Persistence and Reasons for Treatment Discontinuation of Anti-CGRP Therapies in Migraine Prophylaxis: A Systematic Review and Meta-analysis of Real-World Studies
Pain and Therapy, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Derleme
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s40122-026-00895-y
- Dergi Adı: Pain and Therapy
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Anahtar Kelimeler: Eptinezumab, Erenumab, Fremanezumab, Galcanezumab, Gepants, Headache, Pain
- Yozgat Bozok Üniversitesi Adresli: Evet
Özet
Introduction: Anti-calcitonin gene-related peptide (anti-CGRP) therapies have become a mainstay of migraine prophylaxis. In routine care, treatment persistence and the reasons patients discontinue are indicators of long-term effectiveness, tolerability, and acceptability, but the available real-world evidence is fragmented across settings. We aimed to synthesize treatment persistence at 3, 6, and 12 months and to summarize the documented reasons for discontinuation. Methods: This systematic review and meta-analysis (PROSPERO CRD420261298053) searched Embase (via Ovid) and PubMed for real-world studies with a clinical follow-up of adults receiving an anti-CGRP therapy for migraine prophylaxis with longitudinal follow-up. Persistence, defined as the proportion of patients remaining on treatment from initiation, was pooled using random-effects meta-analysis of proportions. Reasons for discontinuation were pooled descriptively. Exploratory subgroup analyses examined migraine type, drug class, and individual monoclonal antibody. Results: Fifty-three studies were included. Pooled persistence was 93.3% (95% CI 90.2–95.9) at 3 months, 84.2% (80.4–87.6) at 6 months and 76.2% (69.7–82.2) at 12 months, with substantial heterogeneity throughout (I2 82–93%). Among 1242 documented discontinuation events, lack of efficacy was the leading reason (63.7%), followed by adverse events or poor tolerability (15.1%). Persistence did not differ significantly by migraine type or between individual monoclonal antibodies. Atogepant showed lower 3-month persistence than monoclonal antibodies (83.5% vs. 94.2%; p = 0.013), although data were limited to early follow-up. Conclusions: Approximately three-quarters of patients remain on anti-CGRP therapy at 1 year, with most discontinuation occurring within the first six months and driven mainly by perceived lack of efficacy rather than tolerability. Marked between-study heterogeneity warrants cautious interpretation and more standardized reporting of persistence in future real-world studies.