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Melhado EM, Santos PSF, Kaup AO, da Costa ATNM, Roesler CADP, Piovesan ÉJ, Sarmento EM, Theotonio GOM, de Campos HC, Fortini I, de Souza JA, Maciel JA, Segundo JBA, de Carvalho JJF, Speziali JG, Calia LC, Barea LM, Queiroz LP, Souza MNP, Figueiredo MRCF, Costa MENDM, Peres MFP, Jurno ME, Peixoto PM, Kowacs PA, Rocha-Filho PAS, Moreira PF, Silva-Neto RP, Fragoso YD. Consensus of the Brazilian Headache Society (SBCe) for the Prophylactic Treatment of Episodic Migraine: part I. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:845-861. [PMID: 36252594 PMCID: PMC9703891 DOI: 10.1055/s-0042-1756441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Brazilian Headache Society (Sociedade Brasileira de Cefaleia, SBCe, in Portuguese) nominated a Committee of Authors with the aim of establishing a consensus with recommendations regarding prophylactic treatment for episodic migraine based on articles published in the worldwide literature, as well as personal experience. Migraine affects 1 billion people around the world and more than 30 million Brazilians. In addition, it is an underdiagnosed and undertreated disorder. It is well known within the medical community of neurologists, and especially among headache specialists, that there is a need to disseminate knowledge about prophylactic treatment for migraine. For this purpose, together with the need for drug updates and to expand knowledge of the disease itself (frequency, intensity, duration, impact and perhaps the progression of migraine), this Consensus was developed, following a full online methodology, by 12 groups who reviewed and wrote about the pharmacological categories of the drugs used and, at the end of the process, met to read and establish conclusions for this document. The drug classes studied were: anticonvulsants, tricyclic antidepressants, monoclonal anti-calcitonin gene-related peptide (anti-CGRP) antibodies, beta-blockers, antihypertensives, calcium channel inhibitors, other antidepressants (selective serotonin reuptake inhibitors, SSRIs, and dual-action antidepressants), other drugs, and polytherapy. Hormonal treatment and anti-inflammatories and triptans in minimum prophylaxis schemes (miniprophylaxis) will be covered in a specific chapter. The drug classes studied for part I of the Consensus were: anticonvulsants, tricyclic antidepressants, monoclonal anti-CGRP antibodies, and beta-blockers.
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Affiliation(s)
- Eliana Meire Melhado
- Centro Universitário Padre Albino, Faculdade de Medicina, Departamento de Neurologia, Catanduva SP, Brazil
| | - Paulo Sergio Faro Santos
- Instituto de Neurologia de Curitiba, Departamento de Neurologia, Setor de Cefaleia e Dor Orofacial, Curitiba PR, Brazil
| | - Alexandre Ottoni Kaup
- Houston Headache Clinic, Houston TX, United States,Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil,Universidade de Santo Amaro, São Paulo SP, Brazil
| | | | | | - Élcio Juliato Piovesan
- Universidade Federal do Paraná, Departamento de Clínica Médica, Disciplina de Neurologia, Curitiba PR, Brazil
| | | | | | | | - Ida Fortini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Jano Alves de Souza
- Universidade Federal Fluminense, Departamento de Medicina Clínica, Disciplina de Neurologia, Niterói RJ, Brazil
| | - Jayme Antunes Maciel
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil
| | | | - João José Freitas de Carvalho
- Unichristus, Curso de Medicina, Disciplina de Neurologia, Fortaleza CE, Brazil,Hospital Geral de Fortaleza, Serviço de Neurologia, Núcleo de Cefaleias, Fortaleza CE, Brazil
| | - José Geraldo Speziali
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurologia, Ribeirão Preto SP, Brazil
| | - Leandro Cortoni Calia
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil
| | - Liselotte Menke Barea
- Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Disciplina de Neurologia, Porto Alegre RS, Brazil
| | - Luiz Paulo Queiroz
- Universidade Federal de Santa Catarina, Hospital Universitário, Serviço de Neurologia, Florianópolis SC, Brazil
| | | | | | | | | | - Mauro Eduardo Jurno
- Fundação José Bonifácio Lafayette de Andrada, Faculdade de Medicina de Barbacena, Barbacena MG, Brazil,Fundação Hospitalar do Estado de Minas Gerais, Hospital Regional de Barbacena Dr. José Américo, Barbacena MG, Brazil
| | | | - Pedro André Kowacs
- Instituto de Neurologia de Curitiba, Serviço de Neurologia, Curitiba PR, Brazil,Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Neurologia, Curitiba PR, Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área de Neuropsquiatria, Recife PE, Brazil,Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Ambulatório de Cefaleias, Recife PR, Brazil
| | - Pedro Ferreira Moreira
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Departamento de Medicina Clínica, Niterói RJ, Brazil
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Nicol MR, Joshi A, Rizk ML, Sabato PE, Savic RM, Wesche D, Zheng JH, Cook J. Pharmacokinetics and Pharmacological Properties of Chloroquine and Hydroxychloroquine in the Context of COVID-19 Infection. Clin Pharmacol Ther 2020; 108:1135-1149. [PMID: 32687630 PMCID: PMC7404755 DOI: 10.1002/cpt.1993] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Chloroquine and hydroxychloroquine are quinoline derivatives used to treat malaria. To date, these medications are not approved for the treatment of viral infections, and there are no well‐controlled, prospective, randomized clinical studies or evidence to support their use in patients with coronavirus disease 2019 (COVID‐19). Nevertheless, chloroquine and hydroxychloroquine are being studied alone or in combination with other agents to assess their effectiveness in the treatment or prophylaxis for COVID‐19. The effective use of any medication involves an understanding of its pharmacokinetics, safety, and mechanism of action. This work provides basic clinical pharmacology information relevant for planning and initiating COVID‐19 clinical studies with chloroquine or hydroxychloroquine, summarizes safety data from healthy volunteer studies, and summarizes safety data from phase II and phase II/III clinical studies in patients with uncomplicated malaria, including a phase II/III study in pediatric patients following administration of azithromycin and chloroquine in combination. In addition, this work presents data describing the proposed mechanisms of action against the severe acute respiratory distress syndrome coronavirus–2 and summarizes clinical efficacy to date.
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Affiliation(s)
- Melanie R Nicol
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abhay Joshi
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Matthew L Rizk
- Quantitative Pharmacology and Pharmacometrics, Merck & Co Inc, Kenilworth, New Jersey, USA
| | - Philip E Sabato
- Quantitative Pharmacology and Pharmacometrics, Merck & Co Inc, Kenilworth, New Jersey, USA
| | - Radojka M Savic
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Jenny H Zheng
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jack Cook
- Clinical Pharmacology Department, Global Product Development, Pfizer Inc, Groton, Connecticut, USA
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Goadsby PJ, Paemeleire K, Broessner G, Brandes J, Klatt J, Zhang F, Picard H, Lenz R, Mikol DD. Efficacy and safety of erenumab (AMG334) in episodic migraine patients with prior preventive treatment failure: A subgroup analysis of a randomized, double-blind, placebo-controlled study. Cephalalgia 2019; 39:817-826. [PMID: 30982348 DOI: 10.1177/0333102419835459] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Erenumab was effective and well tolerated in a pivotal clinical trial of episodic migraine that included subjects both naïve to, and those who had failed, previous preventives. Here we evaluated the efficacy and safety of erenumab (70 mg or 140 mg) versus placebo in the subgroup of patients who had previously failed preventive treatment(s): ≥1 or ≥2 prior failed migraine preventive categories, and in patients who had never failed. METHODS Prespecified subgroup analyses evaluated change from baseline to months 4-6 (the primary endpoint of the blinded study phase) in monthly migraine days, achievement of ≥50% and ≥75% reduction in monthly migraine days, and change from baseline in acute migraine-specific medication days. Adverse events were also evaluated. RESULTS Treatment with both doses of erenumab resulted in greater reductions in monthly migraine days at months 4-6 (treatment difference versus placebo [95% CI], never failed subgroup: -0.9 [-1.5, -0.3] for 70 mg and -1.3 [-1.9, -0.7] for 140 mg; ≥1 prior failed medication categories subgroup: -2.0 [-2.8, -1.2] for 70 mg and -2.5 [-3.4, -1.7] for 140 mg; ≥2 prior failed medication categories subgroup: -1.3 [-2.6, 0.0] for 70 mg and -2.7 [-4.0, -1.4] for 140 mg). Similar results were observed in the monthly acute migraine-specific medication days endpoint, and in the achievement of ≥50% and ≥75% reduction in monthly migraine days. For the ≥50% reduction in monthly migraine day endpoint, placebo response in the no prior treatment failed group was 32.6%, in the ≥1 failed treatment 17.5%, and in the ≥2 failed treatments 11.1%. CONCLUSION Erenumab showed consistent efficacy in episodic migraine patients who had failed prior preventive treatments and was well tolerated across subgroups. The data suggest prior patients with prior treatment failures have lower placebo response rates.
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Affiliation(s)
- Peter J Goadsby
- 1 NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, UK.,2 SLaM Biomedical Research Centre, King's College London, UK
| | - Koen Paemeleire
- 3 Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Gregor Broessner
- 4 Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan Brandes
- 5 Nashville Neuroscience Group and Vanderbilt University School of Neurology, Nashville, TN, USA
| | - Jan Klatt
- 6 Novartis Pharma AG, Basel, Switzerland
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Höcht C, Bertera FM, Santander Plantamura Y, Parola L, Del Mauro JS, Polizio AH. Factors influencing hepatic metabolism of antihypertensive drugs: impact on clinical response. Expert Opin Drug Metab Toxicol 2018; 15:1-13. [DOI: 10.1080/17425255.2019.1558204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Christian Höcht
- Departamento de Farmacología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Buenos Aires, Argentina
| | - Facundo M. Bertera
- Departamento de Farmacología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Buenos Aires, Argentina
| | - Yanina Santander Plantamura
- Departamento de Farmacología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Buenos Aires, Argentina
| | - Luciano Parola
- Departamento de Farmacología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Buenos Aires, Argentina
| | - Julieta S. Del Mauro
- Departamento de Farmacología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Buenos Aires, Argentina
| | - Ariel H. Polizio
- Departamento de Farmacología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Buenos Aires, Argentina
- CONICET
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