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Sacco S, Porreca F. Breaking barriers in migraine care: Advancing gender medicine to bridge the gap for men. Cephalalgia 2024; 44:3331024241238157. [PMID: 38501883 DOI: 10.1177/03331024241238157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Frank Porreca
- Department of Pharmacology, University of Arizona, Tucson, USA
- Mayo Clinic Arizona, Phoenix, Arizona, USA
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Dalby SW, Hvedstrup J, Carlsen LN, Ashina S, Bendtsen L, Schytz HW. Pericranial Muscle Stiffness, Pain Thresholds, and Tenderness during a Treatment Cycle of OnabotulinumtoxinA for Chronic Migraine Prevention. Diagnostics (Basel) 2024; 14:330. [PMID: 38337846 PMCID: PMC10855466 DOI: 10.3390/diagnostics14030330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Treatment with OnabotulinumtoxinA (BoNT-A) is effective as a preventive treatment for chronic migraine (CM). Preclinical studies suggest that the mechanism of action of BoNT-A in migraine is based on blocking unmyelinated C fibers. We aimed to investigate whether the muscle-relaxing effect of BoNT-A is associated with the preventive mechanism in patients with chronic migraine by measuring the stiffness, pain thresholds, and tenderness of the BoNT-A-applied muscles. METHODS A total of 22 patients with CM who were already in BoNT-A treatment participated in this longitudinal prospective study. Pericranial muscle stiffness was measured using ultrasound shear wave elastography, which measures the speed of shear waves propagating through the muscle. Pressure pain thresholds (PPT) were obtained via algometry, and muscle tenderness was measured via manual palpation. Measurements were made before BoNT-A injections and six weeks after the treatment. The measurements were performed while the muscles were maximally relaxed. The patients also completed daily diaries on headache and neck pain. RESULTS No change was observed in muscle stiffness (p = 0.737) or pericranial muscle tenderness (p = 0.400). The PPT over the trapezius muscles increased from 250 kPa before treatment to 304 kPa six weeks after treatment (p = 0.027). No change was observed on the temporalis muscles (p = 0.200) nor the non-dominant index finger (p = 0.067). BoNT-A decreased neck pain (p = 0.008) and headache (p = 0.007). CONCLUSIONS The findings suggest that BoNT-A leads to the desensitization of cutaneous and muscle nociceptors in the head and neck regions, whereas muscle relaxation might not be an important part of the anti-migraine effect.
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Affiliation(s)
- Sebastian Worsaae Dalby
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital–Rigshospitalet-Glostrup, 2600 Copenhagen, Denmark; (S.W.D.); (J.H.)
| | - Jeppe Hvedstrup
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital–Rigshospitalet-Glostrup, 2600 Copenhagen, Denmark; (S.W.D.); (J.H.)
| | - Louise Ninett Carlsen
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital–Rigshospitalet-Glostrup, 2600 Copenhagen, Denmark; (S.W.D.); (J.H.)
| | - Sait Ashina
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1871 Copenhagen, Denmark
- Comprehensive Headache Center, Department of Neurology, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Lars Bendtsen
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital–Rigshospitalet-Glostrup, 2600 Copenhagen, Denmark; (S.W.D.); (J.H.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1871 Copenhagen, Denmark
| | - Henrik Winther Schytz
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital–Rigshospitalet-Glostrup, 2600 Copenhagen, Denmark; (S.W.D.); (J.H.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1871 Copenhagen, Denmark
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3
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Altamura C, Ornello R, Ahmed F, Negro A, Miscio AM, Santoro A, Alpuente A, Russo A, Silvestro M, Cevoli S, Brunelli N, Grazzi L, Baraldi C, Guerzoni S, Andreou AP, Lambru G, Frattale I, Kamm K, Ruscheweyh R, Russo M, Torelli P, Filatova E, Latysheva N, Gryglas-Dworak A, Straburzynski M, Butera C, Colombo B, Filippi M, Pozo-Rosich P, Martelletti P, Sacco S, Vernieri F. OnabotulinumtoxinA in elderly patients with chronic migraine: insights from a real-life European multicenter study. J Neurol 2023; 270:986-994. [PMID: 36326890 DOI: 10.1007/s00415-022-11457-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Although migraine prevalence decreases with aging, some older patients still suffer from chronic migraine (CM). This study aimed to investigate the outcome of OnabotulinumtoxinA (OBT-A) as preventative therapy in elderly CM patients. METHODS This is a post hoc analysis of real-life prospectively collected data at 16 European headache centers on CM patients treated with OBT-A over the first three treatment cycles (i.e., Cy1-3). We defined: OLD patients aged ≥ 65 years and nonOLD those < 65-year-old. The primary endpoint was the changes in monthly headache days (MHDs) from baseline to Cy 1-3 in OLD compared with nonOLD participants. The secondary endpoints were the responder rate (RR) ≥ 50%, conversion to episodic migraine (EM) and the changes in days with acute medication use (DAMs). RESULTS In a cohort of 2831 CM patients, 235 were OLD (8.3%, 73.2% females, 69.6 years SD 4.7). MHDs decreased from baseline (24.8 SD 6.2) to Cy-1 (17.5 SD 9.1, p < 0.000001), from Cy-1 to Cy-2 (14.8 SD 9.2, p < 0.0001), and from Cy-2 to Cy-3 (11.9 SD 7.9, p = 0.001). DAMs progressively reduced from baseline (19.2 SD 9.8) to Cy-1 (11.9 SD 8.8, p < 0.00001), to Cy-2 (10.9 SD 8.6, p = 0.012), to Cy-3 (9.6 SD 7.4, p = 0.049). The 50%RR increased from 30.7% (Cy-1) to 34.5% (Cy-2), to 38.7% (Cy-3). The above outcome measures did not differ in OLD compared with nonOLD patients. CONCLUSION In a population of elderly CM patients with a long history of migraine OBT-A provided a significant benefit, over the first three treatment cycles, as good as in non-old patients.
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Affiliation(s)
- Claudia Altamura
- Unit of Headache and Neurosonology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - R Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy
| | - F Ahmed
- Department of Neurosciences, Hull University Teaching Hospitals, Hull, UK
| | - A Negro
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, 00189, Rome, RM, Italy
| | - A M Miscio
- Unit of Neurology, Headache Center, Fondazione IRCCS "Casa Sollievo Della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - A Santoro
- Unit of Neurology, Headache Center, Fondazione IRCCS "Casa Sollievo Della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - A Alpuente
- Headache Unit, Department of Neurology, Vall d'Hebron University, Barcelona, Spain
- Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - A Russo
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Silvestro
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - S Cevoli
- IRCCS Istituto delle scienze Neurologiche di Bologna, Bologna, Italy
| | - N Brunelli
- Unit of Headache and Neurosonology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - L Grazzi
- Neurology Department, Headache Center, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria,11, 20133, Milan, Italy
| | - C Baraldi
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico Di Modena, Modena, Italy
| | - S Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico Di Modena, Modena, Italy
| | - A P Andreou
- Headache Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Lambru
- Headache Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - I Frattale
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy
| | - K Kamm
- Department of Neurology, Ludwig Maximilians University München, Munich, Germany
| | - R Ruscheweyh
- Department of Neurology, Ludwig Maximilians University München, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - M Russo
- Neurology Unit, Neuromotor and Rehabilitation Department, Headache Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - P Torelli
- Headache Center, University of Parma, Parma, Italy
| | - E Filatova
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | | | - M Straburzynski
- Headache Clinic, Terapia Neurologiczna Samodzielni, Maurycego Mochnackiego 10, 02-042, Warsaw, Poland
| | - C Butera
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - B Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Filippi
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Pozo-Rosich
- Headache Unit, Department of Neurology, Vall d'Hebron University, Barcelona, Spain
- Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - P Martelletti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, 00189, Rome, RM, Italy
| | - S Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy
| | - F Vernieri
- Unit of Headache and Neurosonology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Iannone LF, Fattori D, Marangoni M, Benemei S, Chiarugi A, Geppetti P, De Cesaris F. Switching OnabotulinumtoxinA to Monoclonal Anti-CGRP Antibodies in Drug-Resistant Chronic Migraine. CNS Drugs 2023; 37:189-202. [PMID: 36656298 DOI: 10.1007/s40263-022-00983-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND OnabotulinumtoxinA (BTX-A) and anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (anti-CGRP mAbs) are approved drugs for chronic migraine (CM), a difficult-to-treat condition. Optimization of CM patient management by choosing the best options and determining appropriate time for switching or adding concomitant treatments are highly needed. OBJECTIVE Evaluate clinical response to anti-CGRP mAbs in patients who switched from BTX-A due to ineffectiveness defined by different cut-offs and assess the retention rate, effectiveness, and safety of both drugs within the first 9 months of treatment. METHODS A monocentric, cohort study, enrolling patients with CM, resistant to several preventive treatments, first treated with BTX-A and then with anti-CGRP mAbs with two observational phases of 9 months preceded by respective baseline. First, the retention rate and effectiveness of both treatments were measured in all patients. A second analysis assessed effectiveness in patients stratified according to <50 or <30% response rate to BTX-A. The absolute change from baseline in monthly headache days (MHDs), response rate, analgesic use, and persistence in medication overuse (MO) at 3, 6, and 9 months of treatment were recorded. Last observation carried forward (LOCF) analyses, including all patients and assuming no further changes after discontinuation, were performed for all outcomes. RESULTS Of the 78 enrolled patients (80.8% female, and 89.7% with MO at baseline), 32 (41.0%) received erenumab, 32 (41.0%) galcanezumab, and 14 (18.0%) fremanezumab. Retention rate was 62.2 and 91.0% for BTX-A and 76.9 and 96.2%, for anti-CGRP mAbs at 3 and 9 months of treatment, respectively. At 9 months of treatment, 22.4% of BTX-A patients and 65.0% of anti-CGRP mAbs patients achieved a ≥50% response rate. Anti-CGRP mAbs reduced MHDs, AMN, and AMDs, and decreased the number of MO patients at 9 months. In patients stratified according to <50 or <30% response rate to BTX-A, response rate (≥50% response at 9 months) to anti-CGRP was 62.9 and 57.9%, respectively. LOCF analyses confirmed these findings. No serious adverse events (AEs) were recorded and only two patients discontinued treatment due to AEs. CONCLUSIONS Difficult-to-treat CM patients who discontinued BTX-A and received anti-CGRP mAbs showed a substantial clinical improvement in migraine-related outcomes. Switching to an anti-CGRP mAb appears to be a viable option in patients with insufficient response after the first 2 cycles with BTX-A. The appropriate variables, cut-offs, and timing to define ineffectiveness and the best time to switch or combine therapies for difficult-to-treat CM need to be investigated further.
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Affiliation(s)
- Luigi Francesco Iannone
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
| | - Davide Fattori
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - Martina Marangoni
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - Silvia Benemei
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Chiarugi
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
| | - Pierangelo Geppetti
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy.
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy.
| | - Francesco De Cesaris
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
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5
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Baraldi C, Lo Castro F, Ornello R, Sacco S, Pani L, Guerzoni S. OnabotulinumtoxinA: Still the Present for Chronic Migraine. Toxins (Basel) 2023; 15:59. [PMID: 36668879 PMCID: PMC9865956 DOI: 10.3390/toxins15010059] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
OnabotulinumtoxinA (BT-A) is one of the few drugs approved for the preventive treatment of chronic migraine (CM). Despite this, some aspects of its mechanism of action are still a matter of debate, and the precise magnitude of BT-A effects needs to be completely elucidated. BT-A acts primarily upon trigeminal and cervical nerve endings, by inhibiting the release of inflammatory mediators such as calcitonin gene-related peptide, as well as reducing the insertion of ionotropic and metabotropic receptors into the neuronal membrane. These actions increase the depolarization threshold of trigeminal and cervical nerve fibers, thus reducing their activation. The central actions of BT-A are still a matter of debate: a retrograde axonal transport has been postulated, but not clearly assessed in humans. Clinically, the efficacy of BT-A in CM has been assessed by large, randomized placebo-controlled trials, such as the Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials. Those results were also confirmed in a wide range of open-label studies, even for long-term periods. Recently, novel findings have led to a better understanding of its pharmacological actions and clinical usefulness in migraine prevention. This narrative review summarizes, updates and critically revises the available data on BT-A and its possible implementation in chronic migraine. Moreover, the current role of BT-A in CM treatment has been discussed.
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Affiliation(s)
- Carlo Baraldi
- Department of Biomedical, Metabolic and Neural Sciences, PhD School in Neurosciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Flavia Lo Castro
- Department of Biomedical, Metabolic and Neural Sciences, Post Graduate School of Pharmacology and Clinical Toxicology, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Luca Pani
- Department of Biomedical, Metabolic and Neural Sciences, Pharmacology Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136, USA
- VeraSci, Durham, NC 27707, USA
- Department of Specialist Medicines, Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, AOU Policlinico Di Modena, 41124 Modena, Italy
| | - Simona Guerzoni
- Department of Specialist Medicines, Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, AOU Policlinico Di Modena, 41124 Modena, Italy
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García-Azorín D, Martínez B, Gutiérrez M, Ruiz-Piñero M, Echavarría A, Sierra Á, Guerrero ÁL. Real-World Evaluation of the Tolerability to Onabotulinum Toxin A: The RETO Study. Toxins (Basel) 2022; 14:toxins14120850. [PMID: 36548746 PMCID: PMC9783903 DOI: 10.3390/toxins14120850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Onabotulinumtoxin A (onabotA) has shown efficacy in chronic migraine (CM), with good tolerability and a low rate of adverse effects, most of them not severe. The aim of this study is to evaluate tolerability and adverse effects of onabotA in clinical practice and to analyze if there is a relationship between tolerability to treatment administration, adverse effects' (AEs) occurrence and clinical response. We included patients with CM that received treatment with onabotA for the first time. Tolerability to treatment was evaluated by a 0-10 numeric rating scale (0: worst possible, 10: optimal tolerability). We assessed the presence of AEs by using a standardized questionnaire. Treatment response was based on the 50 and 75% responder rate between weeks 20 and 24, compared with the baseline, according to headache diaries. We analyzed whether the tolerability was associated with a higher frequency of AEs or a higher probability of clinical response. We included 105 patients, 87.7% female, with an age of 43.9 ± 10.7 years. Mean tolerability was 7.8/10 and 7.2/10 in the first and second onabotA administration, respectively. AEs were reported by (first-second) 71.4-68.6% patients. The percentage of patients with a 50% response was 56.3%. There was no association between tolerability and AEs' occurrence or clinical response.
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Affiliation(s)
- David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain
- Department of Medicine, University of Valladolid, 47002 Valladolid, Spain
- Correspondence:
| | - Blanca Martínez
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain
| | - María Gutiérrez
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain
| | - Marina Ruiz-Piñero
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain
| | - Ana Echavarría
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain
| | - Álvaro Sierra
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain
| | - Ángel L. Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain
- Department of Medicine, University of Valladolid, 47002 Valladolid, Spain
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7
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Ornello R, Baraldi C, Ahmed F, Negro A, Miscio AM, Santoro A, Alpuente A, Russo A, Silvestro M, Cevoli S, Brunelli N, Vernieri F, Grazzi L, Pani L, Andreou A, Lambru G, Frattale I, Kamm K, Ruscheweyh R, Russo M, Torelli P, Filatova E, Latysheva N, Gryglas-Dworak A, Straburzyński M, Butera C, Colombo B, Filippi M, Pozo-Rosich P, Martelletti P, Guerzoni S, Sacco S. Excellent Response to OnabotulinumtoxinA: Different Definitions, Different Predictors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710975. [PMID: 36078699 PMCID: PMC9518492 DOI: 10.3390/ijerph191710975] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 05/10/2023]
Abstract
The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineurs treated with onabotulinumtoxinA and followed-up for, at least, 9 months was performed. Excellent responders were defined either as patients with a ≥75% decrease in monthly headache days (percent-based excellent responders) or as patients with <4 monthly headache days (frequency-based excellent responders). The characteristics of excellent responders at the baseline were compared with the ones of patients with a <30% decrease in monthly headache days. Percent-based excellent responders represented about 10% of the sample, whilst frequency-based excellent responders were about 5% of the sample. Compared with non-responders, percent-based excellent responders had a higher prevalence of medication overuse and a higher excellent response rate even after the 1st and the 2nd injection. Females were less like to be frequency-based excellent responders. Chronic migraine sufferers without medication overuse and of female sex may find fewer benefits with onabotulinumtoxinA. Additionally, the excellent response status is identifiable after the first cycle.
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Affiliation(s)
- Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio 1 Coppito, 67100 L’Aquila, Italy
| | - Carlo Baraldi
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, 41125 Modena, Italy
- Correspondence: ; Tel.: +39-0594222104
| | - Fayyaz Ahmed
- Department of Neurosciences, Hull University Teaching Hospitals, Hull HU3 2JZ, UK
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy
| | - Anna Maria Miscio
- Headache Center, Unit of Neurology, Fondazione IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Antonio Santoro
- Headache Center, Unit of Neurology, Fondazione IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Alicia Alpuente
- Headache Unit, Department of Neurology, Vall D’Hebron University, 08035 Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall D’Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Nicoletta Brunelli
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy
| | - Licia Grazzi
- Headache Center, Neuroalgology Department, IRCCS Foundation “Carlo Besta” Neurological Institute, Via Celoria, 11, 20133 Milan, Italy
| | - Luca Pani
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, 41125 Modena, Italy
- Pharmacology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Coral Gables, FL 33146, USA
- VeraSci, Durham, NC 27707, USA
| | - Anna Andreou
- Headache Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Giorgio Lambru
- Headache Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Ilaria Frattale
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, 00133 Rome, Italy
| | - Katharina Kamm
- Department of Neurology, Ludwig Maximilians University München, 80539 Munich, Germany
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University München, 80539 Munich, Germany
| | - Marco Russo
- Headache Center, Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Paola Torelli
- Headache Center, University of Parma, 43121 Parma, Italy
| | - Elena Filatova
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Nina Latysheva
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | | | - Marcin Straburzyński
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Calogera Butera
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
| | - Massimo Filippi
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
| | - Patricia Pozo-Rosich
- Headache Unit, Department of Neurology, Vall D’Hebron University, 08035 Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall D’Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy
| | - Simona Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio 1 Coppito, 67100 L’Aquila, Italy
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