Abstract text (incl. figure legends and references)

Question: how do patients evaluate a mandatory drug holiday during treatment with monoclonal antibodies targeting the CGRP pathway?

Methods: patients under treatment with monoclonal antibodies targeting the CGRP pathway were given a survey on how they evaluated this mandatory yearly drug holiday of 2 (erenumab) to 3 months (fremanezumab or galcanezumab).

Results: 79 adult patients either under treatment with erenumab, fremanezumab or galcanezumab were included. 75% deteriorated subjectively during the drug holiday. For 10% of the patients, this deterioration even required a quicker re-introduction of their preventive treatment. 22% had a stable disease or even a further improvement. 13% of the patients prolonged injection intervals in order to shorten the drug holiday. As for the timing of the deterioration, 47% had a worsening of their migraine already during the first month, while for 10% this only happened during the 2nd or 3rd month. For 11% of the patients the deterioration did only take place after 3 months, therefore the re-introduction of their preventive treatment could be postponed.

For 81% of the patients the mandatory drug holiday led to anxiety, of which 44% rated this anxiety as at least 'a lot'. On the other hand more than half of the patients (54%) found this drug holiday useful in order to assess the need for the continuation of their treatment, of which 23% even rated this as 'very useful'.

Conclusions: although a mandatory drug holiday is feasible and is considered useful for the majority of patients, it leads to both a swift aggravation of their migraine and substantial anxiety. A rigid and mandatory yearly drug holiday of 2-3 months seems not feasible for all migraine patients under treatment with a monoclonal antibody targeting the CGRP pathway.