CGRP monoclonal antibodies early onset of efficacy following four weeks of treatment in chronic migraine

2021 ◽  
Vol 429 ◽  
pp. 119271
Author(s):  
Francesca Schiano Di Cola ◽  
Salvatore Caratozzolo ◽  
Matteo Cortinovis ◽  
Paolo Liberini ◽  
Renata Rao ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Chronic Migraine ◽  
Early Onset

Looking for the identikit of refractory chronic migraine patients in the CGRP-monoclonal antibodies scenario: Insight from the real-word experience

2021 ◽  
Vol 429 ◽  
pp. 119260
Author(s):  
Fabrizio Scotto Di Clemente ◽  
Alessandro Tessitore ◽  
Marcello Silvestro ◽  
Giorgia Battista ◽  
Gioacchino Tedeschi ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Chronic Migraine ◽  
Real Word ◽  
The Real ◽  
Refractory Chronic Migraine

scholarly journals Anti-CGRP monoclonal antibodies in chronic migraine with medication overuse: real-life effectiveness and predictors of response at 6 months

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Edoardo Caronna ◽  
Victor José Gallardo ◽  
Alicia Alpuente ◽  
Marta Torres-Ferrus ◽  
Patricia Pozo-Rosich
Keyword(s):  
Monoclonal Antibodies ◽  
Chronic Migraine ◽  
Medication Overuse ◽  
Real Life ◽  
Daily Practice ◽  
Headache Frequency ◽  
Electronic Diary ◽  
Life Effectiveness ◽  
Medication Intake ◽  
Acute Medication

Abstract Background In daily practice, anti-CGRP monoclonal antibodies (MAbs) may be useful in chronic migraine (CM) with medication overuse (MO), but data is limited. We evaluated their effectiveness in a real-life clinical cohort. Methods This is a prospective study conducted in CM patients with and without medication overuse treated with monthly MAbs during 6 months (erenumab/galcanezumab). We collected headache characteristics, including acute medication intake, through an electronic diary. We compared patients (1) with and without MO at baseline, (2) with and without ongoing MO after treatment, defining MO resolution as < 10 or 15 days/month of acute medication intake, according to analgesic type, during the 6-month treatment. Results Of 139 CM patients completing 6-month treatment with anti-CGRP MAbs, 71.2% (99/139) had MO at baseline. After 6 months, patients with and without MO at baseline had significant and similar proportions of ≥50% reduction in migraine days/month (MO: 63.6% vs. non-MO: 57.5%, p = 0.500). 60.6% (60/99) no longer satisfied MO definition. Reduction in headache frequency compared to baseline occurred in both MO-ongoing and MO-resolution group, although those who stopped overusing had a greater improvement (headache days/month: − 13.4 ± 7.6 vs. -7.8 ± 7.2, p < 0.0001). No differences in MO resolution were observed according to the MAbs used. Baseline lower pain severity was associated with MO resolution (OR [95%]:0.236[0.054–0.975]; p = 0.049). Conclusions In real-life anti-CGRP MAbs are as effective in CM patients with MO as in patients without it and facilitate MO cessation. Reduction in headache frequency and acute medication days/month occurs regardless of whether patients stop overusing or not.

scholarly journals Calcitonin Gene-Related Peptide Monoclonal Antibodies Versus Botulinum Neurotoxin a in the Preventive Treatment of Chronic Migraine: An Adjusted Indirect Treatment Comparison Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yao-Yao Chen ◽  
Xiao-Qian Ye ◽  
Tai-Chun Tang ◽  
Tian-Wei She ◽  
Min Chen ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Chronic Migraine ◽  
Botulinum Neurotoxin ◽  
Meta Analysis ◽  
Preventive Treatment ◽  
Calcitonin Gene Related Peptide ◽  
Controlled Trials ◽  
Botulinum Neurotoxin A ◽  
Related Peptide ◽  
Calcitonin Gene

Purpose: Calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs) are new agents approved by the US Food and Drug Administration for preventive treatment of chronic migraine. Comparison between CGRPmAbs and previously approved Botulinum neurotoxin A (BoNT-A) will inform optimal preventive treatment of chronic migraine, but head-to-head trials are lacking. We therefore aimed to perform adjusted indirect comparison between CGRPmAbs and BoNT-A through a meta-analysis.Methods: OVID MEDLINE, EMBASE and the Cochrane central register of controlled trials, clinical registries, and government websites were searched from inception to September 2019. Randomized controlled trials comparing CGRPmAbs or BoNT-A with placebo in the preventive treatment of chronic migraine were included. The primary outcomes were headache days and migraine days measured at week 12. Data were synthesized by using a frequentist approach; and the treatments were ranked by P-score.Results: We included 10 trials (n = 4,678) after screening 1049 candidates. Six trials were with low risk of bias. Fremanezumab had an effect similar to BoNT-A in the reduction of headache days at week 12 (standard mean difference [SMD] 0.08, 95%CI -0.55 to -0.7). Galcanezumab reduced more migraine days than BoNT-A at week 12 (SMD, -0.94, 95%CI −1.24 to −0.63); fremanezumab showed similar findings (SMD, −0.55, 95%CI −0.85 to −0.24). Galcanezumab and fremanezumab had better effect in mitigating headache impact at week 12. CGRPmAbs and BoNT-A had similar adverse event rate.Conclusion: CGRPmAbs and BoNT-A had similar effect in the preventive treatment of chronic migraine. BoNT-A might be preferentially selected owing to its cost-effectiveness profiles. Further studies with direct comparison of the two treatments are warranted.

Anti-CGRP monoclonal antibodies for migraine prevention: A systematic review and likelihood to help or harm analysis

Cephalalgia ◽  
2021 ◽  
pp. 033310242198960
Author(s):  
Konstantina Drellia ◽  
Lili Kokoti ◽  
Christina I Deligianni ◽  
Dimitrios Papadopoulos ◽  
Dimos D Mitsikostas
Keyword(s):  
Clinical Trials ◽  
Monoclonal Antibodies ◽  
Chronic Migraine ◽  
Episodic Migraine ◽  
Randomised Clinical Trials ◽  
Migraine Prevention ◽  
Number Of Patients ◽  
Calcitonin Gene ◽  
Using Data ◽  
Risk Ratios

Introduction and objective Monoclonal antibodies targeting the calcitonin gene-related peptide pathway (anti-CGRP mAbs) have shown promising efficacy in randomised clinical trials for the prevention of episodic and chronic migraine, but no head-to-head comparisons with established treatments are available. We aimed to examine absolute differences in benefit-risk ratios between anti-CGRP mAbs, topiramate and propranolol for the prevention of episodic migraine and between anti-CGRP mAbs, topiramate and onabotulinumtoxinA for the prevention of chronic migraine using a likelihood to help versus harm analysis. Methods The number of patients needed to be treated for a patient to achieve ≥ 50% reduction in migraine days (NNTB50%) was used as an effect size metric of efficacy. The number of patients needed to be treated for a patient to experience an adverse event that led to treatment discontinuation (NNTHD-AE) was used as a measure of risk. Likelihood to help versus harm values – which are the ratios of NNTH:NNTB – were calculated using data from phase 3 randomised clinical trials. Results All agents tested were more likely to be beneficial than harmful (likelihood to help versus harm > 1) with the exception of topiramate at 200 mg per day for the prevention of episodic migraine. Anti-CGRP mAbs in all tested doses had higher LHH values than propranolol or topiramate for episodic migraine and onabotulinumtoxinA or topiramate for chronic migraine prevention. Fremanezumab had the highest LHH ratio in episodic migraine and galcanezumab in chronic migraine. Conclusion This analysis showed that anti-CGRP mAbs exhibit a more favourable benefit-risk ratio than established treatments for episodic and chronic migraine. Head-to-head studies are needed to confirm these results.

Early Onset of Efficacy With Fremanezumab for the Preventive Treatment of Chronic Migraine

2019 ◽  
Vol 59 (10) ◽  
pp. 1743-1752 ◽  
Author(s):  
Paul K. Winner ◽  
Egilius L. H. Spierings ◽  
Paul P. Yeung ◽  
Ernesto Aycardi ◽  
Tricia Blankenbiller ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Early Onset ◽  
Preventive Treatment
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