PRIME-Teen—Treatment Persistence and Outcomes Associated with CGRP Monoclonal Antibodies Compared with Conventional Oral Preventives in Adolescents with High-Burden Migraine: An Exploratory Real-World Analysis from the German Pain e-Registry (GPeR)

TL;DR

This study compares CGRP monoclonal antibodies with traditional oral treatments for migraines in adolescents, finding better persistence and outcomes with CGRP.

Contribution

Provides real-world comparative data on CGRP monoclonal antibodies versus conventional oral preventives in adolescents with high-burden migraine.

Findings

CGRP-mAb episodes had 88.2% 6-month persistence compared to 30.6% for conventional preventives.

CGRP-mAb reduced monthly migraine days more effectively than conventional treatments.

CGRP-mAb showed broader improvements in secondary outcomes like disability and sick leave.

Abstract

Background: Adolescent migraine is highly prevalent and associated with substantial functional and psychosocial burden. Conventional oral preventives are widely used off-label with limited pediatric efficacy and frequent tolerability problems. Real-world data on calcitonin gene-related peptide (CGRP) monoclonal antibodies in adolescents are scarce. Methods: We conducted an exploratory, retrospective cohort analysis of depersonalized routine-care data from adolescents with migraine in the German Pain e-Registry. Patients were eligible if they had at least one 6-month episode with high-evidence conventional oral preventives (HECP) and one 6-month episode with a CGRP monoclonal antibody (CGRP-mAb), each with baseline and follow-up documentation, enabling intra-individual descriptive comparisons. The primary endpoint was a pragmatic composite of 6-month treatment persistence and ≥50% reduction in monthly migraine days (MMD). Secondary outcomes included MMD, MMD with acute medication (MMDAM), migraine-related sick-leave days (MMSLD), disability (MIDAS), and patient-reported psychosocial outcomes. Results: A total of 422 adolescents contributed 1448 HECP and 422 CGRP-mAb episodes. Premature discontinuation occurred in 68.8% (HECP) and 11.9% (CGRP-mAb) of episodes; corresponding 6-month persistence was 30.6% and 88.2%, respectively. Mean MMD decreased from 11.7 to 9.4 during HECP episodes and from 11.6 to 4.4 during CGRP-mAb episodes. A ≥50% MMD reduction occurred in 25.4% (HECP) and 70.9% (CGRP-mAb) of episodes; the composite endpoint was met in 23.7% and 69.9%, respectively. CGRP-mAb episodes were associated with numerically larger improvements across secondary outcomes. Conclusions: In this high-burden adolescent cohort, CGRP-mAb treatment episodes were associated with higher persistence and broader improvements than prior conventional preventive episodes. Given the retrospective, non-randomized, sequential design, these findings are hypothesis-generating and do not constitute evidence of comparative effectiveness. Controlled pediatric trials and long-term safety studies are warranted.