Abstract text (incl. figure legends and references)

Question

The aim of this analysis was to investigate the reasons for starting, stopping or switching treatment with calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) for migraine prevention in the European ObserVational survey of the Epidemiology, tReatment and Care of MigrainE (OVERCOME [EU]) study.

Methods

Data were obtained from a cross-sectional web‐based survey (2020-2021). Adult respondents fulfilled International Classification of Headache Disorders (ICHD)‐3 criteria for migraine or had a self-reported physician diagnosis. Respondents who ever used mAbs (erenumab, fremanezumab, galcanezumab) were considered in this analysis. Reasons to start, stop, or switch treatment were collected and summarised using descriptive statistics.

Results

Of 20,756 respondents, 2167 (10.4%) had used one or more mAbs. Among users of mAbs, the mean (standard deviation [SD]) age was 32.9 (10.4) years, 38.8% were female, and mean (SD) headache days per month was 3.4 (4.4). A total of 333 (15.4%) had switched and 1189 (54.9%) had stopped. No dominant reasons for starting mAbs could be identified (all reported as 15-20%). The 3 most common reasons for switching were recommendation from the doctor (27.0%) or a friend/family member (26.7%), and preference for the injector/needle used (26.7%). Reasons for stopping included improvement in headaches, recommendations from others, dosage, or tolerability. Only 11.5% stopped their medication because it was not working.

Conclusions

Reasons for starting mAbs were multiple, including physician recommendation and patient efficacy expectations. The finding that recommendation from others was the most frequent reason for switching highlights the importance of the patient-physician relationship and family support in the management of migraine.