{"title":"Late response to anti-CGRP therapy for migraine.","authors":"Oreste Marsico, Marta Lioi, Michele Trimboli","doi":"10.1080/17581869.2025.2550931","DOIUrl":null,"url":null,"abstract":"<p><p>Migraine is a debilitating neurological disorder affecting 1 billion people worldwide. Traditional preventive drugs showed low efficacy and poor tolerability. Monoclonal antibodies against calcitonin gene-related peptide (CGRP) or its receptors offer a new efficacious and safe therapeutic option for migraine patients. According to randomized controlled trials, these disease-specific drugs reduce migraine frequency by ≥ 50% within 3 months. However, real-world studies show that some patients require a longer treatment duration (6 or 12 months). This narrative review aimed to investigate the occurrence of late and ultra-late responses to anti-CGRP therapy, exploring their potential mechanisms and clinical significance. A literature search was performed [PubMed, Web of Science and Google Scholar; publications up to July 2025] to identify relevant studies for this narrative review. Across 10 real-world studies, a proportion of patients who did not respond at 3 months achieved a meaningful clinical response at later time points: some between 3 and 6 months (\"late responders\") and others between 6 and 12 months (\"ultra-late responders\"). Around one-third of initial non-responders improved by 6 months, and among those who remained non-responsive at that point, a further proportion benefited by 12 months. The pathophysiological mechanism behind late response is a field of investigation, and the interaction of anti-CGRPs on the process of central desensitization seems to be crucial. Our review underscores the need to extend treatment beyond the typical 3-month period to attain meaningful benefits from anti-CGRP therapies.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"745-751"},"PeriodicalIF":1.5000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pain management","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/17581869.2025.2550931","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/21 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Migraine is a debilitating neurological disorder affecting 1 billion people worldwide. Traditional preventive drugs showed low efficacy and poor tolerability. Monoclonal antibodies against calcitonin gene-related peptide (CGRP) or its receptors offer a new efficacious and safe therapeutic option for migraine patients. According to randomized controlled trials, these disease-specific drugs reduce migraine frequency by ≥ 50% within 3 months. However, real-world studies show that some patients require a longer treatment duration (6 or 12 months). This narrative review aimed to investigate the occurrence of late and ultra-late responses to anti-CGRP therapy, exploring their potential mechanisms and clinical significance. A literature search was performed [PubMed, Web of Science and Google Scholar; publications up to July 2025] to identify relevant studies for this narrative review. Across 10 real-world studies, a proportion of patients who did not respond at 3 months achieved a meaningful clinical response at later time points: some between 3 and 6 months ("late responders") and others between 6 and 12 months ("ultra-late responders"). Around one-third of initial non-responders improved by 6 months, and among those who remained non-responsive at that point, a further proportion benefited by 12 months. The pathophysiological mechanism behind late response is a field of investigation, and the interaction of anti-CGRPs on the process of central desensitization seems to be crucial. Our review underscores the need to extend treatment beyond the typical 3-month period to attain meaningful benefits from anti-CGRP therapies.
偏头痛是一种使人衰弱的神经系统疾病,影响着全世界10亿人。传统预防药物疗效低,耐受性差。抗降钙素基因相关肽(CGRP)或其受体的单克隆抗体为偏头痛患者提供了一种新的有效和安全的治疗选择。根据随机对照试验,这些疾病特异性药物在3个月内减少偏头痛频率≥50%。然而,现实世界的研究表明,一些患者需要更长的治疗时间(6或12个月)。本文旨在探讨抗cgrp治疗的晚期和超晚期反应的发生情况,探讨其潜在机制和临床意义。进行文献检索[PubMed, Web of Science and b谷歌Scholar;[截至2025年7月],以确定本叙述性综述的相关研究。在10项真实世界的研究中,在3个月时没有反应的患者中,有一部分在后来的时间点获得了有意义的临床反应:一些在3到6个月之间(“晚期反应者”),另一些在6到12个月之间(“超晚期反应者”)。大约三分之一的最初无反应者在6个月后得到改善,而在那些仍然无反应的人中,进一步的比例在12个月后受益。延迟反应背后的病理生理机制是一个研究领域,抗cgrps在中枢脱敏过程中的相互作用似乎是至关重要的。我们的综述强调需要延长治疗时间,超过典型的3个月,以获得抗cgrp治疗的有意义的益处。