Erenumab Discontinuation Following 12-Month Treatment: A Multicentric Observational Real-Life Study

ABSTRACT OBJECTIVE: to assess migraine outcome following twelve months treatment with erenumab and compare patients who underwent three months erenumab discontinuation following the first treatment cycle to those who continued monthly administrations. METHODS: this is a multicentric observational study in migraine patients in treatment with erenumab. Following a full 12 months treatment cycle (T12) patients could either continue or discontinue erenumab for at least three months. Patients who underwent treatment discontinuation were assessed following three months (T15) to decide whether to start re-treatment. Patients were then assessed following at T16 and T18. RESULTS: Thirty consecutive patients were enrolled. Nineteen patients underwent treatment suspension at T12 up to T15, whereas 11 continued phrophylaxis. At T15, patients who discontinued treatment documented significantly more migraine days (17.06±6.5 vs 4.8±2.5; p CONCLUSIONS: Following treatment discontinuation, a rapid migraine worsening was found, despite the high clinical response during treatment and at re-treatment, which might be secondary to an untimely interruption of a potentially disease modifying pharmacological intervention. Although clinical improvement was documented following retreatment, given the high frequency and degree of worsening during discontinuation, it seems plausible – even ethical – to re-evaluate current timing of discontinuation. CLASSIFICATION OF EVIDENCE: This study provides class III evidence that people with migraine discontinuing erenumab migraine prophylaxis after 12 months were more likely to have an increase in non-responder status and migraine days than those who continued treatment.