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Santos-Lasaosa S, Belvís R, Cuadrado ML, Díaz-Insa S, Gago-Veiga A, Guerrero-Peral AL, Huerta M, Irimia P, Láinez JM, Latorre G, Leira R, Pascual J, Porta-Etessam J, Sánchez Del Río M, Viguera J, Pozo-Rosich P. Calcitonin gene-related peptide in migraine: from pathophysiology to treatment. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:390-402. [PMID: 35672126 DOI: 10.1016/j.nrleng.2019.03.025] [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] [Received: 12/20/2018] [Accepted: 03/07/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.
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Affiliation(s)
- S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.
| | - R Belvís
- Unidad de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M L Cuadrado
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S Díaz-Insa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Fe, Valencia, Spain
| | - A Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - A L Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación de Salamanca (IBSAL), Spain
| | - M Huerta
- Sección de Neurología, Hospital de Viladecans, Barcelona, Spain
| | - P Irimia
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Spain
| | - J M Láinez
- Servicio de Neurología, Hospital Clínico Universitario de Valencia, Universidad Católica de Valencia, Valencia, Spain
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - R Leira
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - J Pascual
- Hospital Universitario Marqués de Valdecilla e IDIVAL, Santander, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - M Sánchez Del Río
- Departamento de Neurología, Clínica Universidad de Navarra, Madrid, Spain
| | - J Viguera
- Consulta de Cefalea, Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grupo de Investigación en Cefalea, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
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Santos-Lasaosa S, Belvís R, Cuadrado ML, Díaz-Insa S, Gago-Veiga A, Guerrero-Peral AL, Huerta M, Irimia P, Láinez JM, Latorre G, Leira R, Pascual J, Porta-Etessam J, Sánchez Del Río M, Viguera J, Pozo-Rosich P. Calcitonin gene-related peptide in migraine: from pathophysiology to treatment. Neurologia 2022; 37:390-402. [PMID: 31326215 DOI: 10.1016/j.nrl.2019.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/07/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.
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Affiliation(s)
- S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto Aragonés de Ciencias de la Salud, Zaragoza, España.
| | - R Belvís
- Unidad de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M L Cuadrado
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - S Díaz-Insa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Fe, Valencia, España
| | - A Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, España
| | - A L Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación de Salamanca (IBSAL), España
| | - M Huerta
- Sección de Neurología, Hospital de Viladecans, Barcelona, España
| | - P Irimia
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, España
| | - J M Láinez
- Servicio de Neurología, Hospital Clínico Universitario de Valencia. Universidad Católica de Valencia, Valencia, España
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada. Universidad Rey Juan Carlos, Madrid, España
| | - R Leira
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J Pascual
- Hospital Universitario Marqués de Valdecilla e IDIVAL, Santander, España
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - M Sánchez Del Río
- Departamento de Neurología, Clínica Universidad de Navarra, Madrid, España
| | - J Viguera
- Consulta de Cefalea, Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Investigación en Cefalea; VHIR; Universitat Autònoma de Barcelona, Barcelona, España
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Mingazova LR, Orlova OR, Soiher MI, Bychenko VG, Komissarova NV. [The effectiveness of botulinum therapy of trigeminal neuralgia]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:40-45. [PMID: 34283528 DOI: 10.17116/jnevro202112106140] [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: 11/17/2022]
Abstract
OBJECTIVE To evaluate the treatment protocol with the use of onabotulinum toxin type A (botox) and the efficacy of a single botulinum therapy procedure for clinical manifestations in patients with trigeminal neuralgia (TN). MATERIAL AND METHODS We studied 90 patients (57 women, 33 men), including 80 people with primary TN and 10 people with secondary TN. Then 20 patients with primary TN (11 women and 9 men, mean age 61.8 years) received local injections of onabotulinum toxin type A (botox). Clinical examination included taking anamnesis, assessment of pain on a visual analogue scale (VAS), assessment of the frequency of pain paroxysms, taking into account the average indicator (0 to 100 seizures during the day); neurosensory examination according to the developed protocol with the definition of pain, temperature, tactile sensitivity, the study of stimulus-dependent pain; MRI of the brain to diagnose neurovascular conflict. RESULTS A month after the injections, the pain intensity practically did not change (8.5 versus 7.2 points on the VAS), but the number of paroxysms decreased (31.2 versus 22.5 seizures per day). Two months after the use of botox, the number of pain attacks continued to decrease (31.2 versus 17.7; Mann-Whitney U-test, p=0.006). At the same time, there was a decrease in pain intensity according to the VAS (8.5 versus 6.1, t-test 2.75 points; p=0.02). After three months, there was a decrease in the number of paroxysms from 31.2 to 9.2 (paired Student's test, p<0.001) and the severity of pain (8.85 versus 4.0 points on the VAS, paired t-test 3.95 points, p<0.001). There were significant differences in the average dose of carbamazepine (867.5 versus 670.8 after 3 months, t-test 196.7 mg, p=0.02). In TN patients who underwent destructive operations with exposure to the peripheral branches of the trigeminal nerve, signs of severe neurosensory deficit on the face and burning pain are added to the main symptoms, which corresponds to the clinical criteria of post-traumatic trigeminal neuropathy. CONCLUSION Local injections of type A onabotulinum toxin (botox) are minimally invasive, safe and effective symptomatic therapy for patients with TN. Persistent sensory disturbances that develop in patients after destructive surgeries call into question the safety of these therapies for TN.
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Affiliation(s)
- L R Mingazova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O R Orlova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M I Soiher
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V G Bychenko
- Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
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Efficacy of calcitonin gene-related peptide (CGRP) receptor blockers in reducing the number of monthly migraine headache days (MHDs): A network meta-analysis of randomized controlled trials. J Neurol Sci 2021; 427:117505. [PMID: 34082147 DOI: 10.1016/j.jns.2021.117505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/27/2021] [Accepted: 05/18/2021] [Indexed: 12/11/2022]
Abstract
The Global burden of disease study ranked migraine as the sixth most common disorder worldwide in 2016, with significant social and economic sequelae. In this study, we assessed the efficacy of different Calcitonin gene-related peptide (CGRP) receptor blockers as potential pharmacological approaches and compare them to placebo using the systematic review (SR) and network meta-analysis (NMA) approach. We performed a computerized search of SCOPUS, PubMed, Cochrane central, and Embase databases through January 2019 and included randomized controlled trials (RCTs), which were performed on episodic and chronic migraine patients who used Erenumab, Eptinezumab, Fremanezumab, or Galcanezumab. The combined analysis revealed that after six, eight, and twelve weeks of intervention, the medications with the most potent effects in comparison to placebo were Fremanezumab 900 mg, (SMD = -0.55, 95% CI [-0.97, -0.12]); Erenumab 140 mg, (SMD = -0.51, 95% CI [-0.61, 0.41]); and Erenumab 140 mg, (SMD = -0.48, 95% CI [-0.571, 0.39]), respectively. For chronic migraine patients, Fremanezumab 900 mg, Erenumab 140 mg, in addition to Erenumab 70 mg, were associated with the highest efficacy after 6, 8, and 12 weeks, correspondingly. The analysis of combined groups data (Chronic and Episodic) showed that Fremanezumab was the most effective drug after six weeks, where Erenumab was the most effective after 8 and 12 weeks. The current evidence retrieved from this NMA suggests that Fremanezumab was the most effective anti-migraine medication in decreasing MHDs per month after six weeks in both chronic and episodic patients.
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Wu S, Lian Y, Zhang H, Chen Y, Wu C, Li S, Zheng Y, Wang Y, Cheng W, Huang Z. Botulinum Toxin Type A for refractory trigeminal neuralgia in older patients: a better therapeutic effect. J Pain Res 2019; 12:2177-2186. [PMID: 31410051 PMCID: PMC6643497 DOI: 10.2147/jpr.s205467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background Some studies have indicated that a local injection of Botulinum Toxin Type A (BTX-A) is a promising therapy for trigeminal neuralgia (TN). However, BTX-A treatment is still ineffective for approximately 10-43% of patients. We therefore investigated which factors are associated with the therapeutic effect in BTX-A treatment of medically refractory, classical TN. Methods We performed a retrospective cohort study with a total of 104 patients who were receiving BTX-A injection for medically refractory classical TN between August 2013 and October 2016. A VAS score, pain attack frequency per day as well as patients' overall response to treatment and side effects were evaluated in 104 patients with TN who were receiving BTX-A. Results A total of 87 patients reported successful results; 41 stated that their pain was completely controlled while 46 reported adequate pain relief, totaling 83.7%. Our study suggests that treatment success was higher in patients 50 or older (OR=3.66, 95% CI: 1.231-10.885). Univariate and multivariate analyses demonstrated that the patient's age was independently associated with treatment outcome (OR=1.72, 95% CI: 1.063-2.282), with ≥50 years being a significant predictor of pain relief (P=0.020 and P=0.033, respectively). Seventeen patients (16.3%) reported mild side effects. Conclusion A local injection of BTX-A may be a safe and efficient treatment for classical TN which lasts for several months. BTX-A is a novel strategy which is particularly worth trying for particularly middle-aged and elderly patients who cannot tolerate drug side effects and may be afraid of serious complications from microvascular decompression.
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Affiliation(s)
- Shouyi Wu
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Haifeng Zhang
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yuan Chen
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Chuanjie Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shuang Li
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yake Zheng
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yuhan Wang
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Wenchao Cheng
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Zhi Huang
- Department of Neurology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
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Negro A, Martelletti P. Patient selection for migraine preventive treatment with anti-CGRP(r) monoclonal antibodies. Expert Rev Neurother 2019; 19:769-776. [DOI: 10.1080/14737175.2019.1621749] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy
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Tajti J, Szok D, Nyári A, Vécsei L. Therapeutic strategies that act on the peripheral nervous system in primary headache disorders. Expert Rev Neurother 2019; 19:509-533. [DOI: 10.1080/14737175.2019.1615447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- János Tajti
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Délia Szok
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Aliz Nyári
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group of the Hungarian Academy of Sciences, Szeged, Hungary
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García-Azorin D, Santos-Lasaosa S, Gago-Veiga AB, Viguera Romero J, Guerrero-Peral AL. Real world preventative drug management of migraine among Spanish neurologists. J Headache Pain 2019; 20:19. [PMID: 30770719 PMCID: PMC6734505 DOI: 10.1186/s10194-019-0971-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/11/2019] [Indexed: 01/06/2023] Open
Abstract
Background Many different preventatives have showed efficacy in the treatment of migraine. National guidelines differ in their recommendations and patients’ characteristics are usually taken into account in their selection. In Spain, real life use of preventive therapies seems to be heterogeneous. We aimed to evaluate differences in clinical practice and adherence to national guidelines among Spanish neurologists. Methods Observational descriptive study. A survey was conducted among neurologists ascribed to the Spanish Society of Neurology. Participants were differentiated in accordance with their dedication to headache disorders. We analysed socio-demographic parameters and evaluated 43 questions considering migraine management as well as therapeutic choices regarding migraine sub-types and finally, neurologists’ personal perception. Results One hundred fifty-five neurologists participated from 17 different regions, 43.4% of them female and 53.3% under 40 years of age. 34.9% confirmed headache disorders as their main interest. The first choice for preventive therapy in chronic migraine among participants was topiramate (57%) followed by amytriptiline (17.9%) and beta-blockers (14.6%). However in episodic migraine, the preferred options were beta-blockers (47.7%), topiramate (21.5%) and amytriptiline (13.4%). Regarding perceived efficacy, topiramate was considered the best option in chronic migraine (42.7%) followed by onabotulinumtoxinA (25.5%) and amitryptiline (22.4%). Where episodic migraine was concerned, surveyed neurologists perceived topiramate (43.7%) and beta-blockers (30.3%) as the best options. When we evaluated the duration of treatment use with a view to adequate therapeutic response, 43.5% of neurologists preferred 3 months duration and 39.5% were in favour of 6 months duration in episodic migraine. However, considering the preferred duration of treatment use in chronic migraine, 20.4% recommended 3 months, 42.1% preferred 6 months and 12.5% and 22.4% opted for 9 and 12 months respectively. When considering onabotulinumtoxinA therapy, the number of prior therapeutic failures was zero in 7.2% of neurologists, one in 5.9%, two in 44.1%, three in 30.9% and four or more in 11.9%. Following an initial treatment failure with onabotulinumtoxinA, 49% of subjects decided against a second treatment. The number of OnabotA procedures before considering it as ineffective was two in 18.9% of neurologists, three in 70.8% and four in 10.4%. Conclusions The initial management of migraine among Spanish Neurologists is in line with most guidelines, where first choice preventative drugs are concerned. The Management of episodic migraine differed from chronic migraine, both in terms of neurologist preference and in their perceived efficacy. Electronic supplementary material The online version of this article (10.1186/s10194-019-0971-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D García-Azorin
- Headache Unit, Neurology Department, Hospital Universitario Clínico de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain.
| | - S Santos-Lasaosa
- Headache Unit. Neurology Departmente, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A B Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - J Viguera Romero
- Headache Unit, Neuroscience Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A L Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Universitario Clínico de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain.,Institute for Biomedical Research of Salamanca, IBSAL, Salamanca, Spain
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Cowan RP. The Future of Migraine Prevention. Headache 2018; 58 Suppl 3:291-297. [DOI: 10.1111/head.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
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Abstract
BACKGROUND AND OBJECTIVES While existing studies about onabotulinumtoxinA for chronic migraines have focused on injection location and appropriate dosing, little consideration has been given to patient body habitus and its potential impact on efficacy. We hypothesized that with increasing patient body mass index (BMI) there would be more subcutaneous fat separating targeted muscle groups from the skin surface, such that standard 0.5-inch needles used in existing protocols may not allow intramuscular injection. This may have implications for treatment planning. METHODS Anatomically normal computed tomography scans of the head, neck, and face were randomly selected. Subjects were stratified into 4 groups based on BMI, with 30 patients in each group. Four standardized locations were chosen to obtain measurements from the skin surface to the underlying muscle fascia, including (1) frontalis, (2) temporalis, (3) semispinalis capitis, and (4) trapezius. RESULTS Median depth for the temporalis was 12.65 mm (Q1 = 9.32 mm, Q3 = 15.08 mm) for the BMI greater than 35 kg/m group. Median depth for the semispinalis capitis was 13.77 mm (Q1 = 10.3 mm, Q3 = 15.7 mm) for the BMI 30 to 35 kg/m group, and 14.75 mm (Q1 = 11.00, Q3 = 17.00 mm) for the BMI greater than 35 kg/m group. Median depth for the trapezius was 13.95 mm (Q1 = 10.18 mm, Q3 = 19.00 mm) for the BMI greater than 35 kg/m group. These medians exceeded the length of the standard 0.5-inch (12.-mm) needle used in existing protocols. CONCLUSIONS Our study demonstrates that with increasing BMI there is a greater distance between the skin surface and the muscle fascia of muscles that are targeted for injection in standard chronic migraine botulinum toxin injection protocols. Because of this, patient body habitus may be an important factor in injection technique.
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Vikelis M, Argyriou AA, Dermitzakis EV, Spingos KC, Makris N, Kararizou E. Sustained onabotulinumtoxinA therapeutic benefits in patients with chronic migraine over 3 years of treatment. J Headache Pain 2018; 19:87. [PMID: 30225735 PMCID: PMC6755578 DOI: 10.1186/s10194-018-0918-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022] Open
Abstract
Background Evidence on whether the therapeutic effect and good safety profile of onabotulinumtoxinA (Botox®) in chronic migraine (CM) patients is maintained over long term treatment is still limited. We herein aimed at assessing whether there is a sustained benefit and good safety with repeated onabotulinumtoxinA sessions in CM over more than three years of treatment. Methods We prospectively enrolled 65 CM patients, who were classified as responders after three sessions of onabotulinumtoxinA and were eligible to further continue treatment. Data documenting longitudinal changes from the trimester after the third onabotulinumtoxinA administration (T1) to the trimester after completing two years of treatment (T2) and eventually to the trimester after completing three years of treatment (T3) in (i) mean number of monthly headache days (ii) migraine severity as expressed by the mean number of days with peak headache intensity of > 4/10, and (iii) mean number of days with use of any acute headache medication, were prospectively collected from patients’ headache diaries. Results A total of 56 (86.1%) of 65 patients achieved to attain onabotulinumtoxinA over three years. At T3, a significant reduction in mean monthly headache days was evident, compared to T1 (3.4 ± 1.7 vs 7.2 ± 3.8; P < 0.001) with diminished mean number of monthly days with peak headache intensity of more than 4/10 and a significant change in days using acute headache medications per month between T1 and T3 (2.8 ± 1.3 vs 4.7 ± 3.2; P < 0.001). Significant changes were also noticed in all efficacy variables from T2 to T3. Therapy was safe and well tolerated with low rates of adverse events or drop-outs. Conclusion The long -term treatment with onabotulinumtoxinA proved effective, safe and well tolerated over three years. Our findings support the strategy to consistently deliver sessions of use of onabotulinumtoxinΑ over long time in CM patients (Trial registration NTC03606356, registered retrospectively, 28 July 2018).
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Affiliation(s)
- Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, Glyfada, Greece. .,Glyfada Headache Clinic, 8 Lazaraki Str, 16675, Glyfada, Greece. .,Headache Outpatient Clinic, 1st Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece.
| | - Andreas A Argyriou
- Neurology Department, Saint Andrew's State General Hospital of Patras, Patras, Greece
| | | | | | - Nikolaos Makris
- Neurology Department, Saint Andrew's State General Hospital of Patras, Patras, Greece
| | - Evangelia Kararizou
- Headache Outpatient Clinic, 1st Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
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Martelletti P. The Application of CGRP(r) Monoclonal Antibodies in Migraine Spectrum: Needs and Priorities. BioDrugs 2018; 31:483-485. [PMID: 29124668 DOI: 10.1007/s40259-017-0251-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Migraine is among the highest impact illnesses in the global population. Its negative ramifications are personal, social, economic and work related. Research on the development of new preventative migraine therapies has been idle for decades. The introduction, shortly, of an innovative pharmacological class useful for migraine prevention, namely monoclonal antibodies towards calcitonin gene-related peptide or its receptor, opens a new, immense therapeutic scenario. The necessity to manage the chronic and refractory forms of migraine must not take our attention away from the target of the pre-chronic forms. This is the most important target in every study. Indeed, by reducing the evolution towards chronic and consequently refractory chronic migraine, we will reduce complications caused by pharmacological abuse, the serious disability of these devastating chronic states, and the healthcare expenses needed to manage chronicity, abuse and consequent pathologies. We will, lastly, be able to rehabilitate these patients to achieve a quality working and social life, and facilitate their reintegration into daily normality.
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Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy. .,Regional Referral Headache Centre, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
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13
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Martelletti P. The journey from genetic predisposition to medication overuse headache to its acquisition as sequela of chronic migraine. J Headache Pain 2018; 19:2. [PMID: 29322261 PMCID: PMC5762616 DOI: 10.1186/s10194-017-0830-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/25/2017] [Indexed: 12/12/2022] Open
Abstract
Migraine remains one of the biggest clinical case to be solved among the non-communicable diseases, second to low back pain for disability caused as reported by the Global Burden of Disease Study 2016. Despite this, its genetics roots are still unknown. Its evolution in chronic forms hits 2–4% of the population and causes a form so far defined Medication Overuse Headache (MOH), whose pathophysiological basis have not been explained by many dedicated studies. The Global Burden of Disease Study 2016 has not recognized MOH as independent entity, but as a sequela of Chronic Migraine. This concept, already reported in previous studies, has been confirmed by the efficacy of OnabotulinumtoxinA in Chronic Migraine independently from the presence of MOH. The consistency of the current definitions of both Medication Overuse Headache and Chronic Migraine itself might be re-read on the basis of new evidences.
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Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy. .,Regional Referral Headache Centre, Sant'Andrea Hospital, Via di Grottarossa, 1035, 00189, Rome, Italy.
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14
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Giamberardino MA, Affaitati G, Costantini R, Cipollone F, Martelletti P. Calcitonin gene-related peptide receptor as a novel target for the management of people with episodic migraine: current evidence and safety profile of erenumab. J Pain Res 2017; 10:2751-2760. [PMID: 29263689 PMCID: PMC5727105 DOI: 10.2147/jpr.s128143] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Migraine is a highly disabling neurological condition, and preventative treatment still remains problematic, due to aspecificity of the majority of the currently available prophylactic drugs. Calcitonin-gene-related peptide (CGRP) plays a crucial role in migraine pathophysiology; agents aimed at blocking its activity have, therefore, been developed in recent years, among which are monoclonal antibodies (mAbs) against CGRP, to prevent migraine. Erenumab is the only mAb that targets the CGRP receptor instead of the ligand, with high specificity and affinity of binding. This review will report on the most recent data on erenumab characteristics and on the results of clinical trials on its employment in the prevention of episodic migraine (4–14 monthly migraine days): one Phase II and two Phase III trials (completed) and one Phase III trial (ongoing). Monthly subcutaneous administration (70 mg or 140 mg) of erenumab vs placebo for 3–6 months showed significantly higher efficacy in reducing the mean monthly number of migraine days and the use of migraine-specific medication, and in decreasing physical impairment and impact of migraine on everyday activities (P<0.001). A favorable safety profile was demonstrated by the lack of significant differences in the occurrence of adverse events in erenumab-treated vs placebo-treated patients. Global results so far obtained point to erenumab as a new promising candidate for the preventative treatment of episodic migraine. Licence applications for erenumab were recently submitted to the Food and Drug Administration in the USA and European Medicines Agency in Europe (May/June 2017).
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Affiliation(s)
- Maria Adele Giamberardino
- Department of Medicine and Science of Aging, Headache Center, Geriatrics Clinic and Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Giannapia Affaitati
- Department of Medicine and Science of Aging, Headache Center, Geriatrics Clinic and Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Raffaele Costantini
- Department of Medical, Oral and Biotechnological Sciences, Institute of Surgical Pathology, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Science of Aging, Medical Clinic and Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Regional Referral Headache Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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15
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Hou M, Xing H, Cai Y, Li B, Wang X, Li P, Hu X, Chen J. The effect and safety of monoclonal antibodies to calcitonin gene-related peptide and its receptor on migraine: a systematic review and meta-analysis. J Headache Pain 2017; 18:42. [PMID: 28389966 PMCID: PMC5383797 DOI: 10.1186/s10194-017-0750-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/22/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Migraine has been recognized as one of the leading causes of disability in the 2013 Global Burden of Disease Study and seriously affects the quality of patients' life, current treatment options are not ideal. Monoclonal antibodies to calcitonin gene-related peptide and its receptor (CGRP-mAbs) appear more promising for migraine because of considerably better effect and safety profiles. The objective of this study is to systematically assess the clinical efficacy and safety of CGRP-mAbs for migraine therapy. METHODS A systematic literature search in PubMed, Cochrane Library and Baidu Scholar was performed to identify randomized controlled trials (RCTs), which compared the effect and safety of CGRP-mAbs with placebo on migraine. Regarding the efficacy, the reduction of monthly migraine days from baseline to weeks 1-4, 5-8, and 9-12; responder rates were extracted as the outcome measures of the effects of CGRP-mAbs. Regarding the safety, total adverse events, the main adverse events, and other adverse events were evaluated. RESULTS We found significant reduction of monthly migraine days in CGRP-mAbs vs. placebo (weeks 1-4: SMD -0.49, 95% CI -0.61 to -0.36; weeks 5-8: SMD -0.43, 95% CI -0.56 to -0.30; weeks 9-12: SMD -0.37, 95% CI -0.49 to -0.24). 50% and 75% responder rates (OR 2.59, 95% CI 1.99 to 3.37; and OR 2.91, 95% CI 2.06 to 4.10) were significantly increased compared with placebo. There was no significant difference in total adverse events (OR 1.17, 95% CI 0.91 to 1.51), and the main adverse events including upper respiratory tract infection (OR 1.44, 95% CI 0.82 to 2.55), nasopharyngitis (OR 0.59, 95% CI 0.30 to 1.16), nausea (OR 0.61, 95% CI 0.29 to 1.32), injection-site pain (OR 1.73, 95% CI 0.95 to 3.16) and back pain (OR 0.97, 95% CI 0.49 to 1.90) were not obviously changed compared with placebo control, but the results showed significant increase of dizziness in CGRP-mAbs vs. placebo (OR 3.22, 95% CI 1.09 to 9.45). CONCLUSIONS This meta-analysis suggests that CGRP-mAbs are effective in anti-migraine therapy with few adverse reactions, but more and larger sample-size RCTs are required to verify the current findings.
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Affiliation(s)
- Min Hou
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Haiyan Xing
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Yongqing Cai
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Bin Li
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Xianfeng Wang
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Pan Li
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China
| | - Xiaolin Hu
- China Pharmacy Publishing House, Chongqing, 500000, People's Republic of China
| | - Jianhong Chen
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China.
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16
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Negro A, Curto M, Lionetto L, Guerzoni S, Pini LA, Martelletti P. A Critical Evaluation on MOH Current Treatments. Curr Treat Options Neurol 2017; 19:32. [PMID: 28808924 DOI: 10.1007/s11940-017-0465-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Migraine is the most frequent neurological disorder observed in clinical practice characterized by moderate to severe pain attacks associated with neurological, gastrointestinal, and dysautonomic symptoms. Each year, 2.5% of patients with episodic migraine develop chronic migraine (CM). CM is characterized by high frequency of the attacks that may result into chronic intake of abortive medications. Nearly, the 70% of CM patients referring to tertiary head centers show acute pain medications overuse that may lead to the development of medication overuse headache (MOH). The management of MOH requires three steps: (1) education, (2) withdrawal of the overuse drug and detoxification, and (3) re-prophylaxis. In the last years, several real-life prospective studies provided further evidence in clinical setting of the onabotulinumtoxinA 155-195 U efficacy for the headache prophylaxis in CM with MOH patients. There is a general agreement on two factors: (1) withdrawal of the overuse drug is condicio sine qua non to reverse the pattern to medium-low-frequency migraine, and (2) the focus of management needs to shift from acute treatment of pain to prevention of headache. CM patients close to developing MOH, patients with high-frequency episodic migraine, and those already abusing of drugs require special attention and should refer to tertiary headache centers. For all of them, a solution could be an "early treatment." Early should be their referral to a tertiary headache center, early should be the withdrawal of the overuse drug and a proper detoxification, and perhaps early should be the start of a preventative therapy.
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Affiliation(s)
- Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy. .,Regional Referral Headache Centre, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00191, Rome, Italy.
| | - Martina Curto
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, IDI Istituto Dermopatico dell'Immacolata - IRCSS, Rome, Italy
| | - Simona Guerzoni
- Department of Diagnostic and Clinical Medicine and Public Health, Proteomic Lab, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Alberto Pini
- Department of Diagnostic and Clinical Medicine and Public Health, Proteomic Lab, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00191, Rome, Italy
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17
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Zhang H, Lian Y, Xie N, Chen C, Zheng Y. Single-dose botulinum toxin type a compared with repeated-dose for treatment of trigeminal neuralgia: a pilot study. J Headache Pain 2017; 18:81. [PMID: 28799056 PMCID: PMC5552618 DOI: 10.1186/s10194-017-0793-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/04/2017] [Indexed: 11/25/2022] Open
Abstract
Background Several RCT studies including ours, seem to prove the role of Botulinum toxin type A (BTX-A) in the treatment of trigeminal neuralgia (TN), but no standardized dosing regimen has been established. In our study, we compare two different methods of administration: single-dose or repeated-dose strategy which was most frequently applied over the years in our centre. Methods An open-label trail was conducted. One hundred patients with classic TN symptoms were recruited, and randomly and equally apportioned to single- or repeated-dose group. Patients in the single-dose group received a local BTX-A injection of 70 to 100 U. The repeated-dose group received an initial BTX-A injection of 50 to 70 U and then another of equal volume 2 weeks later. All patients were followed for 6 months. Results In the single- and repeated-dose groups, 44 and 37, respectively, completed the entire study. The groups were statistically similar in TN frequency, time between treatment and effect, time to peak effect, VAS scores, and rates of adverse reactions (latency and duration). However, the single-dose group experienced significantly longer duration of effect (P = 0.032). Conclusions The single- and repeated-dosing BTX-A regimens were largely comparable in efficacy and safety. This study suggests that repeated dosing has no advantage over single dosing of BTX-A for TN. Dosing should be adjusted for the individual patient.
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Affiliation(s)
- Haifeng Zhang
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China
| | - Yajun Lian
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China.
| | - Nanchang Xie
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China
| | - Chen Chen
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China
| | - Yake Zheng
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East R, Zhengzhou City, HeNan Province, 450052, People's Republic of China
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18
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Affiliation(s)
- Paolo Martelletti
- a Department of Clinical and Molecular Medicine , Sapienza University , Rome , Italy
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19
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Pellesi L, Guerzoni S, Pini LA. Spotlight on Anti-CGRP Monoclonal Antibodies in Migraine: The Clinical Evidence to Date. Clin Pharmacol Drug Dev 2017; 6:534-547. [PMID: 28409893 PMCID: PMC5697612 DOI: 10.1002/cpdd.345] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/27/2017] [Indexed: 12/16/2022]
Abstract
Migraine, a common neurovascular brain disorder, represents a severe and widespread health problem; along with medication‐induced (medication‐overuse) headache, it is the third‐leading cause of disability worldwide. Currently, its therapeutic management remains unsatisfactory for several reasons; up to 40% of migraineurs are eligible for prophylactic treatment, but there are issues of efficacy, safety, and adherence. In recent years the evidence on the role of calcitonin gene‐related peptide (CGRP) in migraine pathophysiology has been consolidated, so new and promising treatments for migraine pain and its possible prevention have been developed. The following review reports the results of the clinical trials conducted so far with each of the new monoclonal antibodies targeting CGRP or its receptor, with particular reference to safety, tolerance, and efficacy in migraine prevention. Moreover, the pharmacological characterization and further developments of each monoclonal antibody are reported, based on current knowledge.
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Affiliation(s)
- Lanfranco Pellesi
- Medical Toxicology and Headache Center, Policlinic Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Guerzoni
- Medical Toxicology and Headache Center, Policlinic Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Alberto Pini
- Medical Toxicology and Headache Center, Policlinic Hospital, University of Modena and Reggio Emilia, Modena, Italy
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20
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Sandrini G, De Icco R, Tassorelli C, Smania N, Tamburin S. Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia. J Headache Pain 2017; 18:38. [PMID: 28324318 PMCID: PMC5360746 DOI: 10.1186/s10194-017-0744-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/10/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite their huge epidemiological impact, primary headaches, trigeminal neuralgia and other chronic pain conditions still receive suboptimal medical approach, even in developed countries. The limited efficacy of current pain-killers and prophylactic treatments stands among the main reasons for this phenomenon. Botulinum neurotoxin (BoNT) represents a well-established and licensed treatment for chronic migraine, but also an emerging treatment for other types of primary headache, trigeminal neuralgia, neuropathic pain, and an increasing number of pain conditions. METHODS We searched and critically reviewed evidence for the efficacy of BoNT for the treatment of chronic pain. RESULTS Meta-analyses and randomized controlled trials (RCTs) suggest that BoNT potentially represents a multi-purpose drug for the treatment of pain in several disorders due to a favorable safety profile and a long-lasting relief after a single injection. CONCLUSIONS BoNT is an emerging treatment in different pain conditions. Future RCTs should explore the use of BoNT injection therapy combined with systemic drugs and/or physical therapies as new pain treatment strategies.
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Affiliation(s)
- Giorgio Sandrini
- C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Roberto De Icco
- C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy.,Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy.
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21
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Aicua-Rapun I, Martínez-Velasco E, Rojo A, Hernando A, Ruiz M, Carreres A, Porqueres E, Herrero S, Iglesias F, Guerrero AL. Real-life data in 115 chronic migraine patients treated with Onabotulinumtoxin A during more than one year. J Headache Pain 2016; 17:112. [PMID: 27957623 PMCID: PMC5153399 DOI: 10.1186/s10194-016-0702-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/28/2016] [Indexed: 12/11/2022] Open
Abstract
Background OnabotulinumtoxinA (OnabotA) is effective in Chronic Migraine (CM) during first year of treatment and longer. In real clinical setting, CM patients with acute Medication Overuse (MO) or concurrently receiving oral preventatives are treated with OnabotA. We aim to assess evolution of CM patients beyond first year on OnabotA. Methods Data were retrospectively collected in three headache units. We analyzed cases who had received at least five sessions of OnabotA according to PREEMPT protocol. We continued OnabotA therapy when a reduction of number of headache days of at least 30% was achieved. Results We included 115 patients (98 females, 17 males) who completed 7.6 ± 2.3 (5–13) OnabotA procedures. Previously they had not responded to topiramate and, at least, one other preventative. Age at inclusion was 45.3 ± 12 (14–74) years, and latency between CM onset and OnabotA therapy was 43.1 ± 38.2 (6–166) months. At first OnabotA session 92 patients (80%) fulfilled MO criteria and 107 (93%) received a concurrent oral preventative. In 42 cases (36.5%) OnabotA dose was increased over 155 units. After first year in 57 out of 92 patients (61.9%) MO was discontinued. Among those receiving preventatives, in 52 out of 107 they were retired (48.6%). In 22 cases (19.1%) OnabotA administration was delayed to the fourth or fifth month and in 12 (10.4%) it was temporally stopped. Finally, in 18 patients (15.7%) OnabotA was discontinued due to lack of efficacy beyond first year of treatment. Conclusion Our results suggest that discontinuation of acute medication overuse and oral preventive therapies are achievable objectives in long-term using of OnabotA in CM patients.
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Affiliation(s)
- I Aicua-Rapun
- Neurology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - E Martínez-Velasco
- Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain
| | - A Rojo
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - A Hernando
- Neurology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - M Ruiz
- Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain
| | - A Carreres
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - E Porqueres
- Neurology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - S Herrero
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - F Iglesias
- Neurology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - A L Guerrero
- Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain.
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