doi:10.1007/s00415-025-13177-yengGarcía-Castillo, María ClaraSierra-Mencía, ÁlvaroCaronna, EdoardoToledo-Alfocea, DanielJaimes, AlexUrtiaga, SarayCasas-Limón, JavierMuñoz-Vendrell, AlbertSantos Lasaosa, SoniaGarcía Martín, ValvanuzMartín Ávila, GuillermoPolanco, MarcosVillar-Martínez, Maria DoloresTrevino-Peinado, CristinaRubio-Flores, LauraSánchez-Soblechero, AntonioPortocarrero Sánchez, LeonardoLuque-Buzo, ElisaLozano-Ros, AlbertoGago-Veiga, Ana BeatrizDíaz-De-Terán, JavierRecio García, AndreaCanales Rodríguez, JavieraGómez García, AndreaGonzález Salaices, MartaCampoy, SergioMínguez-Olaondo, AneManiataki, StefaniaGonzález-Quintanilla, VicentePorta-Etessam, JesúsCuadrado, María-LuzGuerrero Peral, Ángel LuisPozo-Rosich, PatriciaRodríguez-Vico, JaimeHuerta-Villanueva, MarianoPascual, JulioGoadsby, Peter J.Gonzalez-Martinez, AliciaConcomitant anti-CGRP and immunomodulatory treatments in patients with migraine: towards integrated management strategiesART-2025-144321Preclinical evidence supports the immunoregulatory role of calcitonin gene-related peptide (CGRP) in migraine pathophysiology. The increasing use of anti-CGRP therapies in patients with migraine and other comorbidities raises the question whether the potential use of anti-CGRP monoclonal antibodies (CGRP-mAbs) therapies in combination with other immunological therapies is effective and safe. Methods. This multicenter study included patients with migraine receiving CGRP-mAbs combined with immunosuppressive and immunomodulatory treatments. Clinical and demographic data, treatment history, laboratory markers and treatment-emergent adverse events (TEAEs) were analyzed. Effectiveness outcomes included the change in monthly migraine days (MMD) and monthly headache days (MHD) at 3, 6, 9 and 12 months, alongside the > 50% response rate. Moreover, autoimmune disease progression was also evaluated. We explored differences between patients with and without autoimmune disease activation. Results.Among 89 patients, there were 80 (90%) females with a mean age of 50 years (SD: 11), who had a high prevalence of psychiatric comorbidities (anxiety 44%, depression 49%) and medication overuse (68%). Patients receiving immunological treatments experienced significant reductions in MMD and MHD, with MMD decreasing from 16 (SD: 7) at baseline to 9 (SD: 8) at 6 months, and MHD dropping from 23 (SD: 8) to 17 (SD: 11). A 50% response in MMD was achieved by 46% at 6 months. TEAEs were reported in 28%, most commonly constipation (16%) and dizziness (9%). Conclusions. CGRP-mAbs therapies combined with immunological treatments appear effective and safe in patients with autoimmune diseases. Larger prospective studies are necessary to confirm these findings and optimize management strategies.2025http://zaguan.unizar.es/record/16166910.1007/s00415-025-13177-yhttp://zaguan.unizar.es/record/161669oai:zaguan.unizar.es:161669info:eu-repo/grantAgreement/ES/ISCIII/CM21-00178info:eu-repo/grantAgreement/ES/ISCIII/JR23/0005info:eu-repo/grantAgreement/ES/ISCIII/PI24-01085Journal of Neurology 272, 6 (2025), 12 pp.byhttps://creativecommons.org/licenses/by/4.0/deed.esinfo:eu-repo/semantics/openAccess