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Background <p>Migraine is common in people with multiple sclerosis (PwMS) and substantially contributes to disability and impaired quality of life. Although (CGRP)–targeting therapies have reshaped migraine prevention, evidence on their use in PwMS remains scarce, particularly in people receiving concomitant disease-modifying therapies (DMTs).</p> Methods <p>We retrospectively collected data from 17 Italian multiple sclerosis (MS) centers on adult PwMS with comorbid migraine treated with anti-CGRP monoclonal antibodies or gepants in addition to stable DMTs. Monthly headache days (MHDs) and total number of analgesics per month were compared between treatment initiation and last follow-up. MS activity was assessed through clinical relapses, Expanded Disability Status Scale (EDSS), and MRI findings. A ≥ 50% reduction in MHDs defined treatment response. Multivariate regression models were used to explore predictors of response to anti-CGRP therapies.</p> Results <p>Fifty-four patients were included (46 women; mean age 42.3 years; 85% relapsing MS). Baseline MHDs averaged 19.87 ± 6.97 and declined to 11.40 ± 9.35 at follow-up (<i>p</i> &lt; 0.001), with a parallel decrease in analgesic use (<i>p</i> &lt; 0.001). Responder rate at the last follow-up was 53.7%. MS disease activity remained stable, with no significant changes in relapse rate, EDSS score, or MRI activity. Higher baseline headache burden was associated with greater reduction in MHDs (β=+0.685, <i>p</i> &lt; 0.001), whereas longer MS duration predicted poorer response (OR1.43, 95%CI 1.06–1.92, <i>p</i> = 0.016). Mild adverse events occurred in four patients (7%), without treatment discontinuation.</p> Conclusion <p>Anti-CGRP pathway therapies provided meaningful migraine improvement in PwMS while maintaining MS stability. MS disease duration and baseline headache frequency may influence therapeutic response to anti-CGRP drugs in PwMS.</p> Clinical trial number <p>Not applicable</p>

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Predictive factors of response to anti-CGRP pathway drugs in people with multiple sclerosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月3日

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  • Viviana Nociti,
  • Simone Cesarano,
  • Marina Romozzi,
  • Rocco Totaro,
  • Maria Albanese,
  • Alfonsina Casalena,
  • Pietro Annovazzi,
  • Roberta Fantozzi,
  • Carla Tortorella,
  • Marco Vercellino,
  • Luigi Francesco Iannone,
  • Giovanna De Luca,
  • Valentina Tomassini,
  • Massimiliano Di Filippo,
  • Lorena Lorefice,
  • Giorgia Teresa Maniscalco,
  • Damiano Paolicelli,
  • Federica Pinardi,
  • Valentina Torri Clerici,
  • Girolama Alessandra Marfia,
  • Diego Centonze,
  • Claudio Marcello Solaro,
  • Claudio Gasperini,
  • Paolo Calabresi,
  • Massimiliano Mirabella,
  • Catello Vollono,
  • Eleonora Cocco,
  • Francesca Pistoia

摘要

Background

Migraine is common in people with multiple sclerosis (PwMS) and substantially contributes to disability and impaired quality of life. Although (CGRP)–targeting therapies have reshaped migraine prevention, evidence on their use in PwMS remains scarce, particularly in people receiving concomitant disease-modifying therapies (DMTs).

Methods

We retrospectively collected data from 17 Italian multiple sclerosis (MS) centers on adult PwMS with comorbid migraine treated with anti-CGRP monoclonal antibodies or gepants in addition to stable DMTs. Monthly headache days (MHDs) and total number of analgesics per month were compared between treatment initiation and last follow-up. MS activity was assessed through clinical relapses, Expanded Disability Status Scale (EDSS), and MRI findings. A ≥ 50% reduction in MHDs defined treatment response. Multivariate regression models were used to explore predictors of response to anti-CGRP therapies.

Results

Fifty-four patients were included (46 women; mean age 42.3 years; 85% relapsing MS). Baseline MHDs averaged 19.87 ± 6.97 and declined to 11.40 ± 9.35 at follow-up (p < 0.001), with a parallel decrease in analgesic use (p < 0.001). Responder rate at the last follow-up was 53.7%. MS disease activity remained stable, with no significant changes in relapse rate, EDSS score, or MRI activity. Higher baseline headache burden was associated with greater reduction in MHDs (β=+0.685, p < 0.001), whereas longer MS duration predicted poorer response (OR1.43, 95%CI 1.06–1.92, p = 0.016). Mild adverse events occurred in four patients (7%), without treatment discontinuation.

Conclusion

Anti-CGRP pathway therapies provided meaningful migraine improvement in PwMS while maintaining MS stability. MS disease duration and baseline headache frequency may influence therapeutic response to anti-CGRP drugs in PwMS.

Clinical trial number

Not applicable