Influence of triptans use on anti-CGRP mAbs response: a prospective, cohort study

Background: This study aimed to compare the differences in clinical characteristics and response to monoclonal antibodies against CGRP (anti-CGRP mAbs) between patients who habitually used triptans (TRIPTANS group) and patients who were non-current users (NO-TRIPTANS group). Methods: In this prospective cohort study, all consecutive outpatients treated with anti-CGRP mAbs for 12 months were included. Clinical data were collected at baseline and monthly: number of headache days (MHDs), the absolute number of analgesics (AMNs), and the number of days with at least one analgesic (AMDs), Headache Impact Test-6 (HIT-6), and Migraine Disability Assessment (MIDAS) questionnaires. The outcomes were to evaluate the differences between TRIPTANS and NO-TRIPTANS groups (users or non-users of triptans in the 6 months before and during anti-CGRP mAb treatment) in MHDs and the other clinical variables during treatment. Response rates were assessed based on reductions in MHDs (≤ 25%, ≥ 50%, ≥ 75%). Results: A total of 336 patients treated with mAbs were included. At baseline, NO-TRIPTANS group had higher MHDs (24.7 ± 6.7) compared to the TRIPTANS group (21.8 ± 6.9), p < 0.001. Comparative and normalized analyses showed significant and sustained lower MHDs in the TRIPTANS group during treatment. The MIDAS score was also significantly lower in the TRIPTANS group at month-3, 6, 9, 12, and lower AMDs and AMNs compared to NO-TRIPTANS group were seen in most of the time-points. The number of patients with ≥ 50% reduction of MHDs was significantly higher in the TRIPTANS group at months 1 and 12. Conclusions: This study showed greater effectiveness of anti-CGRP mAb in habitual triptans users, possibly due to a common and/or synergistic action.