2026 Volume 53 Issue 1 Pages 108-114
Objective: CGRP-related monoclonal antibodies have demonstrated efficacy in the preventive treatment of migraine. However, the extent to which patients continue treatment for 6 to 12 months in real-world clinical practice, and the clinical characteristics of patients who discontinue treatment, remain insufficiently clarified. This study evaluated treatment continuation and injection attainment rates, reasons for discontinuation, and clinical indices among patients with migraine who initiated CGRP-related monoclonal antibodies in a real-world outpatient setting.
Methods： We retrospectively reviewed １８４ patients with migraine who initiated CGRP-related monoclonal antibodies at our clinic between May 2021 and March 2026. We assessed the rate of treatment continuation for at least 6 months and the proportion of patients who reached twelve injections, as well as reasons for discontinuation and clinical indices, including monthly headache days (MHD) , Headache Impact Test-6 (HIT-6) scores, and patient satisfaction.
Results: Among all treated patients, 108 of 184 patients reached six or more injections, and the six-injection attainment rate among patients evaluable at 6 months was 68.4%. Among patients evaluable at 12 months, the twelve-injection attainment rate was 31.2%, indicating that long-term continuation was not achieved in many real-world cases. Among patients who discontinued or changed treatment before twelve injections, those who discontinued after sufficient improvement showed reductions in MHD from 13.0 to 3.8 days and HIT-6 scores from 62.7 to 47.7, and 93.8% reported high satisfaction. In contrast, patients who discontinued or changed treatment because of insufficient efficacy had a higher baseline MHD of 21.1 days and persistent headache burden at the final evaluation, with an MHD of 16.4 days and a HIT-6 score of 59.6. The mean number of injections was 6.1 in the sufficient-improvement discontinuation group and 5.2 in the insufficient-efficacy group.
Conclusions: Patients who discontinue CGRP-related monoclonal antibody treatment should be evaluated according to the reasons for discontinuation, treatment duration, and clinical status at discontinuation. In patients with a high headache burden, treatment goals should be shared in advance, and efficacy should be assessed after an adequate continuation period whenever feasible, considering the possibility of late response.
