This is quite an interesting study.

Key Points
• Source: Neurology Clinical Practice
• Conclusions/Relevance: “After treatment discontinuation, a rapid migraine worsening was found, despite the high clinical response during treatment and at retreatment, which might be secondary to an untimely interruption of a potentially disease-modifying pharmacologic intervention. Although clinical improvement was documented after retreatment, given the high frequency and degree of worsening during discontinuation, it seems plausible—even ethical—to re-evaluate current timing of discontinuation.”
• Current guidelines recommend 12 months of erenumab treatment vs. 3 months of discontinuation.
• This study examined patient response of discontinuation after a 12-month treatment cycle of erenumab. The authors also examined migraine outcomes following retreatment in patients who discontinued this agent and decompensated.
• Patients who underwent retreatment exhibited more migraine days and increased use of analgesics vs those who didn’t discontinue, although the retreatment group still benefited. The only factors linked to clinical worsening at the end of the 12-month treatment cycle were baseline diagnosis and treatment discontinuation.
• No DMARDs have been previously available for migraine, with the only previous prophylaxis being onabotulinumtoxin A, which is discontinued only when clinical improvement continues for 3 months.
• “The rapid deterioration in patients undergoing erenumab discontinuation, despite good response during treatment and at retreatment, might be secondary to an untimely interruption of a potentially disease-modifying pharmacologic intervention, which, possibly, might take longer to demonstrate its full effect,” stated the authors.