Onabotulinumtoxin‐A in Chronic Migraine: Should Timing and Definition of Non‐Responder Status Be Revised? Suggestions From a Real‐Life Italian Multicenter Experience

Abstract Background. Treatment with onabotulinumtoxin A (BT-A) is safe and effective for chronic migraine (CM). Several studies assessed possible predictors of response to treatment with BT-A, but there is little knowledge on the frequency and predictors of sustained response. The aim of this study was to evaluate sustained response to BT-A in patients with CM.Main body. In this prospective open-label study, 115 patients with CM and treated with BT-A were consecutively enrolled in two Italian headache centers and followed up for 15 months. Anytime responders were defined as those patients who achieved a ≥50% reduction in headache days during any three-month treatment cycle compared with the three months prior to initiation of BT-A treatment. Sustained responders were defined as those who achieved a ≥50% reduction in headache days within the third treatment cycle and maintained response until the end of follow-up. Non-responders were defined as those patients who never achieved a ≥50% reduction in headache days during the follow-up. Headache characteristics prior to BT-A treatment were assessed in order to evaluate their ability in predicting treatment response.The 115 enrolled patients (84.3% female; median age 50 years) had a median migraine duration of 30 years (interquartile range 22-38). At the end of follow-up, 66 patients (57.4%) were classified as anytime responders. Among the 51 patients who achieved a clinical response within the third month of treatment, 33 (64.7%) were sustained responders. Patients with sustained response had a lower CM duration (median 31 vs 65 months; P=0.030) and a lower number of headache days (median 25 vs 30; P=0.013) at baseline compared with non-responders.Conclusions. About two thirds of patients who gain ≥50% response to BT-A within the third cycle of treatment maintain this positive response over time. More recent onset of CM and more headache-free days at baseline are associated with sustained response. We suggest not to delay preventive treatment of CM with BT-A, in order to increase the likelihood to achieve sustained clinical response.

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Real-life data in 115 chronic migraine patients treated with Onabotulinumtoxin A during more than one year

The Journal of Headache and Pain ◽

10.1186/s10194-016-0702-1 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 33

Author(s):

I. Aicua-Rapun ◽

E. Martínez-Velasco ◽

A. Rojo ◽

A. Hernando ◽

M. Ruiz ◽

...

Keyword(s):

Chronic Migraine ◽

Real Life ◽

Life Data ◽

Onabotulinumtoxin A ◽

Real Life Data ◽

One Year

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Sustained response to onabotulinumtoxin A in patients with chronic migraine: real-life data

The Journal of Headache and Pain ◽

10.1186/s10194-020-01113-6 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 3

Author(s):

Raffaele Ornello ◽

Simona Guerzoni ◽

Carlo Baraldi ◽

Luana Evangelista ◽

Ilaria Frattale ◽

...

Keyword(s):

Chronic Migraine ◽

Real Life ◽

Sustained Response ◽

Life Data ◽

Onabotulinumtoxin A ◽

Real Life Data

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Sustained Response To Onabotulinumtoxin A In Patients With Chronic Migraine: Real-Life Data

10.21203/rs.3.rs-18479/v1 ◽

2020 ◽

Author(s):

Raffaele Ornello ◽

Simona Guerzoni ◽

Carlo Baraldi ◽

Luana Evangelista ◽

Ilaria Frattale ◽

...

Keyword(s):

Clinical Response ◽

Chronic Migraine ◽

Treatment Cycle ◽

Real Life ◽

Sustained Response ◽

Response To Treatment ◽

Main Body ◽

The Third ◽

Onabotulinumtoxin A

Abstract Background Treatment with onabotulinumtoxin A (BT-A) is safe and effective for chronic migraine (CM). Several studies assessed possible predictors of response to treatment with BT-A, but there is little knowledge on the frequency and predictors of sustained response. The aim of this study was to evaluate sustained response to BT-A in patients with CM. Main body In this prospective open-label study, 115 patients with CM and treated with BT-A were consecutively enrolled in two Italian headache centers and followed up for 15 months. Anytime responders were defined as those patients who achieved a ≥50% reduction in headache days during any three-month treatment cycle compared with the three months prior to initiation of BT-A treatment. Sustained responders were defined as those who achieved a ≥50% reduction in headache days within the third treatment cycle and maintained response until the end of follow-up. Non-responders were defined as those patients who never achieved a ≥50% reduction in headache days during the follow-up. Headache characteristics prior to BT-A treatment were assessed in order to evaluate their ability in predicting treatment response. The 115 enrolled patients (84.3% female; median age 50 years) had a median migraine duration of 30 years (interquartile range 22-38). At the end of follow-up, 66 patients (57.4%) were classified as anytime responders. Among the 51 patients who achieved a clinical response within the third month of treatment, 33 (64.7%) were sustained responders. Patients with sustained response had a lower CM duration (median 31 vs 65 months; P=0.030) and a lower number of headache days (median 25 vs 30; P=0.013) at baseline compared with non-responders. Conclusions About two thirds of patients who gain ≥50% response to BT-A within the third cycle of treatment maintain this positive response over time. More recent onset of CM and more headache-free days at baseline are associated with sustained response. We suggest not to delay preventive treatment of CM with BT-A, in order to increase the likelihood to achieve sustained clinical response.

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Is Treat-to-target in Lupus Nephritis Realistic in Clinical Practice?

Current Rheumatology Reviews ◽

10.2174/1573397114666180406100857 ◽

2018 ◽

Vol 15 (1) ◽

pp. 2-6 ◽

Cited By ~ 3

Author(s):

Chi Chiu Mok

Keyword(s):

Lupus Nephritis ◽

Disease Activity ◽

Safety Concern ◽

Real Life ◽

Current Treatment ◽

Treat To Target ◽

Low Disease Activity ◽

Activity State ◽

Definition Of ◽

Comparative Trials

The Treat-to-Target (T2T) principle has been advocated in a number of inflammatory and non-inflammatory medical illnesses. Tight control of disease activity has been shown to improve the outcome of rheumatoid arthritis and psoriatic arthritis as compared to the conventional approach. However, whether T2T can be applied to patients with lupus nephritis is still under emerging discussion. Treatment of lupus nephritis should target at inducing and maintaining remission of the kidney inflammation so as to preserve renal function and improve survival in the longterm. However, there is no universal agreement on the definition of remission or low disease activity state of nephritis, as well as the time points for switching of therapies. Moreover, despite the availability of objective parameters for monitoring such as proteinuria and urinary sediments, differentiation between ongoing activity and damage in some patients with persistent urinary abnormalities remains difficult without a renal biopsy. A large number of serum and urinary biomarkers have been tested in lupus nephritis but none of them have been validated for routine clinical use. In real life practice, therapeutic options for lupus nephritis are limited. As patients with lupus nephritis are more prone to infective complications, tight disease control with aggressive immunosuppressive therapies may have safety concern. Not until the feasibility, efficacy, safety and cost-effectiveness of T2T in lupus nephritis is confirmed by comparative trials, this approach should not be routinely recommended with the current treatment armamentarium and monitoring regimes.

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OnabotulinumtoxinA for chronic migraine: a real-life Italian multicenter experience

Neurological Sciences ◽

10.1007/s10072-018-3393-3 ◽

2018 ◽

Vol 39 (S1) ◽

pp. 171-172 ◽

Cited By ~ 3

Author(s):

Fabrizio Vernieri ◽

Matteo Paolucci ◽

Claudia Altamura ◽

Patrizio Pasqualetti ◽

Vincenzo Mastrangelo ◽

...

Keyword(s):

Chronic Migraine ◽

Real Life

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Training of a future social professional for the formation of safe adolescent behavior in social networks

SOCIOПРОСТІР ◽

10.26565/2218-2470-2021-11-04 ◽

2021 ◽

Keyword(s):

Social Networks ◽

Information Exchange ◽

Professional Training ◽

Social Groups ◽

Real Life ◽

Well Being ◽

The Internet ◽

Stage Of Development ◽

Safe Behavior ◽

Definition Of

The article analyzes different approaches to the definition of «social networks» as technological complexes of organization and management of electronic information exchange among the subjects of social relations, united by common interests, information needs and skills. Based on the analysis of the scientific literature the essential characteristics of social networks that affect the formation and development of the adolescent's personality are revealed. Role of social networks at the present stage of development of society, which is manifested in the representation of interests not only of social groups but also of entire social groups, is defined in the article. The negative impact of social networks on the personality of the adolescent, which is manifested in the expansion of adolescents in cyberspace, the desire for independence and adulthood, selfexperimentation, which leads to risky activities both on the Internet and in real life are revealed. Concept of safe behavior in social networks as a set of actions of the individual when using the Internet, helping to meet the needs and at the same time prevent the possibility of causing damage to physical, mental, social well-being and property of man and others is analyzed. The basic rules of safe behavior in social Internet communities are highlighted. The structural components of safe behavior of adolescents in social networks are singled out: cognitive, motivational and actionreflexive; the concept of «professional training of future social professionals for the formation of safe behavior of adolescents in social networks» is revealed. Readiness is revealed as a result of the process of training future social specialists for professional activity on the formation of safe behavior of adolescents in social networks; the author's definition of the concept «readiness of future social professionals to form safe behavior of adolescents in social networks» is given. Components of readiness of future social workers to form safe behavior of teenagers in social networks, such as cognitive, motivational-personal and activity, are described.

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ISMAR-study presentation: in-hospital epidemiology and clinical management of respiratory and cardiac comorbidities in cardiac and respiratory disease units

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2014.406 ◽

2014 ◽

Vol 9 ◽

Author(s):

Roberto Tramarin ◽

Mario Polverino ◽

Maurizio Volterrani ◽

Bruna Girardi ◽

Claudio Chimini ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Management ◽

Real Life ◽

Length Of Hospital Stay ◽

Relevant Information ◽

Hospital Epidemiology ◽

Discharge Data ◽

Definition Of ◽

Current Guidelines

Background: Cardiovascular and respiratory diseases are leading causes of morbidity and their co-occurrence has important implications in mortality and other outcomes. Even the most recent guidelines do not reliably address clinical, prognostic, and therapeutic concerns due to the overlap of respiratory and cardiac diseases. Study objectives and design: In order to evaluate in the reality of clinical practice the epidemiology and the reciprocal impact of cardio-pulmonary comorbidity on the clinical management, diagnostic workup and treatment, 1,500 cardiac and 1,500 respiratory inpatients, admitted in acute and rehabilitation units, will be enrolled in a multicenter, nationwide, prospective observational study. For this purpose, each center will enroll at least 50 consecutive patients. At discharge, data analysis will be aimed at the definition of cardiac and pulmonary inpatient comorbidity prevalence, demographic characteristics, length of hospital stay, and risk factors, taking into account also procedures, pharmacological and non-pharmacological treatment, and follow up in patients with cardio-respiratory comorbidity. Conclusions: The purely observational design of the study aims to give new relevant information on the assessment and management of overlapping patients in real life clinical practice, and new insight for improvement and implementation of current guidelines on the management of individual diseases.

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