ArticleThe journal of headache and pain2026
Prescriber adherence to treatment guidelines for monoclonal antibodies against Calcitonin Gene-Related Peptide in migraine prophylaxis - a register-based cohort study.
Article in The journal of headache and pain, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCalcitonin Gene-Related Peptide targeting monoclonal antibodies (CGRP mAbs) were introduced for migraine prophylaxis in Sweden through the National Joint Introduction process to ensure an equal, cost-effective, and appropriate national use. This study aimed to assess prescriber adherence to treatment guidelines and evaluate patient treatment persistence during the national introduction of CGRP mAbs.
methodsIn this register-based cohort study, we followed individuals with a migraine diagnosis or dispensation of migraine drugs within Stockholm County from July 2018 to June 2022. We evaluated the guidelines for CGRP mAb treatment (erenumab, fremanezumab, or galcanezumab) according to four categories: 1) patient eligibility, 2) prescriber qualifications, 3) treatment evaluation, and 4) monitoring/reporting. We used a Sankey diagram to illustrate treatment switching and discontinuation patterns and employed boxplots along with Kaplan-Meier estimates to assess the persistence to CGRP mAbs.
resultsAmong 93,263 eligible individuals, 2266 (2%) had at least one CGRP mAb dispensation. Most (90%) had a prior migraine diagnosis at the first CGRP mAb dispensation, and 66% had been dispensed at least two prior prophylactic drugs against migraine. In nearly all cases (97%), CGRP mAb prescriptions were issued by neurology or headache specialists. Switching between CGRP mAbs was common and treatment persistence declined across successive sequences. Overall median treatment duration was 5.8 months (interquartile range: 2.8–11.9 months) and was longer for erenumab than fremanezumab and galcanezumab in sequence 1, but not in sequence 2. Kaplan–Meier analysis revealed a 12-month persistence of 58% in sequence 1, 53% in sequence 2, and 46% in sequence 3. A higher persistence was observed for fremanezumab and galcanezumab compared with erenumab in sequence 1, while estimates were similar in sequence 2.
conclusionPrescribers within Stockholm County adhere well to CGRP mAb treatment guidelines, with dispensations largely supported by a sound medical rationale, indicating appropriate integration into clinical practice. Guidance on switching between CGRP mAbs is limited and our findings show frequent switching and reduced persistence across sequences. These insights can help clinicians avoid unnecessary switches and optimize migraine care and resource use.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.