Context
Ending anti-CGRP monoclonal antibody therapy results in more frequent migraine without a change in plasma free CGRP concentration
Calcitonin Gene-Related Peptide (CGRP) is a key neurotransmitter involved in the pathogenesis of migraine. Over the past decade, CGRP has emerged as a particular and effective therapeutic target in migraine. Monoclonal antibodies (mAbs) directed either against the CGRP molecule itself or its receptor (CGRP-R) have been developed and approved for migraine prophylaxis, particularly in patients experiencing four or more monthly migraine days (MMD). Among these, erenumab (targeting the CGRP receptor), as well as galcanezumab and fremanezumab (targeting CGRP directly), have demonstrated strong efficacy and good tolerability.
CGRP plasma concentrations have also been investigated as potential biomarkers of migraine activity. Studies have shown that CGRP levels rise during migraine attacks and normalize following the administration of acute treatments such as antimigraine drugs. This reinforces the peptide’s central role in migraine pathogenesis and underscores the clinical relevance of therapies targeting the CGRP pathway.
In 2019, the European Headache Federation issued expert consensus guidelines recommending that CGRP(-R) mAb therapy be administered for a duration of 6 to 12 months, followed by a treatment discontinuation. However, accumulating real-world evidence has shown that stopping these therapies often leads to a significant and continuing increase in migraine frequency.
Thanks to Bertin’s human CGRP ELISA kit (#A05481), Raffaelli and her team compared CGRP plasma concentrations at the end and after discontinuation of CGRP-R or CGRP mAb treatment. They also compared migraine frequency at both timepoints. Finally, they assessed whether patients previously treated with these antibodies showed different CGRP levels compared to those without any preventive therapy.
