTS A total of 360 patients, 82% women, with a median (interquartile range [IQR]) age at migraine onset of 18 (12) years. The median (IQR) MHD at T-baseline was 20 (13) and MMD was 5 (6); at T-suspension, the median (IQR) MHD was 5 (6) and MMD was 4 (5); at T-worsening, the median (IQR) MHD was 16 (13) and MMD was 12 (6); and at T-reintroduction, the median (IQR) MHD was 8 (8) and MHD was 5 (5). In the second period of treatment, a 50% response rate was achieved by 57.4% of patients in MHD and 65.8% in MMD. Multivariate models showed significant differences in MHD between the third month after reintroduction and last month before suspension of first treatment period (p < 0.001). CONCLUSION The results suggest that anti-CGRP MAb therapy is effective after reintroduction. However, 3 months after resumption, one third of the sample reached the same improvement as after the first treatment period.
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Affiliation(s)
- Celia Romero Del Rincón
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Alicia Gonzalez-Martinez
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Sonia Quintas
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - David García-Azorín
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Iris Fernández Lázaro
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Angel Luis Guerrero-Peral
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | | | | | | | | | | | | | - Sendoa Gil Luque
- Headache Unit, Hospital Clínico Universitario de Burgos, Burgos, Spain
| | - Mariano Huerta-Villanueva
- Neurology Department of Neurology, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
- Servicio de Neurología, Unidad de Cefaleas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Campoy Díaz
- Neurology Department of Neurology, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
- Servicio de Neurología, Unidad de Cefaleas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Muñoz-Vendrell
- Servicio de Neurología, Unidad de Cefaleas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Izaro Kortazar-Zubizarreta
- Department of Neurology, Hospital de Álava, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Spain
| | - Amaya Echeverría
- Department of Neurology, Hospital de Álava, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Spain
| | | | | | | | | | - Robert Belvis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Nuria Montes
- Unidad de Metodología, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Servicio de Reumatología, Hospital Universitario La Princesa, Madrid, Spain
- Plant Physiology, Pharmaceutical and Health Sciences Department, Faculty of Pharmacy, Universidad San Pablo-CEU, CEU-Universities, Boadilla del Monte, Spain
| | - Ana Beatriz Gago-Veiga
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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