Super- and absolute responders to anti-cgrp monoclonal antibodies in migraine: A one-year multicenter, prospective,...

To assess the frequency of super-responders (≥ 75% reduction in migraine frequency) and absolute responders (100% reduction) to monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) after one year of treatment in individuals with high frequency (HFEM) or chronic migraine (CM).

This multicenter (n = 16), prospective, real-life study, involved consecutive adults with HFEM or CM and ≥ 3 prior preventive failures, receiving subcutaneous anti-CGRP mAbs for ≥ 12 months. Co-primary endpoints were the 12-month rates of super- and absolute responders. Secondary endpoints included subgroup analyses by migraine type and timing of response, categorized as early (≤ 3 months), late (> 3-6 month), or ultra-late (> 6-12 month).

572 patients completed 12 months of treatment: 70.0% achieved super-response (HFEM: 64.9%; CM: 71.8%) and 23.4% absolute response (HFEM: 29.9%; CM: 21.0%). Both outcomes exhibited a time-dependent progression. Among super-responders (n = 400), 29.4% were early, 22.6% late, and 18.0% ultra-late. Among absolute responders (n = 134), 3.1% responded early, 3.7% late, and 16.6% ultra-late.

One year of anti-CGRP mAbs therapy yields a ≥ 75% response in over two-thirds and a 100% response in nearly one-quarter of patients with HFEM or CM and prior treatment failures. Most super- and absolute responses emerge after six months, supporting long-term continuation treatment.