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Sajjad Q, Khan AU, Khan A. Pharmacological investigation of genistein for its therapeutic potential against nitroglycerin-induced migraine headache. J Pharm Pharmacol 2024:rgae084. [PMID: 39010707 DOI: 10.1093/jpp/rgae084] [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: 11/28/2023] [Accepted: 06/15/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Migraine, typically occurs on one side of the head, lasts for hours to days. Trigemino-vascular system (TVS) plays a vital role in pain generation, with neurogenic inflammation and oxidative stress playing key roles in its pathophysiology. METHODS This study aimed to investigate genistein's potential as anti-inflammatory and anti-oxidant agent in mitigating migraine pain. Genistein (20 and 50 mg/kg) was administered intraperitoneally (IP) to nitroglycerin (NTG; 10 mg/kg)-induced migraine model in rats. Behavioral analysis, antioxidant assay, immunohistochemistry (IHC), histopathological examination, ELISA, and RT-PCR were conducted to evaluate the antimigraine potential of genistein. KEY FINDINGS In-silico analysis showed genestien's ACE values of -4.8 to -9.2 Kcal/mol against selected protein targets. Genistein significantly reversed mechanical and thermal nociception, light phobicity, and head scratching; increased the intensities of GST, GSH, catalase; and down regulated lipid peroxidase (LPO) in cortex and trigeminal nucleus caudalis (TNC). It also reduced Nrf2, NF-kB, and IL6 expression, analyzed through IHC, improved histopathological features, and increased COX-2 and decreased PPAR-γ expressions, while RT-PCR analysis revealed increased PPAR-γ expressions in genistein-treated rats. CONCLUSION Genistein exhibited potent antioxidant and anti-inflammatory properties in migraine treatment, acting through multifactorial mechanisms by modulating the expression of numerous proteins in the region cortex and TNC.
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Affiliation(s)
- Qirrat Sajjad
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Arif-Ullah Khan
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Aslam Khan
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
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Zhao YJ, Ong JJY, Sonu SK, Dang J, Ng CC, Herr KJ, Bose R, Jion YI. A real-world prospective observational study of eptinezumab in Asian patients with migraine. Headache 2024; 64:810-824. [PMID: 38785386 DOI: 10.1111/head.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To evaluate the real-world effectiveness of eptinezumab for migraine prevention in Asian patients. BACKGROUND Eptinezumab is a monoclonal antibody that targets calcitonin gene-related peptide (CGRP), a potent vasodilator with an important role in migraine pathophysiology. Although there is robust clinical evidence from pivotal Phase 3 placebo-controlled trials of the efficacy of eptinezumab for migraine prevention, there are limited data on the real-world effectiveness of eptinezumab in Asian patient cohorts. METHODS This was a non-interventional, prospective, multisite cohort study of adults with migraine (International Classification of Headache Disorders, 3rd edition criteria) in Singapore who were prescribed eptinezumab (100 mg at baseline and Month 3, administered intravenously) and were followed until Month 6. The primary endpoint was change from baseline in monthly migraine days (MMDs) at Month 3 and Month 6. Secondary endpoints were ≥30% and ≥50% responder rates, and change from baseline in the Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), Migraine-Specific Quality of Life (MSQ), patient-identified most bothersome symptom (PI-MBS), acute medication use at Month 3 and Month 6, and safety. RESULTS Enrolled patients (completed = 29/30) had on average 3.4 (SD 2.9) previous preventive treatments; 29/30 of the patients had trialed at least one previous preventive treatment without benefit. Most had previously trialed oral preventives (87%, 26/30) and anti-CGRP (70%, 21/30). Relative to baseline, mean MMDs decreased by 4.3 days (95% CI 2.1-6.4; p < 0.001) at Month 3 and 4.9 days (95% CI 2.1-7.7; p < 0.001) at Month 6. At Month 3 and Month 6, 14/30 (47%) and 15/29 (52%) of the patients were ≥30% responders, and 6/30 (20%) and 8/29 (28%) patients were ≥50% responders, respectively. The number of patients with severe life impairment based on the HIT-6 score (total score 60-78) decreased from 24/30 (80%) at baseline to 19/30 (63%) at Month 3 and 19/29 (66%) at Month 6. The mean MIDAS score decreased by 24.6 points (95% CI 2.82-46.38; p = 0.028) at Month 6, and the mean MSQ score increased by 12.2 points (95% CI 5.18-19.20; p = 0.001) at Month 3 and 13.6 points (95% CI 4.58-22.66; p = 0.004) at Month 6. Most patients reported improvement in the PI-MBS at Month 3 (73%, 22/30) and Month 6 (55%, 16/29). Acute medication use for headache relief decreased by 3.3 days/month (95% CI 1.0-5.6; p = 0.007) at Month 3 and 4.7 days/month (95% CI 1.7-7.7; p = 0.003) at Month 6. Treatment-emergent adverse events (TEAEs) were reported in 16/30 (54%) patients, mostly mild/moderate in severity. No serious TEAEs led to treatment discontinuation. CONCLUSION Quarterly eptinezumab administration was effective and well-tolerated in Asian patients with chronic migraine.
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Affiliation(s)
- Yi Jing Zhao
- Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Jonathan Jia Yuan Ong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
- YLL School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sumit Kumar Sonu
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Jiaojiao Dang
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Chai Ching Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | | | - Rohini Bose
- Lundbeck Singapore Pte. Ltd., Singapore, Singapore
| | - Yasmin Idu Jion
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
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Callen E, Clay T, Alai J, Crawford P, Visconti A, Nederveld A, Cruz I, Perez B, Roper KL, Oser TK, Saint Laurent ML, Jabbarpour Y. Migraine care practices in primary care: results from a national US survey. Fam Pract 2024; 41:277-282. [PMID: 37221301 DOI: 10.1093/fampra/cmad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Primary care clinicians play a critical role in diagnosis and treatment of migraine, yet barriers exist. This national survey assessed barriers to diagnosis and treatment of migraine, preferred approaches to receiving migraine education, and familiarity with recent therapeutic innovations. METHODS The survey was created by the American Academy of Family Physicians (AAFP) and Eli Lilly and Company and distributed to a national sample through the AAFP National Research Network and affiliated PBRNs from mid-April through the end of May 2021. Initial analyses were descriptive statistics, ANOVAs, and Chi-Square tests. Individual and multivariate models were completed for: adult patients seen in a week; respondent years since residency; and adult patients with migraine seen in a week. RESULTS Respondents who saw fewer patients were more likely to indicate unclear patient histories were a barrier to diagnosing. Respondents who saw more patients with migraine were more likely to indicate the priority of other comorbidities and insufficient time were barriers to diagnosing. Respondents who had been out of residency longer were more likely to change a treatment plan due to attack impact, quality of life, and medication cost. Respondents who had been out of residency shorter were more likely to prefer to learn from migraine/headache research scientists and use paper headache diaries. CONCLUSIONS Results demonstrate differences in familiarity with migraine diagnosis and treatment options based on patients seen and years since residency. To maximise appropriate diagnosis within primary care, targeted efforts to increase familiarity and decrease barriers to migraine care should be implemented.
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Affiliation(s)
- Elisabeth Callen
- American Academy of Family Physicians, Leawood, KS, United States
| | - Tarin Clay
- American Academy of Family Physicians, Leawood, KS, United States
| | - Jillian Alai
- American Academy of Family Physicians, Leawood, KS, United States
| | - Paul Crawford
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Adam Visconti
- Department of Family Medicine, MedStar Georgetown University, Washington, DC, United States
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Inez Cruz
- Department of Family and Community Medicine, University of Texas Health San Antonio, San Antonio, TX, United States
| | - Bailey Perez
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Karen L Roper
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Graves E, Cowling T, McMullen S, Ekwaru P, Pham T, Mayer M, Ladouceur MP, Hubert M, Bougie J, Amoozegar F. Migraine Treatment and Healthcare Resource Utilization in Alberta, Canada. Can J Neurol Sci 2023:1-11. [PMID: 37842773 DOI: 10.1017/cjn.2023.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Migraine poses a significant burden worldwide; however, there is limited evidence as to the burden in Canada. This study examined the treatment patterns, healthcare resource use (HRU), and costs among newly diagnosed or recurrent patients with migraine in Alberta, Canada, from the time of diagnosis or recurrence. METHODS This retrospective observational study utilized administrative health data from Alberta, Canada. Patients were included in the Total Migraine Cohort if they had: (1) ≥1 International Classification of Diseases diagnostic code for migraine; or (2) ≥1 prescription dispense(s) for triptans from April 1, 2012, to March 31, 2018, with no previous diagnosis or dispensation code from April 1, 2010, to April 1, 2012. RESULTS The mean age of the cohort (n = 199,931) was 40.0 years and 72.3% were women. The most common comorbidity was depression (19.7%). In each medication class examined, less than one-third of the cohort was prescribed triptans and fewer than one-fifth was prescribed a preventive. Among patients with ≥1 dispense, the mean rate of opioid prescriptions was 4.61 per patient-year, compared to 2.28 triptan prescriptions per patient-year. Migraine-related HRU accounted for 3%-10% of all use. CONCLUSION Comorbidities and high all-cause HRU were observed among newly diagnosed or recurrent patients with migraine. There is an underutilization of acute and preventive medications in the management of migraine. The high rate of opioid use reinforces the suboptimal management of migraine in Alberta. Migraine management may improve by educating healthcare professionals to optimize treatment strategies.
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Affiliation(s)
- Erin Graves
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | - Tara Cowling
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | | | - Paul Ekwaru
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | - Tram Pham
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | - Michelle Mayer
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | | | | | | | - Farnaz Amoozegar
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Matsumori Y, Ishida M, Iba K, Kim BK, Ning X, Nakai M, Koga N. Improved quality of life with fremanezumab in Japanese and Korean patients with episodic and chronic migraine: Results of two multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trials. Headache 2023; 63:1304-1313. [PMID: 37602905 DOI: 10.1111/head.14606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To evaluate quality of life (QoL) endpoints from two 12-week trials investigating fremanezumab efficacy and safety in Japanese/Korean patients with chronic (CM) or episodic (EM) migraine. BACKGROUND Migraine is a leading cause of disability and affects QoL considerably, interfering with work and daily activities, social and family life, and emotional wellbeing. METHODS This planned exploratory analysis used data from two multicenter, randomized, double-blind, placebo-controlled, parallel-group studies in which Migraine-Specific QoL (MSQoL; Role Function-Restrictive [RR], Role Function-Preventive [RP], and Emotional Function [EF] domains) scores and Patient Global Impression of Change (PGIC) scores were pre-specified QoL outcomes in individuals receiving monthly or quarterly fremanezumab or placebo. In both trials, MSQoL was assessed at baseline, and MSQoL and PGIC at Weeks 4, 8, and 12. PGIC responders had a score of ≥5 points, indicating significant improvement. RESULTS Mean baseline MSQoL scores were similar across groups in both CM (N = 565; RR, 60.3-61.5; RP, 78.5-80.0; EF, 69.0-71.4) and EM (N = 353; RR, 68.6-71.1; RP, 83.1-85.7; EF, 76.7-81.9) trials. In the CM trial, all three MSQoL domains improved in both fremanezumab groups at 12 weeks compared with placebo: least squares mean (LSM) and standard error (SE) change from baseline, p versus placebo (quarterly; monthly; placebo): RR 14.9 (1.3), p = 0.030; 15.1 (1.4), p = 0.020; 11.6 (1.3); RP 8.9 (1.1), p = 0.007; 8.6 (1.1), p = 0.013; 5.4 (1.1); EF 13.3 (1.5), p < 0.001; 12.5 (1.5), p = 0.003; 7.5 (1.5). In the EM trial, RR/EF domains improved in both fremanezumab groups compared with placebo: LSM change from baseline, p versus placebo (quarterly; monthly; placebo): RR 16.3 (1.4), p = 0.003; 16.4 (1.3), p = 0.002; 11.6 (1.4); EF 13.0 (1.3), p < 0.001; 11.5 (1.2), p = 0.004; 7.4 (1.3); RP improved in the quarterly group RP 8.6 (1.1), p = 0.010; 7.6 (1.1), p = 0.066; 5.4 (1.1). The proportion of PGIC responders at Week 12 was greater in the monthly and quarterly fremanezumab groups compared with the placebo group in the CM (96/182 [52.7%] and 98/180 [54.4%] vs. 68/179 [38.0%]; p < 0.05) and EM trial (81/118 [68.6%] and 86/113 [76.1%] vs. 38/111 [34.2%]; p < 0.001). CONCLUSION Patients with EM/CM receiving monthly or quarterly fremanezumab, for a duration of 12 weeks, showed significant improvements in their QoL.
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Affiliation(s)
| | - Miki Ishida
- Headquarters of Clinical Development, Otsuka Pharmaceutical Co., Ltd., Osaka, Japan
| | - Katsuhiro Iba
- Headquarters of Clinical Development, Otsuka Pharmaceutical Co., Ltd., Osaka, Japan
| | - Byung-Kun Kim
- Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Xiaoping Ning
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, Pennsylvania, USA
| | - Masami Nakai
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Osaka, Japan
| | - Nobuyuki Koga
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Tokushima, Japan
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Davis L, Torphy B. Managing migraine on the frontline: Identifying disease, understanding burden, and incorporating CGRP pathway-targeting therapies in primary care. Br J Pain 2022; 16:560-573. [PMID: 36389011 PMCID: PMC9644104 DOI: 10.1177/20494637221104292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Migraine is a common neurologic disorder with clinical phenotypes encompassing a variety of symptoms which all contribute to the burden felt by patients. In addition to negative impacts on a patient's quality of life, migraine has both direct medical costs and indirect costs related to missed work and decreased productivity that affect individuals as well as society at large. Unfortunately, migraine diagnoses are often missed, and many patients do not receive appropriate treatment. Primary care providers are in a key position to provide timely diagnosis and effectively manage migraine for many patients. This review aims to be a guide for improving migraine management in the primary care setting by providing strategies to overcome common challenges in migraine diagnosis; summarizing current knowledge on the mechanism of action, efficacy, and safety of calcitonin gene-related peptide (CGRP) pathway-targeting therapies; and reviewing approaches to incorporate traditional and emerging treatment options into a patient-centric migraine management strategy.
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Affiliation(s)
- Linda Davis
- Kolvita Family Medical
Group, Mission Viejo, CA, USA
| | - Brad Torphy
- Chicago Headache Center and Research
Institute, Chicago, IL, USA
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Abstract
In light of the multiple pharmacologic alternatives for migraine management, the adverse effects associated with different treatment regimens, and their varying efficacy, it is vital to undertake ongoing evaluations and seek a tailored therapeutic strategy. This case report describes two patients who presented with classic migraine headaches, with the first responding to both abortive and prophylactic migraine medications and the second, with status migrainosus-like presentation, responding to the newer antimigraine agents. We also examined current pharmacological therapeutic options and existing recommendations, analyzing their strengths and weaknesses. This case review exemplifies how treatment in the last 10 years and success in medications used for abortive and prophylactic therapy are evolving from the older agents to newer agents like the recently approved calcitonin gene receptor protein monoclonal antibody inhibitors.
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