Erenumab Discontinuation After 12-Month Treatment A Multicentric, Observational Real-Life Study

Objective To assess migraine outcome after 12-month treatment with erenumab and compare patients who underwent 3-month erenumab discontinuation following the first treatment cycle with those who continued monthly administrations. Methods This is a multicentric observational study in patients with migraine in treatment with erenumab. After a full 12-month treatment cycle (T-12), patients could either continue or discontinue erenumab for at least 3 months. Patients who underwent treatment discontinuation were assessed after 3 months (T-15) to decide whether to start retreatment. Patients were then assessed following at T-16 and T-18. Results Thirty consecutive patients were enrolled. Nineteen patients underwent treatment suspension at T-12 up to T-15, whereas 11 continued prophylaxis. At T-15, patients who discontinued treatment documented significantly more migraine days (17.06 +/- 6.5 vs 4.8 +/- 2.5; p < 0.0001) and analgesics consumption (14.8 +/- 9.2 vs 4.6 +/- 2.5; p = 0.002), compared with those who continued treatment. After retreatment, at T-16, patients who had previously undergone discontinuation documented a significant improvement in terms of migraine days (9.01 +/- 4.4 vs 17.06 +/- 6.5; p < 0.0001) and analgesics consumption (9.6 +/- 7.3 vs 14.8 +/- 9.2; p = 0.004). Such improvement was even greater at T-18, comparable with T-12. Conclusion After treatment discontinuation, a rapid migraine worsening was found, despite the high clinical response during treatment and at retreatment, which might be secondary to an untimely interruption of a potentially disease-modifying pharmacologic intervention. Although clinical improvement was documented after retreatment, given the high frequency and degree of worsening during discontinuation, it seems plausible-even ethical-to re-evaluate current timing of discontinuation.