1
|
Cascella RH, Anderson CC, Perez EJ. The impact of updates in headache quality measures on adherence to best practices in a neurology resident clinic: A quality improvement study. Headache 2024. [PMID: 38923523 DOI: 10.1111/head.14754] [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: 10/21/2023] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To apply the 2019 joint American Academy of Neurology (AAN) and American Headache Society (AHS) quality measures for headache management to a cohort of neurology resident physicians and then assess outcomes related to guideline adherence. BACKGROUND The optimization of headache management is essential to reduce both the individual and systemic impact of these disorders. In 2014, the AAN developed 10 quality measures for evidence-based management of patients with headache. A workgroup updated and condensed its headache quality measures in 2019, narrowing the set to six measurements, four of which would primarily focus on the management of migraine and two of which would address the management of cluster headache. METHODS This quality improvement study was conducted using a pretest-posttest study design. A pre-intervention survey based on retrospective analysis of five clinic notes for adherence to the measures was designed and distributed to all neurology residents (n = 32) at a large, academic tertiary referral center. The intervention included the creation of an electronic medical record template to aid residents in following the measures during clinical encounters, as well as the provision of direct feedback based on pre-intervention results. Finally, a post-intervention survey was distributed for completion based on notes written during the intervention period. Analysis was limited to migraine, given the low percentage of cluster headache seen in clinic. RESULTS An increase in adherence was seen in three of the four migraine-related quality measures, with the Use of Abortive Medications for Migraine and Documentation of Counseling on Modifiable Lifestyle and Chronification Factors demonstrating statistically significant improvements (75.8% to 88.0% [p = 0.013] and 83.9% to 94.0% [p = 0.029] adherence, respectively). For secondary outcomes, the increase in the utilization of appropriate diagnostic criteria (82.6% to 93.2%, p = 0.018) was significant, and the self-assessed confidence rating for adherence to guidelines was significant (p < 0.001). CONCLUSIONS This study provides evidence that the quality improvement intervention led to increased adherence to the AAN and AHS migraine-related measures. It is anticipated that increased adherence may lead to improved patient outcomes.
Collapse
Affiliation(s)
- Robert H Cascella
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Christopher C Anderson
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford Healthcare, Redwood City, California, USA
| | - Enmanuel J Perez
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| |
Collapse
|
2
|
Özge A, Baykan B, Bıçakçı Ş, Ertaş M, Atalar AÇ, Gümrü S, Karlı N. Revolutionizing migraine management: advances and challenges in CGRP-targeted therapies and their clinical implications. Front Neurol 2024; 15:1402569. [PMID: 38938785 PMCID: PMC11210524 DOI: 10.3389/fneur.2024.1402569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Migraine, a prevalent neurological disorder, affects approximately 14.1% of the global population and disproportionately impacts females. This debilitating condition significantly compromises quality of life, productivity, and incurs high healthcare costs, presenting a challenge not only to individuals but to societal structures as a whole. Despite advances in our understanding of migraine pathophysiology, treatment options remain limited, necessitating ongoing research into effective therapies. This review delves into the complexity of migraine management, examining the roles of genetic predisposition, environmental influences, personalized treatment approaches, comorbidities, efficacy and safety of existing acute and preventive treatments. It further explores the continuum between migraine and tension-type headaches and discusses the intricacies of treating various migraine subtypes, including those with and without aura. We emphasize the recent paradigm shift toward trigeminovascular activation and the release of vasoactive substances, such as calcitonin gene-related peptide (CGRP), which offer novel therapeutic targets. We assess groundbreaking clinical trials, pharmacokinetic and pharmacodynamic perspectives, safety, tolerability, and the real-world application of CGRP monoclonal antibodies and gepants. In the face of persisting treatment barriers such as misdiagnosis, medication overuse headaches, and limited access to specialist care, we discuss innovative CGRP-targeted strategies, the high cost and scarcity of long-term efficacy data, and suggest comprehensive solutions tailored to Turkiye and developing countries. The review offers strategic recommendations including the formulation of primary care guidelines, establishment of specialized outpatient clinics, updating physicians on novel treatments, enhancing global accessibility to advanced therapies, and fostering patient education. Emphasizing the importance of lifestyle modifications and holistic approaches, the review underscores the potential of mass media and patient groups in disseminating critical health information and shaping the future of migraine management.
Collapse
Affiliation(s)
- A. Özge
- Department of Neurology, Algology and Clinical Neurophysiology, Mersin University School of Medicine, Mersin, Türkiye
| | - B. Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ş. Bıçakçı
- Department of Neurology, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - M. Ertaş
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - A. Ç. Atalar
- Department of Neurology, University Health Sciences, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Türkiye
| | - S. Gümrü
- Pfizer Pharmaceuticals, Istanbul, Türkiye
| | - N. Karlı
- Department of Neurology, Faculty of Medicine, Uludag University, Bursa, Türkiye
| |
Collapse
|
3
|
Okada M, Katsuki M, Shimazu T, Takeshima T, Mitsufuji T, Ito Y, Ohbayashi K, Imai N, Miyahara J, Matsumori Y, Nakazato Y, Fujita K, Hoshino E, Yamamoto T. Preliminary External Validation Results of the Artificial Intelligence-Based Headache Diagnostic Model: A Multicenter Prospective Observational Study. Life (Basel) 2024; 14:744. [PMID: 38929727 PMCID: PMC11204521 DOI: 10.3390/life14060744] [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: 05/07/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
The misdiagnosis of headache disorders is a serious issue, and AI-based headache model diagnoses with external validation are scarce. We previously developed an artificial intelligence (AI)-based headache diagnosis model using a database of 4000 patients' questionnaires in a headache-specializing clinic and herein performed external validation prospectively. The validation cohort of 59 headache patients was prospectively collected from August 2023 to February 2024 at our or collaborating multicenter institutions. The ground truth was specialists' diagnoses based on the initial questionnaire and at least a one-month headache diary after the initial consultation. The diagnostic performance of the AI model was evaluated. The mean age was 42.55 ± 12.74 years, and 51/59 (86.67%) of the patients were female. No missing values were reported. Of the 59 patients, 56 (89.83%) had migraines or medication-overuse headaches, and 3 (5.08%) had tension-type headaches. No one had trigeminal autonomic cephalalgias or other headaches. The models' overall accuracy and kappa for the ground truth were 94.92% and 0.65 (95%CI 0.21-1.00), respectively. The sensitivity, specificity, precision, and F values for migraines were 98.21%, 66.67%, 98.21%, and 98.21%, respectively. There was disagreement between the AI diagnosis and the ground truth by headache specialists in two patients. This is the first external validation of the AI headache diagnosis model. Further data collection and external validation are required to strengthen and improve its performance in real-world settings.
Collapse
Affiliation(s)
- Mariko Okada
- Department of Neurology, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan; (M.O.)
| | - Masahito Katsuki
- Physical Education and Health Center, Nagaoka University of Technology, Niigata 940-2137, Japan
| | - Tomokazu Shimazu
- Department of Neurology, Saitama Neuropsychiatric Institute, Saitama 338-8577, Japan
| | - Takao Takeshima
- Headache Center and Department of Neurology, Tominaga Hospital, Osaka 556-0017, Japan
| | - Takashi Mitsufuji
- Department of Neurology, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan; (M.O.)
| | - Yasuo Ito
- Department of Neurology, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan; (M.O.)
| | | | - Noboru Imai
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka 420-0853, Japan
| | - Junichi Miyahara
- Headache Center and Department of Neurology, Tominaga Hospital, Osaka 556-0017, Japan
| | | | - Yoshihiko Nakazato
- Department of Neurology, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan; (M.O.)
| | - Kazuki Fujita
- Department of Neurology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Eri Hoshino
- Department of Neurology, Saitama Neuropsychiatric Institute, Saitama 338-8577, Japan
| | - Toshimasa Yamamoto
- Department of Neurology, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan; (M.O.)
| |
Collapse
|
4
|
Ashina S, Muenzel EJ, Nicholson RA, Zagar AJ, Buse DC, Reed ML, Shapiro RE, Hutchinson S, Pearlman EM, Lipton RB. Machine learning identifies factors most associated with seeking medical care for migraine: Results of the OVERCOME (US) study. Headache 2024. [PMID: 38785227 DOI: 10.1111/head.14729] [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: 09/01/2023] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Utilize machine learning models to identify factors associated with seeking medical care for migraine. BACKGROUND Migraine is a leading cause of disability worldwide, yet many people with migraine do not seek medical care. METHODS The web-based survey, ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (US), annually recruited demographically representative samples of the US adult population (2018-2020). Respondents with active migraine were identified via a validated diagnostic questionnaire and/or a self-reported medical diagnosis of migraine, and were then asked if they had consulted a healthcare professional for their headaches in the previous 12 months (i.e., "seeking care"). This included in-person/telephone/or e-visit at Primary Care, Specialty Care, or Emergency/Urgent Care locations. Supervised machine learning (Random Forest) and Least Absolute Shrinkage and Selection Operator (LASSO) algorithms identified 13/54 sociodemographic and clinical factors most associated with seeking medical care for migraine. Random Forest models complex relationships (including interactions) between predictor variables and a response. LASSO is also an efficient feature selection algorithm. Linear models were used to determine the multivariable association of those factors with seeking care. RESULTS Among 61,826 persons with migraine, the mean age was 41.7 years (±14.8) and 31,529/61,826 (51.0%) sought medical care for migraine in the previous 12 months. Of those seeking care for migraine, 23,106/31,529 (73.3%) were female, 21,320/31,529 (67.6%) were White, and 28,030/31,529 (88.9%) had health insurance. Severe interictal burden (assessed via the Migraine Interictal Burden Scale-4, MIBS-4) occurred in 52.8% (16,657/31,529) of those seeking care and in 23.1% (6991/30,297) of those not seeking care; similar patterns were observed for severe migraine-related disability (assessed via the Migraine Disability Assessment Scale, MIDAS) (36.7% [11,561/31,529] vs. 14.6% [4434/30,297]) and severe ictal cutaneous allodynia (assessed via the Allodynia Symptom Checklist, ASC-12) (21.0% [6614/31,529] vs. 7.4% [2230/30,297]). Severe interictal burden (vs. none, OR 2.64, 95% CI [2.5, 2.8]); severe migraine-related disability (vs. little/none, OR 2.2, 95% CI [2.0, 2.3]); and severe ictal allodynia (vs. none, OR 1.7, 95% CI [1.6, 1.8]) were strongly associated with seeking care for migraine. CONCLUSIONS Seeking medical care for migraine is associated with higher interictal burden, disability, and allodynia. These findings could support interventions to promote care-seeking among people with migraine, encourage assessment of these factors during consultation, and prioritize these domains in selecting treatments and measuring their benefits.
Collapse
Affiliation(s)
- Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Anesthesia, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Robert E Shapiro
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Susan Hutchinson
- Orange County Migraine and Headache Center, Irvine, California, USA
| | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
- Montefiore Headache Center, Bronx, New York, USA
| |
Collapse
|
5
|
Turner DP, Bertsch J, Caplis E, Houle TT. Pain medication beliefs in individuals with headache. Headache 2024; 64:390-399. [PMID: 38581194 PMCID: PMC11218751 DOI: 10.1111/head.14708] [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: 10/21/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To evaluate pain medication beliefs in a community sample of individuals with headache. BACKGROUND Previous studies of medication adherence for individuals with headache have identified a high rate of prescription nonfulfillment, frequent medication discontinuation, and widely varying levels of medication-related satisfaction. Still, there is a limited understanding of how these individuals view their medications and their relationships with health-care providers. Insight into these perceptions could prove useful in explaining medication adherence behaviors. METHODS In this secondary analysis of a cross-sectional study, data from N = 215 adults with headache were analyzed. Participants completed the Pain Medication Attitudes Questionnaire (PMAQ), Center for Epidemiologic Studies Depression Scale (CES-D), State-Trait Anxiety Inventory Form Y-2, Weekly Stress Inventory Short Form, and Migraine Disability Scale. These participants also provided a list of their current pain medications. RESULTS Using the PMAQ, participants could be characterized as having medication beliefs that were "trusting and unconcerned" (n = 83/215 [38.6%]), "skeptical and somewhat worried" (n = 99/215 [46.0%]), or "skeptical and concerned" (n = 33/215 [15.3%]). Individuals with skeptical and concerned beliefs expressed elevated concerns (z > 1.15) about side effects, scrutiny, perceived need, tolerance, withdrawal, and addiction. Individuals who were trusting and unconcerned expressed low levels (z < -0.40) of these beliefs. Increasing levels of mistrust and medication concerns were correlated with higher depression scores on the CES-D, with values ranging from r = 0.23 to r = 0.38. CONCLUSIONS Subgroups of pain medication beliefs were identified, including two groups of patients with at least some concerns about their medical providers. Beliefs ranged from a lack of concern about using pain medications to worries about scrutiny and harm. It is unclear if poor experiences with pain medications cause these beliefs or if they prevent individuals from effectively utilizing medications. Additionally, more negative beliefs about pain medications were associated with more depressive symptoms.
Collapse
Affiliation(s)
- Dana P Turner
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Bertsch
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Caplis
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Saad M, Connor L, Hazewinkel M, Peled Z, Hagan R, Gfrerer L, Kassis S. Pearls for Starting a Headache Surgery Practice in Academic and Private Practice. JPRAS Open 2024; 39:127-131. [PMID: 38235265 PMCID: PMC10792448 DOI: 10.1016/j.jpra.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 01/19/2024] Open
Abstract
There has been a growing body of evidence indicative of the effectiveness of headache surgery in treating patients with refractory headache disorders. The American Society of Plastic Surgeons issued a Policy Statement in 2018 stating that peripheral nerve decompression surgery for the treatment of refractory chronic headache disorders in select patients is considered a standard of care treatment. This endorsement sparked the interest of numerous plastic surgeons into initiating their own headache surgery practices. However, establishing a headache surgery clinic introduces challenges and considerations. This report outlines the key pillars for launching a successful headache surgery practice in academic and private practice environments.
Collapse
Affiliation(s)
- M. Saad
- Vanderbilt University Medical Center, Department of Plastic Surgery, Nashville, TN
| | - L. Connor
- Vanderbilt University Medical Center, Department of Plastic Surgery, Nashville, TN
| | - M.H.J. Hazewinkel
- Weill Cornell Medicine, Division of Plastic and Reconstructive Surgery, New York, NY
| | - Z.M. Peled
- Peled Plastic Surgery, San Francisco, CA
| | | | - L. Gfrerer
- Weill Cornell Medicine, Division of Plastic and Reconstructive Surgery, New York, NY
| | - S.A. Kassis
- Vanderbilt University Medical Center, Department of Plastic Surgery, Nashville, TN
| |
Collapse
|
7
|
Zhong C, Zhang X, Qin G, Wu J, Tian Y. Comparison of Lasmiditan 200 mg Versus 100 mg for Migraine Patients: A Meta-analysis of Randomized Controlled Studies. Clin Neuropharmacol 2024; 47:1-6. [PMID: 38154072 DOI: 10.1097/wnf.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
INTRODUCTION The ideal dose of lasmiditan for migraine is not clear. This meta-analysis aims to compare the efficacy of lasmiditan 200 mg versus 100 mg for migraine patients. METHODS We have searched several databases including PubMed, Embase, Web of Science, EBSCO, and Cochrane Library Databases and selected the randomized controlled trials comparing the efficacy of lasmiditan 200 mg versus 100 mg for migraine patients. This meta-analysis was conducted using the random-effect model. RESULTS Five randomized controlled trials were included in this meta-analysis. Compared with lasmiditan 100-mg group in migraine patients, lasmiditan 200-mg group was associated with substantially increased pain free at 2 hours (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.12-1.44; P = 0.0002) and pain free at 24 hours (OR, 1.31; 95% CI, 1.08-1.60; P = 0.007) but demonstrated no obvious impact on pain relief at 2 hours (OR, 1.02; 95% CI, 0.91-1.16; P = 0.72) or MBS free at 2 hours (OR, 0.94; 95% CI, 0.77-1.14; P = 0.52). In addition, the incidence of adverse events was higher in lasmiditan 200-mg group than that in lasmiditan 100-mg group (OR, 1.29; 95% CI, 1.15-1.45; P < 0.0001). CONCLUSIONS Lasmiditan 200 mg is better for the treatment of migraine patients than lasmiditan 100 mg.
Collapse
Affiliation(s)
- Chuan Zhong
- Department of Neurology, The People's Hospital of DaZu District, Chongqing, China
| | | | | | | | | |
Collapse
|
8
|
Johnston K, Powell LC, Popoff E, L'Italien GJ, Pawinski R, Ahern A, Large S, Tran T, Jenkins A. Cost-effectiveness of rimegepant oral lyophilisate compared to best supportive care for the acute treatment of migraine in the UK. J Med Econ 2024; 27:627-643. [PMID: 38590236 DOI: 10.1080/13696998.2024.2340932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
AIMS Migraine is the most common disabling headache disorder and is characterized by recurrent throbbing head pain and symptoms of photophobia, phonophobia, nausea, and vomiting. Rimegepant 75 mg, an oral lyophilisate calcitonin gene-related peptide antagonist, is the first treatment approved for both the acute and preventative treatment of migraine, and the first acute therapy approved in over 20-years. The objective was to assess the cost-utility of rimegepant compared with best supportive care (BSC) in the UK, for the acute treatment of migraine in the adults with inadequate symptom relief after taking at least 2 triptans, or for whom triptans are contraindicated or not tolerated. MATERIALS AND METHODS A de novo model was developed to estimate incremental costs and quality-adjusted life years (QALYs), structured as a decision tree followed by Markov model. Patients received rimegepant or BSC for a migraine attack and were assessed for response (pain relief at 2-h). Responders and non-responders followed different pain trajectories over 48-h cycles. Non-responders discontinued treatment while responders continued treatment for subsequent attacks, with a proportion discontinuing over time. Data sources included a post-hoc pooled analysis of the phase 3 acute rimegepant trials (NCT03235479, NCT03237845, NCT03461757), and a long-term safety study (NCT03266588). The analysis was conducted from the perspective of the UK National Health Service and Personal Social Services over a 20-year time horizon. RESULTS Rimegepant resulted in an incremental cost-utility ratio (ICUR) of £10,309 per QALY gained vs BSC, which is cost-effectiveness at a willingness to pay threshold of £30,000/QALY. Rimegepant generated +0.44 incremental QALYs and higher incremental lifetime costs (£4,492). Improved QALYs for rimegepant were a result of less time spent with severe and moderate headache pain. CONCLUSION This study highlights the economic value of rimegepant which was found to be cost-effective for the acute treatment of migraine in adults unsuitable for triptans.
Collapse
Affiliation(s)
- Karissa Johnston
- Broadstreet Health Economics and Outcomes Research, Vancouver, Canada
| | - Lauren C Powell
- Broadstreet Health Economics and Outcomes Research, Vancouver, Canada
| | - Evan Popoff
- Broadstreet Health Economics and Outcomes Research, Vancouver, Canada
| | | | | | | | | | | | | |
Collapse
|
9
|
Bentivegna E, Galastri S, Onan D, Martelletti P. Unmet Needs in the Acute Treatment of Migraine. Adv Ther 2024; 41:1-13. [PMID: 37943442 PMCID: PMC10796525 DOI: 10.1007/s12325-023-02650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/16/2023] [Indexed: 11/10/2023]
Abstract
Migraine represents the most common neurologic disorder, ranking second among the world's causes of disability [expressed as years lived with disability (YLDs)]. Patients often do not receive the best therapy because of safety issues, tolerance, and prescription accessibility. General practitioners are not always educated about the disease, and specialists are few and often difficult to reach. Therapies are limited and have many side effects that can impede the prescription. Prophylactic therapy is recommended in case of four or more headaches a month, eight or more headache days a month, debilitating headaches, and medication-overuse headaches. The available therapeutic options are in constant development. The classic one consists of non-specific drugs: β-blockers, tricyclics, antiepileptics, and botulinum toxin. Monoclonal antibodies targeting the calcitonin gene receptor (CGRP) peptide or its receptor are the only ones specifically designed to treat migraine. Their efficiency and convenient safety profile have been demonstrated in a number of trials versus both placebo and classic therapies. The treatment of acute migraine attack consists of medications designed to affect the painful symptoms. For over 30 years, the cornerstones of treatment in clinical practice have continued to be represented by triptans and non-steroidal anti-inflammatory drugs (NSAIDs), with the well-know related adverse effects. Opioids are used inappropriately and overprescribed. Polytherapy is strongly not recommended but is still a common practice because treatment is not optimized and thus not efficient. Great promise comes from gepants, also targeting CGRP, and ditans, 5-HT1F receptor agonists. They seem to outweigh the risk of medication overuse headache because of their efficacy and rapid onset and have no cardiovascular contraindications. Nonetheless, these points remain to be confirmed. Although therapies have been implemented in the last years, significant unmet treatment needs remain a reality in patients' lives. This commentary aims to identify the most important unmet needs in the acute treatment of migraine, analyzing the current status of available therapies and their limits. We also analyzed some of the prophylactic therapies available, especially focusing on anti-CGRP monoclonal antibodies, to better understand the importance of setting a therapeutic strategy that includes the two modes, both acute and prophylactic, to reach the best result. We hope that having an overview of the shortcomings will help to provide constructive ideas for improvement.
Collapse
Affiliation(s)
- Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
| | - Silvia Galastri
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Dilara Onan
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Via di Grottarossa 1035-1039, 00189, Rome, Italy
- Back and Neck Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Via di Grottarossa 1035-1039, 00189, Rome, Italy
- Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| |
Collapse
|
10
|
Downes MH, Morgenstern R, Naasan G, Patterson S, Pace A, Agarwal P, Shin S, Abrams R, Mueller B, Young J, Tamler R, Vickrey BG, Kummer BR. Healthcare utilization impacts of an eConsult program for headache at an academic medical center. J Telemed Telecare 2023:1357633X231207908. [PMID: 37901905 DOI: 10.1177/1357633x231207908] [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: 10/31/2023]
Abstract
INTRODUCTION Interprofessional consultations ("eConsults") can reduce healthcare utilization. However, the impact of eConsults on healthcare utilization remains poorly characterized among patients with headache. METHODS We performed a retrospective, 1:1 matched cohort study comparing patients evaluated for headache via eConsult request or in-person referral at the Mount Sinai Health System in New York. Groups were matched on clinical and demographic characteristics. Our primary outcome was one or more outpatient headache-related encounters in 6 months following referral date. Secondary outcomes included one or more all-cause outpatient neurology and headache-related emergency department (ED) encounters during the same period. We used univariable and multivariable logistic regression to model associations between independent variables and outcomes. RESULTS We identified 74 patients with headache eConsults who were matched to 74 patients with in-person referrals. Patients in the eConsult group were less likely to achieve the primary outcome (29.7% vs 62.2%, P < 0.0001) or have an all-cause outpatient neurology encounter (33.8% vs 79.7%, P < 0.0001) than patients in the comparison group. Both groups did not significantly differ by headache-related ED encounters. In multivariable analyses, patients in the eConsult group had significantly lower odds of having one or more headache-related or all-cause neurology encounters than patients in the comparison group (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1-0.6; OR 0.1, 95% CI 0.1-0.3, respectively). DISCUSSION In comparison to in-person referrals, eConsult requests for headache were associated with reduced likelihood of outpatient neurology encounters in the short-term but not with differential use of headache-related ED encounters. Larger-scale, prospective studies should validate our findings and assess patient outcomes.
Collapse
Affiliation(s)
| | - Rachelle Morgenstern
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Georges Naasan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanna Patterson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna Pace
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parul Agarwal
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Shin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rory Abrams
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bridget Mueller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James Young
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald Tamler
- Division of Endocrinology, Diabetes, and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Clinical Informatics, Mount Sinai Health System, New York, NY, USA
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin R Kummer
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Clinical Informatics, Mount Sinai Health System, New York, NY, USA
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
11
|
White CS. Unique Considerations in Episodic Migraine: Underserved Populations. Curr Pain Headache Rep 2023; 27:503-509. [PMID: 37610506 DOI: 10.1007/s11916-023-01152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW Episodic migraine is a common and disabling neurological disorder that is underdiagnosed and undertreated. Additional barriers are put in place for those who belong to an underserved population. This could be based on race, ethnicity, gender, sexual orientation, or socioeconomic status. RECENT FINDINGS There has been a lot of interest in understanding the extent of these disparities, but studies for many of these groups are lacking. More work is needed to understand the disparities and needs of underserved populations. Most of the literature has been done for Black populations but there are many other underserved communities that need assessment and intervention. The healthcare community needs to take action to improve support for populations with a higher incidence of migraine and disability, yet a lower rate of diagnosis and treatment. Some recommendations include awareness of biases, systemic changes, education, and including diverse populations in research and training.
Collapse
Affiliation(s)
- Courtney S White
- Thomas Jefferson University, 901 Walnut St #400, Philadelphia, PA, 19107, USA.
| |
Collapse
|
12
|
Abstract
Migraine is a global neurologic disease that is highly prevalent, especially in women. Studies have observed a predisposition for the development of migraine in women, although the mechanisms involved have yet to be fully elucidated. This review aimed to summarize the recent evidence regarding the epidemiology, pathophysiology, and treatment of migraine and highlight key sex differences. We also identify gaps in care for both women and men living with migraine and discuss the presence of migraine-related stigma and how this may impact the efficacy of clinical care.
Collapse
|
13
|
Zhang L, Novick D, Zhong S, Li J, Walker C, Harrison L, Jackson J, Barlow S, Cotton S. Real-World Analysis of Clinical Characteristics, Treatment Patterns, and Patient-Reported Outcomes of Insufficient Responders and Responders to Prescribed Acute Migraine Treatment in China. Pain Ther 2023; 12:751-769. [PMID: 36944864 PMCID: PMC10199977 DOI: 10.1007/s40122-023-00494-1] [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: 12/20/2022] [Accepted: 02/27/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Migraine is a common disabling primary headache disorder characterized by attacks of severe pain, sometimes accompanied by symptoms including nausea and photo-/phono-phobia. Real-world data of patients with migraine who sufficiently (responders) and insufficiently (insufficient responders) respond to acute treatment (AT) are limited in China. This analysis explored whether responders to AT differ from insufficient responders in terms of clinical characteristics, treatment patterns, and patient-reported outcomes in China. METHODS Data were drawn from the Adelphi Migraine Disease Specific Programme™, a point-in-time survey of internists/neurologists and their consulting patients with migraine, conducted in a real-world setting in China, January-June 2014. Responders and insufficient responders to prescribed AT were patients who typically achieved headache pain freedom within 2 h of AT in ≥ 4 and ≤ 3 of five migraine attacks, respectively. Responders were compared with insufficient responders; logistic regression was used to identify factors associated with insufficient response. RESULTS Of 777 patients currently receiving AT, 44.0% were insufficient responders. Significantly fewer responders than insufficient responders had migraine with aura (13.1 vs. 23.8%; p = 0.0001). Responders reported a significantly lower mean Migraine Disability Assessment (MIDAS) total score (5.5 vs. 6.6; p = 0.0325). Responders reported a lower mean impairment while working (50.0 vs. 63.9%; p < 0.0001), overall work impairment (52.6 vs. 66.0%; p < 0.0001), and activity impairment (48.9 vs. 59.0%; p < 0.0001). Statistically significant factors associated with insufficient response to AT included diabetes, unilateral pain, vomiting, sensitivity to smell, visual aura/sight disturbance, and an increase in MIDAS total score. However, there were no statistically significant differences in ATs received by responders and insufficient responders at any regimen of therapy. CONCLUSIONS Many patients with migraine in China are insufficient responders to AT, experiencing worse symptoms that lead to overall poorer quality of life than responders. This unmet need suggests that new effective treatment options are required for migraine.
Collapse
|
14
|
Zhao H, Xiao Z, Zhang L, Ford J, Zhong S, Ye W, Li J, Tockhorn-Heidenreich A, Cotton S, Chen C. Real-World Treatment Patterns and Outcomes Among Patients with Episodic Migraine in China: Results from the Adelphi Migraine Disease Specific Programme™. J Pain Res 2023; 16:357-371. [PMID: 36762367 PMCID: PMC9904300 DOI: 10.2147/jpr.s371887] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/22/2022] [Indexed: 02/05/2023] Open
Abstract
Objective This study assessed treatment patterns, disease burden, outcomes, and unmet needs among patients with episodic migraine (EM) in China using Adelphi Migraine Disease Specific Programme™ (DSP) real-world data. Background Migraine is a prevalent and debilitating neurological disorder which presents a major public health burden globally. Research on characteristics, disease burden, and treatment patterns in EM patients in China is limited. Methods Data were drawn from an existing data set Adelphi Migraine DSP, a point-in-time survey conducted in China (January-June 2014). Internists/neurologists completed patient record forms for the next 9 patients who consulted them in clinical practice; these same patients completed the 'patient self-completion questionnaires'. Descriptive analyses were used to assess key variables: patient demographics, treatment patterns (current acute and preventive medication [AM/PM]), effectiveness, issues with existing treatment, Migraine Disability Assessment (MIDAS) scores, and Work Productivity and Activity Impairment scores. Results Total of 125 internists/neurologists provided data on 1113 patients with EM (headache days/month <15). Mean (standard deviation [SD]) age was 43.8 (13.1) years; mean (SD) number of migraine days/month was 3.2 (1.7). AM was prescribed in 86.1% of patients (non-steroid anti-inflammatory drugs [NSAIDs]: 62.7%; triptans: 7.7%), PM in 38.5%, and both in 24.9% of patients. Approximately 55% of patients experienced ≥1 issue with their current AM or PM. Migraine-related symptoms (including nausea, photophobia, and phonophobia) were fully controlled in <50% of patients receiving NSAIDs (21.7-38.4%) or triptans (32.4-43.5%). Insufficient response to current AM (migraine headache fully resolved within 2 hours in ≤3/5 attacks) was reported by 42.5% of patients. Mild-to-severe disability was reported by 36.8% of patients with a mean (SD) MIDAS score of 5.8 (7.3). Overall, 58.0% of work time was impaired (including time missed and impairment while working). Conclusion This analysis suggests, despite existing treatment options, disease burden and unmet medical needs remain substantial in Chinese patients with EM.
Collapse
Affiliation(s)
- Hongru Zhao
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Zheman Xiao
- Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Lei Zhang
- Eli Lilly China, Shanghai, People’s Republic of China
| | - Janet Ford
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Shiying Zhong
- Eli Lilly China, Shanghai, People’s Republic of China
| | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Jinnan Li
- Eli Lilly China, Shanghai, People’s Republic of China
| | | | | | - Chunfu Chen
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University Jinan, Jinan, People’s Republic of China,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Correspondence: Chunfu Chen, Department of Neurology, Shandong Provincial Hospital, # 324 Jingwuweiqi, Road, Shandong, 250021, People’s Republic of China, Tel +86 13853153248, Email
| |
Collapse
|
15
|
Muacevic A, Adler JR, Kawamura S, Tachikawa S, Koh A. Fremanezumab for Migraine Prevention in Japanese Elderly Aged Over 70 Years Old. Cureus 2023; 15:e34052. [PMID: 36824556 PMCID: PMC9942430 DOI: 10.7759/cureus.34052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/23/2023] Open
Abstract
Background Elderly migraine is a public health problem with prolonged life expectancy, and effective prophylactic treatment is needed. There were no reports on fremanezumab for the elderly. We described the real-world data of fremanezumab, calcitonin gene-related peptide-related monoclonal antibody (CGRP-mAB), for migraine in elderly over 70 years old. Methods We retrospectively investigated six elderly migraine patients over 70 years old treated with fremanezumab. Headache impact test-6 (HIT-6), monthly headache days (MHD), and monthly acute medication intake days (AMD) before one and three months after starting fremanezumab treatment were evaluated. Results Three women and three men (median age 78; range: 71-99) were included. One was chronic migraine (CM), three were CM and medication-overuse headache, and two were episodic migraine and tension-type headache. All six patients received monthly fremanezumab. The median MHD before, during one, and three months after treatment were 30 (4-30), 30 (4-30), and 29 (15-30, n=4). Those of AMD were 17 (0-30), 9.5 (0-30), and 1 (0-28). Those about HIT-6 were 64 (56-72), 59.5 (52-70), and 55.5 (48-64). Two (33.3%) of the six patients experienced therapeutic effectiveness. There were no side effects. Conclusion We described the six elderly migraine patients aged over 70 years old treated with fremanezumab. Two (33.3%) of the six patients experienced therapeutic effectiveness. This is the first report of fremanezumab for elderly migraine patients aged over 70 years old. Further evidence accumulation is needed about CGRP-mABs for the elderly.
Collapse
|
16
|
Ali MD, Gayasuddin Qur F, Alam MS, M Alotaibi N, Mujtaba MA. Global Epidemiology, Clinical Features, Diagnosis and Current Therapeutic Novelties in Migraine Therapy and their Prevention: A Narrative Review. Curr Pharm Des 2023; 29:3295-3311. [PMID: 38270151 DOI: 10.2174/0113816128266227231205114320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION The current article reviews the latest information on epidemiology, clinical features, diagnosis, recent advancements in clinical management, current therapeutic novelties, and the prevention of migraines. In a narrative review, all studies as per developed MeSH terms published until February 2023, excluding those irrelevant, were identified through a PubMed literature search. METHODS Overall, migraine affects more than a billion people annually and is one of the most common neurological illnesses. A wide range of comorbidities is associated with migraines, including stress and sleep disturbances. To lower the worldwide burden of migraine, comprehensive efforts are required to develop and enhance migraine treatment, which is supported by informed healthcare policy. Numerous migraine therapies have been successful, but not all patients benefit from them. RESULTS CGRP pathway-targeted therapy demonstrates the importance of translating mechanistic understanding into effective treatment. In this review, we discuss clinical features, diagnosis, and recently approved drugs, as well as a number of potential therapeutic targets, including pituitary adenylate cyclase-activating polypeptide (PACAP), adenosine, opioid receptors, potassium channels, transient receptor potential ion channels (TRP), and acid-sensing ion channels (ASIC). CONCLUSION In addition to providing more treatment options for improved clinical care, a better understanding of these mechanisms facilitates the discovery of novel therapeutic targets.
Collapse
Affiliation(s)
- Mohammad Daud Ali
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Abdulrazaq Bin Hammam Street, Al Safa, Dammam 34222, Saudi Arabia
| | - Fehmida Gayasuddin Qur
- Department of Obstetrics and Gynecology, Princess Royal Maternity Hospital, Glasgow, Scotland
| | - Md Sarfaraz Alam
- Department of Pharmaceutics, HIMT College of Pharmacy, Rajpura 8, Institutional Area, Knowledge Park I, Greater Noida, Uttar Pradesh 201301, India
| | - Nawaf M Alotaibi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Northern Border University, Rafha Campus, Arar, Saudi Arabia
| | - Md Ali Mujtaba
- Department of Pharmaceutics, Faculty of Pharmacy, Northern Border University, Rafha Campus, Arar, Saudi Arabia
| |
Collapse
|
17
|
Muacevic A, Adler JR, Kawamura S, Koh A. Monoclonal Antibodies Against the Calcitonin Gene-Related Peptide and Its Receptor in Japanese Adolescents With Migraines. Cureus 2023; 15:e33689. [PMID: 36788886 PMCID: PMC9921030 DOI: 10.7759/cureus.33689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Introduction Adolescent migraines is a public health problem, and effective prophylactic treatment is needed. In Japan, three types of calcitonin gene-related peptide-related monoclonal antibodies (CGRP-mABs) are available. Galcanezumab, fremanezumab, and erenumab can be used for migraine prevention in ages 15 years or older, but reports on adolescent migraine treated with CGRP-mABs remain few. We described this study to report the real-world data of CGRP-mABs' efficacy for adolescents with migraines aged from 15 to 17 years old. Methods We retrospectively investigated ten adolescent migraine patients aged from 15 to 17 years old treated with CGRP-mABs. Headache impact test-6 (HIT-6), monthly headache days (MHD), and monthly acute medication intake days (AMD) before and three months after CGRP-mABs treatment were evaluated. Results Six females and four males were included. Seven had episodic migraines (EM), three had EM and tension-type headaches, one had chronic migraines (CM), and one had CM and medication-overuse headaches. As chief obstacles to life due to headaches, five reported them as detrimental to study, one reported them as detrimental to playing sports, and four reported missing school. The median HIT-6 was 63 (46-68) and 44 (36-65) before and three months after treatment, respectively. Median of MHD was 5.5 (1-29) and 1.5 (1-30), respectively, and the median of AMD was 5.5 (1-30) and 1 (0-30), respectively. A significant reduction of HIT-6 was observed at three months (p=0.008). Six (60%) of the ten patients experienced therapeutic effectiveness. Patients with missing school as the chief obstacle to life due to headaches seemed ineffective compared to those with other obstacles (p=0.048). There were no side effects of CGRP-mABs. Conclusion We herein described the ten adolescent migraine patients treated with CGRP-mABs. HIT-6 score significantly decreased at three months, and six of the ten patients experienced therapeutic effectiveness measured by HIT-6. Now several trials have been ongoing to test the efficacy of CGRP-mABs for adolescents. Urgent evidence accumulation is needed about CGRP-mABs for adolescents.
Collapse
|
18
|
Hirata K, Matsumori Y, Tanji Y, Khanna R, Ozeki A, Komori M. Safety profile of lasmiditan in patients with migraine in an Asian population. Expert Opin Drug Saf 2023; 22:91-101. [PMID: 35736027 DOI: 10.1080/14740338.2022.2087630] [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: 11/04/2022]
Abstract
BACKGROUND MONONOFU, a multicenter, randomized, double-blind, placebo-controlled phase 2 study of Japanese patients with migraine, was pivotal for lasmiditan approval in Japan. However, treatment-emergent adverse events (TEAEs) were more common than in global studies. A detailed safety profile would assist patient management. RESEARCH DESIGN AND METHODS Safety assessments in MONONOFU included specific terms reported, frequency, severity, time to onset, duration, TEAE management, common TEAE risk factors, and TEAE-efficacy associations. RESULTS Of 846 participants, 691 were assessed for safety. The proportion of participants reporting ≥1 TEAE was 23.4% with placebo and 70.9% with lasmiditan; 87.3% of TEAEs with lasmiditan were mild. The most frequent TEAEs with lasmiditan, dizziness (39.4%) and somnolence (19.3%), started ≤1 hour postdose (median durations: 2.5 and 3.3 hours, respectively). Higher lasmiditan dose, but not patient factors including body size, was identified as a clinically meaningful predictor of dizziness and somnolence. There were no adverse consequences of neurological TEAEs, which did not appear to adversely affect lasmiditan efficacy. CONCLUSIONS In the MONONOFU study, TEAEs appeared typically mild, transient, and self-limiting. Lasmiditan may represent a useful and well-tolerated acute treatment option for smaller (body mass index <30 kg/m2) patients and Asian patients with migraine.
Collapse
Affiliation(s)
- Koichi Hirata
- Headache Center, Dokkyo Medical University, Mibu, Japan
| | | | - Yuka Tanji
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Rashna Khanna
- Global Patient Safety, Eli Lilly and Company Limited, Bracknell, UK
| | - Akichika Ozeki
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Mika Komori
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| |
Collapse
|
19
|
Fodeh SJ, Fenton BT, Wang R, Skanderson M, Altalib H, Kuruvilla D, Schindler E, Haskell S, Brandt C, Sico JJ. Understanding headache classification coding within the veterans health administration using ICD-9-CM and ICD-10-CM in fiscal years 2014-2017. PLoS One 2023; 18:e0279163. [PMID: 36598881 PMCID: PMC9812322 DOI: 10.1371/journal.pone.0279163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/17/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Understand the continuity and changes in headache not-otherwise-specified (NOS), migraine, and post-traumatic headache (PTH) diagnoses after the transition from ICD-9-CM to ICD-10-CM in the Veterans Health Administration (VHA). BACKGROUND Headache is one of the most commonly diagnosed chronic conditions managed within primary and specialty care clinics. The VHA transitioned from ICD-9-CM to ICD-10-CM on October-1-2015. The effect transitioning on coding of specific headache diagnoses is unknown. Accuracy of headache diagnosis is important since different headache types respond to different treatments. METHODS We mapped headache diagnoses from ICD-9-CM (FY 2014/2015) onto ICD-10-CM (FY 2016/2017) and computed coding proportions two years before/after the transition in VHA. We used queries to determine the change in transition pathways. We report the odds of ICD-10-CM coding associated with ICD-9-CM controlling for provider type, and patient age, sex, and race/ethnicity. RESULTS Only 37%, 58% and 34% of patients with ICD-9-CM coding of NOS, migraine, and PTH respectively had an ICD-10-CM headache diagnosis. Of those with an ICD-10-CM diagnosis, 73-79% had a single headache diagnosis. The odds ratios for receiving the same code in both ICD-9-CM and ICD-10-CM after adjustment for ICD-9-CM and ICD-10-CM headache comorbidities and sociodemographic factors were high (range 6-26) and statistically significant. Specifically, 75% of patients with headache NOS had received one headache diagnoses (Adjusted headache NOS-ICD-9-CM OR for headache NOS-ICD-10-CM = 6.1, 95% CI 5.89-6.32. 79% of migraineurs had one headache diagnoses, mostly migraine (Adjusted migraine-ICD-9-CM OR for migraine-ICD-10-CM = 26.43, 95% CI 25.51-27.38). The same held true for PTH (Adjusted PTH-ICD-9-CM OR for PTH-ICD-10-CM = 22.92, 95% CI: 18.97-27.68). These strong associations remained after adjustment for specialist care in ICD-10-CM follow-up period. DISCUSSION The majority of people with ICD-9-CM headache diagnoses did not have an ICD-10-CM headache diagnosis. However, a given diagnosis in ICD-9-CM by a primary care provider (PCP) was significantly predictive of its assignment in ICD-10-CM as was seeing either a neurologist or physiatrist (compared to a generalist) for an ICD-10-CM headache diagnosis. CONCLUSION When a veteran had a specific diagnosis in ICD-9-CM, the odds of being coded with the same diagnosis in ICD-10-CM were significantly higher. Specialist visit during the ICD-10-CM period was independently associated with all three ICD-10-CM headaches.
Collapse
Affiliation(s)
- Samah Jamal Fodeh
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
- * E-mail:
| | - Brenda T. Fenton
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Rixin Wang
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
| | - Melissa Skanderson
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Hamada Altalib
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
- Neurology Service, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America
- Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, United States of America
| | - Deena Kuruvilla
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Emmanuelle Schindler
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America
- Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, United States of America
| | - Sally Haskell
- Primary Care Service, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Comprehensive Women’s Health, VA Central Office, Chester, VA, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Cynthia Brandt
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Primary Care Service, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Jason J. Sico
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
- Neurology Service, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America
- Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| |
Collapse
|
20
|
Lyu S, Zhang CS, Sun J, Weng H, Xue CC, Guo X, Zhang AL. Chinese herbal medicine for migraine management: A hospital-based retrospective analysis of electronic medical records. Front Med (Lausanne) 2022; 9:936234. [PMID: 36438031 PMCID: PMC9684313 DOI: 10.3389/fmed.2022.936234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
Background Migraine is a chronic neurological disease causing significant socioeconomic burden and impaired quality of life. Chinese medicine is commonly used for migraine in China. Clinical trials have generated evidence of the effectiveness of Chinese medicine therapies for migraine. However, little is known about how to use these therapies to treat migraine in real-world clinical settings. Methods In this retrospective study, we analyzed data from the electronic medical records (EMRs) of 2,023 migraine patients who attended the Guangdong Provincial Hospital of Chinese Medicine (GPHCM) between July 2018 and July 2020. Results More than three-quarters (77.21%) of the patients were female. Most (78.20%) of the patients were aged between 18 and 50 years, 18.49% were aged above 50 years, and the remaining 3.31% were under 18 years. Sleep disorders were the most documented comorbidity occurring in 27.29% of patients, and more common in females (29.77%) than male (18.87%). Fatigue was the most frequently reported trigger of migraine attacks among all patients (9.39%), while menstruation was the most common trigger for female patients (10.24%). Less than a quarter of patients (21.01%) reported a history of taking analgesic medication for their migraine. The median treatment duration reported by the patients was 10 days. Chinese herbal medicine (CHM) was the predominant treatment for migraine at the hospital (88.48%), while pharmacotherapies were prescribed to 28.97% of the patients. CHM was prescribed more often as a sole treatment (53.58% of patients) than combined with pharmacotherapies (27.39% of patients). Among patients who reported improvements after taking CHM, the most frequently used herbs were fu ling and chuan xiong, the most frequent patented CHM product was tong tian oral solution, and the main herbal formulae were chuan xiong cha tiao san and yi qi cong ming tang. Conclusion CHM formulae, such as chuan xiong cha tiao san and yi qi cong ming tang, patented CHM product tong tian oral solution, and some herbs are potentially effective treatments for migraine. As such, CHM can be used as an alternative to conventional pharmacotherapies for migraine and is worth further evaluation in randomized controlled trials.
Collapse
Affiliation(s)
- Shaohua Lyu
- The China Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Claire Shuiqing Zhang
- The China Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Jingbo Sun
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Heng Weng
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Charlie Changli Xue
- The China Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinfeng Guo
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Xinfeng Guo,
| | - Anthony Lin Zhang
- The China Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
- Anthony Lin Zhang,
| |
Collapse
|
21
|
Zhou J, Luo G, Xu Y, Yang X, Pan X, Dong Z, Zhong S, Liu H, Ji F, Yu S. Safety Findings in Lasmiditan as a Novel Acute Treatment of Migraine in Chinese Patients: A Post Hoc Analysis of the Randomized Controlled Phase 3 CENTURION Trial. Adv Ther 2022; 39:5229-5243. [PMID: 36114949 DOI: 10.1007/s12325-022-02291-2] [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: 06/24/2022] [Accepted: 07/29/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Lasmiditan is the first 5-HT1F receptor agonist with potential to address the huge unmet medical needs for the treatment of migraine in China. The CENTURION study was the first phase 3 study of lasmiditan in Caucasian and Chinese patients with migraine. This post hoc analysis further demonstrates the safety profile of lasmiditan in the Chinese population and was urgently needed. METHODS Patients were randomized 1:1:1 to lasmiditan 200 mg lasmiditan 100 mg, or a control group. The incidence of treatment-emergent adverse events (TEAEs), their severity, and incidence by treated attacks for frequently reported TEAEs (≥ 5%) were evaluated. The duration, onset, and relationship of efficacy with very common TEAEs (≥ 10%) was analyzed. RESULTS A total of 281 Chinese patients were included in this post hoc analysis. No deaths and no study drug-related treatment emergent serious adverse events (TESAEs) were reported. The incidence of at least one TEAE was higher in patients receiving lasmiditan 200 mg (73.9%) and 100 mg (66.3%) versus placebo (26.6%). TEAEs were generally mild or moderate in severity, and the incidence of frequently reported TEAEs was generally highest during the first attack. Very common TEAEs with lasmiditan included dizziness, asthenia, somnolence, muscular weakness, fatigue, and nausea. The duration of dizziness was longest during the first attack. There were no cardio-cerebrovascular ischemic events and serotonin syndrome. The presence of very common TEAEs (except nausea), and severe dizziness, did not appear to have a negative influence on the efficacy. CONCLUSION In the Chinese population of the CENTURION study, most of the TEAEs were neurologic, of mild or moderate severity, and self-limiting. The distribution of frequently reported TEAEs at the first attack differed from the primary cohort, while the overall safety profile of lasmiditan in the Chinese population was generally consistent with the CENTURION primary cohort. No new safety concerns were observed in the Chinese population. TRIAL REGISTRATION NCT03670810.
Collapse
Affiliation(s)
- Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guogang Luo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaosu Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoping Pan
- Department of Neurology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zhao Dong
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | | | - Hui Liu
- Eli Lilly and Company, Shanghai, China
| | - Fei Ji
- Eli Lilly and Company, Shanghai, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| |
Collapse
|
22
|
Ezzati A, Buse DC, Fanning KM, Reed ML, Martin VT, Lipton RB. Predictors of treatment-response to Acute Prescription Medications in Migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Clin Neurol Neurosurg 2022; 223:107511. [DOI: 10.1016/j.clineuro.2022.107511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
|
23
|
Matsumori Y, Komori M, Tanji Y, Ozeki A, Sakai F. Rapid Onset and Sustained Efficacy of Lasmiditan Among Japanese Patients with Migraine: Prespecified Analyses of a Randomized Controlled Trial. Neurol Ther 2022; 11:1721-1734. [PMID: 36136232 DOI: 10.1007/s40120-022-00403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Rapid onset and sustained efficacy are important for acute migraine treatment. Global phase 3 trials have demonstrated the early onset and sustained efficacy of the 5-HT1F receptor agonist lasmiditan. In this prespecified analysis of the MONONOFU study, we assessed the onset and sustained efficacy of lasmiditan in Japanese patients with migraine. METHODS MONONOFU was a multicenter, randomized, placebo-controlled, phase 2 study conducted in Japan (May 2019-June 2020). Eligible adults with migraine (N = 846; modified intent-to-treat population, N = 682) were randomized 7:3:7:6 to placebo, lasmiditan 50 mg, 100 mg, or 200 mg, taken orally within 4 h of moderate-to-severe migraine onset. Patients recorded headache severity and symptoms predose and 0.5-48 h postdose. Sustained and modified sustained pain freedom were defined as patients who were headache pain-free 2 h postdose and had no pain (sustained pain freedom) or had mild or no pain (modified sustained pain freedom) at 24 or 48 h without rescue/recurrence medications. Efficacy outcomes were analyzed by logistic regression. Patients also recorded the actual time of pain-free and of meaningful pain relief (Kaplan-Meier analysis). RESULTS Compared with placebo, significantly more lasmiditan-treated (100 or 200 mg) patients were headache pain-free, had pain relief, were free of their most bothersome symptom, or had total migraine freedom (no headache or migraine-associated symptoms) within 30-60 min. Median time to pain-free was 9.26, 6.88, 2.75, and 2.30 h in placebo, 50-mg, 100-mg, and 200-mg lasmiditan groups, respectively. Significantly greater proportions of patients treated with 100 (19.7-29.5%) or 200 mg (21.1-35.7%) lasmiditan had sustained or modified sustained pain freedom at 24 or 48 h compared with placebo (10.4-15.8%). CONCLUSION This prespecified analysis of data from MONONOFU has confirmed that the efficacy of lasmiditan is rapid in onset and sustained in patients with moderate-to-severe migraine in Japan. TRIAL REGISTRATION ClinicalTrials.gov (NCT03962738).
Collapse
Affiliation(s)
| | - Mika Komori
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., 5-1-28, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan.
| | - Yuka Tanji
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., 5-1-28, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan
| | - Akichika Ozeki
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., 5-1-28, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan
| | | |
Collapse
|
24
|
Polavieja P, Belger M, Venkata SK, Wilhelm S, Johansson E. Relative efficacy of lasmiditan versus rimegepant and ubrogepant as acute treatments for migraine: network meta-analysis findings. J Headache Pain 2022; 23:76. [PMID: 35790906 PMCID: PMC9258126 DOI: 10.1186/s10194-022-01440-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background In the absence of head-to-head trials, comprehensive evidence comparing onset of efficacy of novel agents for acute treatment of migraine is lacking. This study aimed to explore the relative efficacy of lasmiditan (serotonin [5-hydroxytryptamine] 1F receptor agonist) versus rimegepant and ubrogepant (calcitonin gene-related peptide antagonists) for the acute oral treatment of migraine through network meta-analysis (NMA). Methods Data included in the NMA were identified through a systematic literature search (conducted April 2018, updated May/December 2020) of phase II–IV, randomised controlled trials (RCTs) in adults with chronic/episodic migraine with/without aura. Treatments included: lasmiditan 50, 100, 200 mg; rimegepant 75 mg; ubrogepant 25, 50, 100 mg. Pairwise treatment comparisons from Bayesian fixed-effect/random-effects NMA, adjusted by baseline risk where appropriate, were conducted. Comparisons were reported as odds ratios with 95% credible intervals. Early-onset efficacy endpoints included: pain freedom at 2 hours and pain relief at 1 and 2 hours. Adverse drug reaction (ADR) profiles were summarised. Heterogeneity and inconsistency in the network were explored; sensitivity analyses investigated robustness of findings. Results Across 12 RCTs included in the base case, females represented >80% of included patients (mean age 37.9–45.7 years). Odds of achieving both pain freedom and pain relief at 2 hours were higher with lasmiditan 100 and 200 mg versus rimegepant 75 mg and ubrogepant 25 and 50 mg. Results for pain relief at 1 hour were consistent with those at 2 hours, but fewer comparisons were available. There were no statistically significant differences between lasmiditan 50 mg and ubrogepant or rimegepant for any outcome. Sensitivity analyses were in the same direction as base case analyses. Most commonly reported ADRs (incidence ≥2%) were: dizziness, fatigue, paraesthesia, sedation, nausea/vomiting and muscle weakness with lasmiditan; nausea with rimegepant; and nausea, somnolence and dry mouth with ubrogepant. Conclusions The efficacy findings of this indirect comparison indicate that lasmiditan 100 mg or 200 mg might be an appropriate acute treatment option for patients with migraine seeking a fast onset of action. Differently from rimegepant and ubrogepant, lasmiditan use is associated with mainly neurological events, which are mostly mild or moderate in severity and self-limiting. 350/350 words Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01440-w.
Collapse
Affiliation(s)
- Pepa Polavieja
- Eli Lilly and Company, Indianapolis, Indiana, USA. .,, Avenida de la Industria 30, 28108, Alcobendas, Madrid, Spain.
| | - Mark Belger
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | |
Collapse
|
25
|
Charleston L, Savage-Edwards B, Bragg SM, Baygani SK, Dennehy EB. Migraine history and response to lasmiditan across racial and ethnic groups. Curr Med Res Opin 2022; 38:721-730. [PMID: 35350937 DOI: 10.1080/03007995.2022.2057152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The robust enrollment in SPARTAN and SAMURAI provided the opportunity to present post-hoc descriptive details on migraine disease characteristics and treatment outcomes after treatment with lasmiditan, a selective serotonin (5-HT1F) receptor agonist, in racial and ethnic subgroups. METHODS Descriptive data from racial (White [W](n = 3471) and Black or African American [AA](n = 792)) and ethnic (Hispanic or Latinx [HL](n = 775) and Non-Hispanic or Latinx [Non-HL](n = 3637)) populations are presented on pooled data from two double-blind, placebo-controlled, randomized Phase 3 studies (SAMURAI [NCT02439320] and SPARTAN [NCT2605174]). Patients were treated with lasmiditan (50 (SPARTAN only), 100, or 200 mg) or placebo for a single migraine attack of moderate-to-severe intensity. Efficacy data were recorded in an electronic diary at baseline, 30, 60, 90, and 120 min. Safety was evaluated and reported by occurrences of adverse events. RESULTS Clinical characteristics were generally similar across populations. W participants had longer migraine history than AA participants, and Non-HL participants had more migraine disability than HL participants. In the lasmiditan single-attack studies, AA participants waited longer than W participants to take study drug. A higher proportion of HL participants rated baseline migraine severity as severe compared to Non-HL participants. Response to lasmiditan was similar across racial and ethnic groups, including pain response, freedom from most bothersome symptom and migraine-related disability, and safety and tolerability. Across multiple outcomes, AA and HL participants tended to report more positive outcomes. CONCLUSIONS There were few differences in demographic and clinical characteristics across racial and ethnic groups. Similar lasmiditan efficacy and safety outcomes were observed in AA versus W participants, and in HL versus Non-HL participants. Small observed differences may be driven by a tendency toward a more positive response observed across all treatment groups by AA and HL participants.
Collapse
Affiliation(s)
- Larry Charleston
- Department of Neurology and Ophthalmology, Michigan State University College of Human Medicine, East Lansing, MI, USA
| | | | | | | | - Ellen B Dennehy
- Eli Lilly and Company, Indianapolis, IN, USA
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
26
|
Migraine patients visiting Chinese medicine hospital: Protocol for a prospective, registry-based, real-world observational cohort study. PLoS One 2022; 17:e0265137. [PMID: 35290411 PMCID: PMC8923465 DOI: 10.1371/journal.pone.0265137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction
Migraine is a disabling, recurrent headache disorder with complex comorbidities. Conventional treatments for migraine are unsatisfactory, with side effects and limited effectiveness. Chinese herbal medicine (CHM) has been used as an alternative or complementary treatment option for migraine in China. Currently, the existing evidence of benefit of CHM for migraine has been generated from randomised clinical trials using standardised intervention with a focus on internal validity hence with limited external validity. Moreover, CHM individualised intervention design, patients’ preferences and concerns, and clinicians’ experience are critical to clinical decision making and therapeutic success. This real-world observational study aims to gather practice-based evidence of effects and safety of CHM for migraine in the context of integrating Chinese medicine diagnostic procedures, patients’ preferences and matters relevant to clinical decision making.
Methods and analysis
The study is being undertaken at the Guangdong Provincial Hospital of Chinese Medicine (GPHCM) from December 2020 to May 2022. We anticipate that approximately 400 adult migraineurs will be enrolled and observed on their migraine severity, analgesic consumption, quality of life, anxiety, depression and insomnia at baseline and then every four weeks over 12 weeks. Treatments, diagnostic information, and patient-reported most bothersome symptoms will be collected from patient clinical records. Patient’s demographic data, preferences and concerns on CHM treatments will also be gathered at baseline and be analysed. Factors related to clinical outcomes will be explored with multiple correlation and multivariable regression analyses. Effects of CHM will be evaluated using generalised estimated equation, based on clinical outcome data.
Discussion
This study will provide comprehensive evidence of CHM for migraine in the context of evidence-based practice.
Trial registration number
ChiCTR2000041003
Collapse
|
27
|
Sico JJ, Macedo F, Lewis J, Spevak C, Vogsland R, Ford A, Skop K, Sall J. The Primary Care Management of Headache: Synopsis of the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Mil Med 2022; 187:e1091-e1102. [PMID: 35022782 DOI: 10.1093/milmed/usab490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/20/2021] [Accepted: 01/09/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In June of 2020, the U.S. DVA and DoD approved a new joint clinical practice guideline for assessing and managing patients with headache. This guideline provides a framework to evaluate, treat, and longitudinally manage the individual needs and preferences of patients with headache. METHODS In October of 2018, the DVA/DoD Evidence-Based Practice Work Group convened a guideline development panel that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. RESULTS The guideline panel developed key questions, systematically searched and evaluated the literature, created a 1-page algorithm, and advanced 42 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. CONCLUSION This synopsis summarizes the key features of the guideline in three areas: prevention, assessing and treating medication overuse headache, and nonpharmacologic and pharmacologic management of headache.
Collapse
Affiliation(s)
- Jason J Sico
- Headache Centers of Excellence (HCoE) Program, National Programs Center, Orange, CT 06477, USA.,HCoE Research and Evaluation Center, Veterans Health Administration.,Department of Neurology (Headache Medicine and Vascular Neurology) and Internal Medicine (General Medicine), Yale School of Medicine, New Haven, CT 06520, USA.,VA Connecticut Healthcare System Department of Neurology, National Programs Center, Orange, CT 06477, USA
| | - Franz Macedo
- Minneapolis VA Health Care System, Minneapolis, MN 55417, USA
| | - Jeffrey Lewis
- Wright-Patterson Air Force Base Mental Health Clinic, Wright-Patterson AFB, OH 45433, USA
| | - Christopher Spevak
- Physical Medicine and Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Minneapolis VA Health Care System, Minneapolis, MN 55417, USA
| | | | - Aven Ford
- USAFSAM/FECN, Wright-Patterson AFB, OH 45433, USA
| | - Karen Skop
- Physical Medicine and Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA
| | - James Sall
- Quality and Patient Safety, Office of Evidence Based Practice, U.S. Department of Veterans Affairs, New Braunfels, TX 78132, USA.,Department of Clinical Anesthesia, Georgetown University School of Medicine.,Program Director Pain Fellowship, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| |
Collapse
|
28
|
Blumenfeld AM, Knievel K, Manack Adams A, Severt L, Butler M, Lai H, Dodick DW. Ubrogepant Is Safe and Efficacious in Participants Taking Concomitant Preventive Medication for Migraine: A Pooled Analysis of Phase 3 Trials. Adv Ther 2022; 39:692-705. [PMID: 34874514 PMCID: PMC8799553 DOI: 10.1007/s12325-021-01923-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Ubrogepant is a calcitonin gene-related peptide receptor antagonist indicated for acute treatment of migraine that can be used to treat breakthrough attacks in individuals taking preventive treatment for migraine. We evaluated the impact of preventive medication use on the efficacy and safety of ubrogepant for the acute treatment of migraine. METHODS This was an analysis of pooled efficacy data from the ACHIEVE I and ACHIEVE II phase 3 trials, in which efficacy of ubrogepant was assessed at 2 h after taking study medication for pain freedom, absence of most bothersome symptom (MBS), and pain relief. In addition, a long-term safety (LTS) extension trial was completed where safety was assessed on the basis of incidence and severity of treatment-emergent adverse events (TEAEs). Outcomes were compared between participants with or without prior (within 6 months) preventive medication use (anticonvulsants, beta blockers, antidepressants, or onabotulinumtoxinA). For efficacy analyses, data were pooled across ACHIEVE trials for the 50 mg and placebo groups; for safety analyses, data for all dose groups (50 mg and 100 mg) in the LTS trial were pooled. RESULTS Preventive treatments were used by 417 of 2247 (18.6%) participants analyzed in the ACHIEVE trials and by 143 of 813 (17.5%) participants in the LTS trial. Responder rates for all outcomes were similar between participants with or without preventive treatment within each dose group (p > 0.05). No significant differences were noted across the different preventive medications. Rates and types of TEAEs were similar between participants with or without preventive treatment. No serious treatment-related adverse events were reported. CONCLUSION Efficacy and safety of ubrogepant for the acute treatment of migraine were similar between participants with or without prior or current use of concomitant preventive medication. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT02828020 (ACHIEVE I), NCT02867709 (ACHIEVE II), and NCT02873221 (long-term safety trial).
Collapse
Affiliation(s)
- Andrew M Blumenfeld
- Headache Center of Southern California, 6010 Hidden Valley Rd #200, Carlsbad, CA, 92011, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Johnson MAL, Kuruvilla DE. External Trigeminal Nerve Stimulation as a Non-pharmacological Option for the Prevention and Acute Treatment of Migraine. Neurology 2022. [DOI: 10.17925/usn.2022.18.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Migraine is a common condition affecting approximately 1.04 billion people worldwide. Despite the available pharmaceutical therapies, patients with migraine often prefer, or may require, non-medicinal treatments for their disease. External trigeminal nerve stimulation (e-TNS) is a non-invasive, non-drug device treatment approved by the US Food and Drug Administration for the prevention and acute treatment of migraine. The trigeminovascular system plays a key role in migraine pathophysiology; e-TNS percutaneously stimulates the supraorbital and supratrochlear branches of the ophthalmic division of the trigeminal nerve. This article reviews published studies of e-TNS in the prevention and acute treatment of migraine, highlights the versatility of e-TNS in individualizing migraine treatment and discusses future directions for research and clinical applications of e-TNS therapy.
Collapse
|
30
|
Milev S, Pohl G, Sun A, Mason O, Njuguna N, Loo LS. Budget impact of lasmiditan for the acute treatment of migraine in the United States. J Manag Care Spec Pharm 2021; 27:1714-1723. [PMID: 34818093 PMCID: PMC10391167 DOI: 10.18553/jmcp.2021.27.12.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Three novel acute treatments for migraine-lasmiditan, ubrogepant, and rimegepant-were approved by the FDA in 2019 and 2020 for adults with migraine with and without aura. American Headache Society guidance recommends that these novel acute treatments be considered for patients who are contraindicated to or fail to respond or tolerate oral triptans, the current standard of acute care. OBJECTIVE: To estimate, from a US commercial plan perspective, the budget impact of adding lasmiditan as an option to a formulary that already includes ubrogepant and rimegepant. METHODS: Epidemiologic data were drawn from US Census data, the American Migraine Prevalence and Preventive study, and the first wave of the OVERCOME US survey, a web-based survey that included 21,000 patients with migraine. A model with a 3-year time horizon was built assuming that demand for the novel acute treatments would not vary based on whether lasmiditan is included in the formulary. The model examined a variety of populations, in particular beneficiaries with previous use of 1 or more oral triptans or contraindicated to triptans and beneficiaries with previous use of 2 or more oral triptans or contraindicated to triptans. Primary outcomes were the incremental differences in total cost and average cost per member per month (PMPM) between scenarios with and without lasmiditan. One-way sensitivity analyses with model parameters that were varied by plus or minus 15% were conducted to assess the effect of key parameters on the incremental total cost over 3 years. RESULTS: The addition of lasmiditan to a formulary that already includes ubrogepant and rimegepant resulted in a total savings of -$927,657 (-1.5% compared with the scenario without lasmiditan) over a 3-year time horizon in the population with previous history of using 1 or more oral triptans or contraindicated to a triptan. In the population with previous history of using 2 or more oral triptans or contraindicated, the addition of lasmiditan resulted in a total budget impact of -$466,518 (-1.3%) over a 3-year time horizon. Most of the cost savings was attributable to reductions in drug acquisition cost. Savings in total costs resulted in average incremental cost per PMPM of -0.03 and -$0.01, respectively. CONCLUSIONS: The addition of lasmiditan to the formulary as a novel acute treatment option for migraine alongside ubrogepant and rimegepant resulted in lower budget impact on a 3-year time horizon from a US commercial payer's perspective. This result is important to US commercial payers as they seek to incorporate the emerging novel acute treatments for migraine into their benefit designs. DISCLOSURES: This work was funded by Eli Lilly and Company. Milev and Sun are employed by Evidera, which received funding from Eli Lilly and Company for work on this project. Pohl, Mason, Njuguna, and Loo are employees and stockholders of Eli Lilly and Company.
Collapse
|
31
|
Gu P, Chen C, Wu Q, Dong C, Wang T, Wan Q, Dong X. The Effect and Safety of 5-HT 1F Receptor Agonist Lasmiditan on Migraine: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6663591. [PMID: 34660796 PMCID: PMC8517628 DOI: 10.1155/2021/6663591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/04/2021] [Accepted: 08/30/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Migraine has a great impact on public health. Current acute therapies do not satisfy all migraineurs. The novel serotonin 5-HT1F receptor agonist appears more promising for aborting migraine attacks. OBJECTIVE To evaluate the clinical efficacy and safety of lasmiditan in treating acute migraine attacks. METHODS The literature search was performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) which assessed the effect and safety of lasmiditan on migraine. The risk of bias was assessed using the Cochrane Collaboration's risk of bias tool. Results were extracted and pooled as risk ratios (RRs) with a fixed or random-effects model. RESULTS Based on the four included RCTs, pooled estimates showed that lasmiditan with the 50 mg, 100 mg, and 200 mg doses was superior to placebo at 2 h after the first dose in terms of pain freedom, absence of migraine-associated symptoms, headache relief, no/mild disability, and global impression of change (very much/much better) (RRs ranged from 1.13 to 1.96), except for nausea-free and vomiting-free. Both lasmiditan 100 mg and 200 mg resulted in significantly fewer patients using rescue medication (100 mg: RR = 0.75, 95% CI (0.61, 0.92), P = 0.007; 200 mg: RR = 0.81, 95% CI (0.66, 0.99), P = 0.04) at 2-24 h postdose, compared with placebo. Safety data showed that the proportion of patients reporting at least one treatment-emergent adverse event (TEAE) and the incidence of most common TEAEs such as dizziness, paresthesia, fatigue, somnolence, and nausea was higher in the lasmiditan groups (50 mg, 100 mg, and 200 mg), compared with placebo. There was no significant difference between lasmiditan and placebo in terms of cardiovascular-related TEAEs (RR = 2.75, 95% CI (0.81, 9.37), P = 0.11). Compared with lasmiditan 100 mg, lasmiditan 200 mg was more effective in pain freedom at 2 h after the first dose (RR = 0.83, 95% CI (0.74, 0.94), P = 0.004) but associated with a higher risk of reporting at least one TEAE (RR = 0.88, 95% CI (0.81, 0.96), P = 0.006). CONCLUSIONS Lasmiditan with the 50 mg, 100 mg, and 200 mg doses are effective and safe in acute migraine treatment. Lasmiditan 200 mg is more effective than lasmiditan 100 mg in pain freedom, while lasmiditan 100 mg is better tolerated in the short-term follow-up. Further larger sample-size RCTs are required to verify the applicability and tolerability in the long term.
Collapse
Affiliation(s)
- Ping Gu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Cheng Chen
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, China
- Department of Neurology, The Second Affiliated Hospital of Wannan Medical College, 10 Kangfu Road, Wuhu, Anhui Province, China
| | - Qian Wu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Changhong Dong
- Department of Clinical Medicine, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu Province, China
| | - Teng Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Qi Wan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Xin Dong
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| |
Collapse
|
32
|
Harris L, L'Italien G, O'Connell T, Hasan Z, Hutchinson S, Lucas S. A Framework for Estimating the Eligible Patient Population for New Migraine Acute Therapies in the United States. Adv Ther 2021; 38:5087-5097. [PMID: 34057676 PMCID: PMC8478730 DOI: 10.1007/s12325-021-01781-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/07/2021] [Indexed: 01/05/2023]
Abstract
Introduction Migraine is associated with considerable disability for patients not adequately managed with current standards of care. New acute therapies may offer relief for this population of patients; however, population size and associated potential costs of new therapies are unclear. In this study, a conceptual framework was developed to estimate anticipated use of new acute therapies. Methods Targeted literature review (TLR) was conducted to identify factors affecting access to migraine-specific acute therapies, and characteristics of individuals who would be eligible for new acute therapies. Findings from the TLR were combined to create a framework for estimating the size of the eligible patient population. This framework was used to calculate two estimates of the eligible patient population by applying parameters (i) identified in the TLR and (ii) from a recent budget-impact analysis (BIA). Results The primary factors affecting access to migraine-specific acute therapies identified in the TLR were consulting a healthcare professional for headache, receiving a migraine diagnosis, and receiving a prescription for migraine-specific treatment. Characteristics of individuals likely to use new acute therapies reflected in the TLR were contraindication to triptans, or failure to respond to/tolerate at least two oral triptans. Application of the framework suggested that 15–25% of individuals with migraine would be eligible for new acute therapies. Conclusion A limited number of patients currently use migraine-specific acute therapies. Among such patients, a significant proportion do not have adequate symptom control. Accordingly, a minority of individuals with migraine may be expected to use new acute therapies. The framework developed in this study is intended to facilitate estimating the eligible patient population in assessments of costs of new acute therapies. Such assessments should also consider recommendations that patients have access to multiple types of acute therapies, which may yield savings from reduced medication-overuse headache (MOH), progression to chronic migraine, and urgent-care costs. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01781-z.
Collapse
Affiliation(s)
| | | | | | | | | | - Sylvia Lucas
- Department of Neurology, University of Washington Medical Center, Seattle, WA, USA
| |
Collapse
|
33
|
Tepper SJ, Fang J, Zhou L, Vo P, Abdrabboh A, Glassberg M, Ferraris M. Comparative effectiveness of erenumab versus oral preventive medications among migraine patients: A US claims database study. CEPHALALGIA REPORTS 2021. [DOI: 10.1177/25158163211040061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Erenumab, a fully human monoclonal antibody targeting the calcitonin gene-related peptide pathway, was developed specifically for preventive treatment of migraine. Objective: To compare the real-world effectiveness of erenumab and non-specific oral migraine preventive medication (OMPM) on acute medication usage and healthcare resource utilization (HCRU) among migraine patients. Methods: This retrospective US claims analysis included patients (≥18 years) diagnosed with migraine who initiated erenumab (May 01, 2018 and September 30, 2019) or OMPM (May 01, 2016 and October 31, 2017). Cohorts were matched 1:1 using the propensity score (PS) method with stratification. Acute medication usage, HCRU, and a composite endpoint of 1) outpatient visit with a migraine diagnosis and associated acute medication claim, 2) hospital admission with a primary migraine diagnosis, or 3) emergency room visit with a primary migraine diagnosis were assessed 6 months post-treatment initiation. Results: Following PS matching, both cohorts included 2,343 patients. At 6 months, erenumab was associated with significantly less acute medication usage versus OMPM, including number of types of acute medications used, number of claims per person, and proportion of patients using acute medication. HCRU and number of composite events were also significantly lower among erenumab users. Conclusion: Erenumab is more effective than OMPM at reducing acute medication usage and HCRU among migraine patients. Trial registration: N/A.
Collapse
Affiliation(s)
| | - Juanzhi Fang
- RWE and Data Science, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Lujia Zhou
- KMK Consulting Inc., Morristown, NJ, USA
| | - Pamela Vo
- HEOR, Novartis Pharma AG, Basel, Switzerland
| | - Ahmad Abdrabboh
- Department of Neuroscience, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Matias Ferraris
- Department of Neuroscience, Novartis Pharma AG, Basel, Switzerland
| |
Collapse
|
34
|
Maiti R, Mishra A, Puliappadamb HM, Jena M, Srinivasan A. Efficacy and Safety of Lasmiditan for Acute Treatment of Migraine in Adults: A Meta-Analysis. J Clin Pharmacol 2021; 61:1534-1544. [PMID: 34472095 DOI: 10.1002/jcph.1962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/25/2021] [Indexed: 01/03/2023]
Abstract
Monotherapy with triptans in acute migraine is ineffective in many patients and contraindicated in certain cardiovascular diseases where alternative therapeutic options are necessary to explore. This meta-analysis has evaluated the efficacy and safety of lasmiditan for the treatment of acute migraine in adults. After performing a literature search on MEDLINE/PubMed, Scopus, Cochrane databases, and International Clinical Trial Registry Platform, reviewers assessed eligibility and extracted data from 4 relevant articles. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed in the selection, analysis, and reporting of findings. A random-effects model was used to estimate effect size. Quality assessment was done using the risk of bias assessment tool and meta-regression for probable variables affecting effect size. Subgroup analysis was done depending on the dose of lasmiditan. Lasmiditan use was associated with a significantly higher percentage of patients with pain freedom (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.72-2.39; P < .00001), sustained pain freedom (OR, 1.93; 95%CI, 1.55-2.39; P <.00001), headache response (OR, 2.05; 95%CI, 1.77-2.36; P < .00001), clinical disability level (OR, 1.36; 95%CI, 1.20-1.55; P < .00001), patients' global impression (OR, 1.88; 95%CI, 1.69-2.10; P < .00001), and significantly lower use of rescue medication (OR, 0.49; 95%CI, 0.38-0.63; P < .00001) compared to placebo. Lasmiditan use was also associated with a higher likelihood of adverse effects like dizziness (OR, 6.54; 95%CI, 4.24-10.07; P < .00001), paresthesia (OR, 4.28; 95%CI, 2.97-6.17; P < .00001), and fatigue (OR, 5.67; 95%CI, 3.78-8.52; P < .00001) compared to placebo. Subgroup analysis showed a dose-dependent effect of lasmiditan on pain freedom, sustained pain freedom, patient's global impression, and occurrence of adverse drug reactions. Prediction probability for effect estimate favoring placebo was calculated to be 0.0017%. Lasmiditan has shown a favorable effect in terms of efficacy and safety in the treatment of an acute attack of migraine in comparison to placebo. Further studies are needed to evaluate long-term safety, efficacy, and use in specific subgroups of patients. PROSPERO Registration Number: CRD42020177838.
Collapse
Affiliation(s)
- Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Monalisa Jena
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| |
Collapse
|
35
|
Kiarashi J, VanderPluym J, Szperka CL, Turner S, Minen MT, Broner S, Ross AC, Wagstaff AE, Anto M, Marzouk M, Monteith TS, Rosen N, Manrriquez SL, Seng E, Finkel A, Charleston L. Factors Associated With, and Mitigation Strategies for, Health Care Disparities Faced by Patients With Headache Disorders. Neurology 2021; 97:280-289. [PMID: 34108270 PMCID: PMC8424498 DOI: 10.1212/wnl.0000000000012261] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review contemporary issues of health care disparities in headache medicine with regard to race/ethnicity, socioeconomic status (SES), and geography and propose solutions for addressing these disparities. METHODS An Internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in headache medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with a group of 16 experts from a range of headache subspecialties. RESULTS Taken together, a multitude of factors, including racism, SES, insurance status, and geographical disparities, contribute to the inequities that exist within the health care system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy, and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities. CONCLUSION Neurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.
Collapse
Affiliation(s)
- Jessica Kiarashi
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing.
| | - Juliana VanderPluym
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Christina L Szperka
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Scott Turner
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Mia T Minen
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Susan Broner
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Alexandra C Ross
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Amanda E Wagstaff
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Marissa Anto
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Maya Marzouk
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Teshamae S Monteith
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Noah Rosen
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Salvador L Manrriquez
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Elizabeth Seng
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Alan Finkel
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Larry Charleston
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| |
Collapse
|
36
|
Ducros A, de Gaalon S, Roos C, Donnet A, Giraud P, Guégan-Massardier E, Lantéri-Minet M, Lucas C, Mawet J, Moisset X, Valade D, Demarquay G. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 2: Pharmacological treatment. Rev Neurol (Paris) 2021; 177:734-752. [PMID: 34340810 DOI: 10.1016/j.neurol.2021.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022]
Abstract
The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the second part of the guidelines, which is focused on the pharmacological treatment of migraine, including both the acute treatment of attacks and the prophylaxis of episodic migraine as well as chronic migraine with and without medication overuse. The specific situations that can be encountered in women with migraine are also discussed, including pregnancy, menstrual migraine, contraception and hormonal replacement therapy.
Collapse
Affiliation(s)
- A Ducros
- Department of neurology, Gui-de-Chauliac hospital, CHU Montpellier, university of Montpellier, 34000 Montpellier, France
| | - S de Gaalon
- Department of neurology, Laënnec hospital, CHU de Nantes, Nantes, France
| | - C Roos
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Donnet
- Centre d'évaluation et de traitement de la douleur, FHU INOVPAIN, hôpital de La Timone, Marseille, France
| | - P Giraud
- Department of neurology, Annecy Genevois hospital, Annecy, France
| | | | - M Lantéri-Minet
- Pain department, FHU InovPain, CHU Nice Côte Azur université, Nice, France
| | - C Lucas
- Centre d'évaluation et de traitement de la douleur, service de neurochirurgie, hôpital Salengro, CHRU de Lille, Lille, France
| | - J Mawet
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - X Moisset
- Neuro-Dol, université Clermont Auvergne, CHU de Clermont-Ferrand, INSERM, Clermont-Ferrand, France
| | - D Valade
- Department of neurosurgery, hôpital Pitié-Sapêtrière, Paris, France
| | - G Demarquay
- Neurological hospital, Lyon, neuroscience research center (CRNL), INSERM U1028, CNRS UMR5292, Lyon, France.
| |
Collapse
|
37
|
Minen MT, Yang J, Ashina S, Rosen N, Duarte R. Survey of Pain Medicine Specialists' Familiarity with Migraine Management. PAIN MEDICINE 2021; 22:3030-3040. [PMID: 34270743 DOI: 10.1093/pm/pnab149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pain specialists treat patients with headache and interface with those who use opioids more so than neurologists and headache specialists. We assessed headache medicine knowledge and needs of pain specialists. DESIGN/SETTING Cross-sectional online survey. SUBJECTS Members of the American Academy of Pain Medicine. METHODS Survey was based on a prior survey on primary care providers' knowledge and needs and was iteratively updated by four headache specialists, two with pain medicine affiliations. RESULTS Of the 105 respondents, 71.4% were physicians, 34.3% were women, and they averaged 20.0 ± 13.6 years in practice. The most common specialty was anesthesia (36.1%, n = 35/97) followed by neurology (14.4%, n = 14/97). About half of providers (55.7%, n = 34/61 and 53.3%, n = 32/60) were familiar with the American Academy of Neurology Guidelines for pharmacological migraine prevention and the Choosing Wisely Campaign recommendations for limiting neuroimaging and opioids. Less than half of all providers (39.7%, n = 23/58) were familiar with the American Headache Society guidelines for emergency management of migraine. Providers were aware of Level A evidence-based nonpharmacological therapies, with over three-fourths recognizing cognitive behavioral therapy (80.7%, n = 50/62) and biofeedback (75.8%, n = 47/62) as evidence-based interventions. About 80% of providers (n = 50/64) estimate making migraine diagnoses in ≤ 50% of their patients with headache. Providers consider starting preventive headache therapy at 7.1 ± 3.9 days/month and report referring 34.3%±34.2% of patients to behavioral interventions. CONCLUSIONS Dissemination and implementation of headache guidelines is needed for pain medicine specialists. Providers may need help diagnosing migraine based on currently accepted guidelines and referring for evidence-based behavioral therapies.
Collapse
Affiliation(s)
- Mia T Minen
- Departments of Neurology and Public Health; NYU Langone Health, 222 E 41st Street, Floor 10, New York, NY 10017
| | - Jackie Yang
- Departments of Neurology and Public Health; NYU Langone Health, 222 E 41st Street, Floor 10, New York, NY 10017
| | | | - Noah Rosen
- Department of Neurology and Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center
| | - Robert Duarte
- Pain and Headache Center, Northwell Department of Neurology, Zucker School of Medicine
| |
Collapse
|
38
|
Update on Management of Acute Migraine. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40138-021-00235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
39
|
Thiele A, Strauß S, Angermaier A, Klehr L, Bartsch L, Kronenbuerger M, Schmidt S, Fleischmann R. Treatment Realities of Headache Disorders in Rural Germany by the Example of the Region of Western Pomerania. Brain Sci 2021; 11:839. [PMID: 34202861 PMCID: PMC8301947 DOI: 10.3390/brainsci11070839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Headache disorders are among the most disabling medical conditions but the supply with experienced providers is outpaced by the demand for service. It is unclear to what extent particularly patients in rural regions are affected by limited access to comprehensive care. Furthermore, it is unknown what role general practitioners (GPs) play in headache care. (2) Methods: First-time consultations to a specialised headache clinic at a tertiary care centre were asked to participate. Their socio-demographic background, general and headache-specific medical history, disability and quality of life (QoL) were assessed. Additionally, 176 GPs in neighbouring districts were contacted regarding headache management. (3) Results: We assessed 162 patients with first-time consultations (age 46.1 ± 17.0 years, 78.1% female), who suffered from migraine (72%), tension type, cluster and secondary headaches (each 5-10%). About 50% of patients received a new headache-diagnosis and 60% had treatment inconsistent with national guidelines. QoL was significantly worse in all domains compared to the general population. About 75% of GPs see headache patients at least several times per week, and mostly treat them by themself. (4) Conclusions: More than every second headache patient was neither correctly diagnosed nor received guideline adherent treatment. Headache-related disability is inferior to what is expected from previous studies. Access to specialised health care is more limited in rural than in urban regions in Germany and GPs request more training.
Collapse
Affiliation(s)
- Anne Thiele
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Sebastian Strauß
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Lara Klehr
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Luise Bartsch
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| | - Martin Kronenbuerger
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
- Medical School OWL, University of Bielefeld, 33615 Bielefeld, Germany
| | - Sein Schmidt
- Clinical Research Unit, Charité Campus Mitte, Berlin Institute of Health, 10117 Berlin, Germany;
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (A.T.); (S.S.); (A.A.); (L.K.); (L.B.); (M.K.)
| |
Collapse
|
40
|
Hutchinson S, Dodick DW, Treppendahl C, Bennett NL, Yu SY, Guo H, Trugman JM. Ubrogepant for the Acute Treatment of Migraine: Pooled Efficacy, Safety, and Tolerability From the ACHIEVE I and ACHIEVE II Phase 3 Randomized Trials. Neurol Ther 2021; 10:235-249. [PMID: 33608814 PMCID: PMC8140011 DOI: 10.1007/s40120-021-00234-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/30/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Ubrogepant is an oral, small-molecule calcitonin gene-related peptide receptor antagonist approved for the acute treatment of migraine. The efficacy and safety of ubrogepant were demonstrated in two pivotal phase 3, single-attack, randomized, placebo-controlled trials (ACHIEVE I and ACHIEVE II). METHODS We conducted a post hoc analysis of pooled data from the ACHIEVE trials to evaluate the efficacy, safety, and tolerability of ubrogepant 50 mg (the only dose evaluated in both trials) versus placebo across a large population of participants with migraine. The coprimary efficacy outcomes were pain freedom and absence of the most bothersome migraine-associated symptom (including photophobia, phonophobia, and nausea) at 2 h post dose. Secondary outcomes included pain relief at 2 h post dose, sustained pain relief and pain freedom from 2 to 24 h, and absence of specific migraine-associated symptoms at 2 h post dose. RESULTS A total of 2240 eligible participants were randomized to placebo (n = 1122) or ubrogepant 50 mg (n = 1118) in the ACHIEVE trials. Pain freedom at 2 h was reported in 13.0% of participants in the pooled placebo group and 20.5% in the pooled ubrogepant 50 mg group (odds ratio [OR] 1.72; 95% confidence interval [CI] 1.34, 2.22; P < 0.001). Absence of the most bothersome migraine-associated symptom at 2 h was reported by 27.6% in the pooled placebo group and by 38.7% in the pooled ubrogepant 50 mg group (OR 1.68; 95% CI 1.37, 2.05; P < 0.001). Adverse events (AEs) within 48 h after the initial or optional second dose were reported by 11.5 and 11.2% of participants in the pooled placebo and pooled ubrogepant 50 mg groups, respectively. The most common AE was nausea (1.8 and 1.9%, respectively). No serious AEs related to treatment or discontinuations due to AEs were reported. CONCLUSION These results further support the efficacy, safety, and tolerability of ubrogepant for the acute treatment of migraine. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: ACHIEVE I: NCT02828020; ACHIEVE II: NCT02867709.
Collapse
|
41
|
Kim BK, Chu MK, Yu SJ, Dell'Agnello G, Han JH, Cho SJ. Burden of migraine and unmet needs from the patients' perspective: a survey across 11 specialized headache clinics in Korea. J Headache Pain 2021; 22:45. [PMID: 34030630 PMCID: PMC8146656 DOI: 10.1186/s10194-021-01250-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Migraine is a neurological, primary headache disorder affecting more than 1 billion people worldwide, with a multi-faceted burden that can significantly impact the everyday life of a patient, both during and between attacks. However, studies on patient awareness, burden, and clinical management of migraine in Korea are limited and outdated. The aim of this study was to comprehensively investigate the current difficulties and unmet needs that Korean patients with migraine encounter from their perspective. METHODS A total of 207 patients with episodic or chronic migraine aged between 15 and 76 years, completed a survey designed to cover the following topics: diagnosis, understanding of the disease, treatment experience, disability, and quality of life. Patients were recruited by their neurologists from 11 specialized headache clinics in Korea and completed the survey between 22 July and 19 August 2019. Validated scales such as the Migraine Disability Assessment (MIDAS) questionnaire and Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQv2.1) were used to assess levels of disability and quality of life, respectively, in patients. RESULTS On average, it took 10.1 years from onset of symptoms to diagnosis and a mean of 3.9 hospitals were visited for treatment prior to the patient's current hospital. There was a lack of understanding among respondents about migraine, with 55.6% believing that unilateral headache is a unique feature of migraine compared with other headache disorders. On average, high levels of disability and poor quality of life were reported by patients, as assessed by MIDAS and MSQv2.1, respectively, but only 23.7% had regularly taken preventive medication in the past. Overall satisfaction with previous doctor-patient relationships was reported by 29.5% of respondents, and satisfaction with preventive and acute medications by only 40.8% and 27.1% of the respondents, respectively. CONCLUSION Korean patients with migraine experience significant disability and reduced quality of life as a result of the disease and have clear unmet needs in terms of diagnosis, understanding of the disease, and disease management including treatment.
Collapse
Affiliation(s)
- Byung-Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University School of Medicine, Seoul, South Korea
| | | | | | | | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea.
| |
Collapse
|
42
|
Hutchinson S, Silberstein SD, Blumenfeld AM, Lipton RB, Lu K, Yu SY, Severt L. Safety and efficacy of ubrogepant in participants with major cardiovascular risk factors in two single-attack phase 3 randomized trials: ACHIEVE I and II. Cephalalgia 2021; 41:979-990. [PMID: 33874756 DOI: 10.1177/03331024211000311] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the safety and efficacy of ubrogepant for acute treatment of migraine across cardiovascular (CV) disease risk categories. METHODS ACHIEVE I and II were multicenter, double-blind, single-attack, phase 3 trials in adults with migraine, with or without aura. Participants were randomized 1:1:1 to placebo or ubrogepant (50 or 100 mg in ACHIEVE I; 25 or 50 mg in ACHIEVE II), to treat one migraine attack of moderate or severe headache pain intensity. This post-hoc analysis pooled data from ubrogepant 50 mg and placebo groups from the ACHIEVE trials to examine the safety and efficacy of ubrogepant by baseline cardiovascular disease risk factors. Using a cardiovascular risk assessment algorithm, participants were categorized as having no cardiovascular risk, low cardiovascular risk or moderate-high cardiovascular risk at baseline. Treatment-emergent adverse events were documented 48 h and 30 days after taking the trial medication. Co-primary efficacy outcomes were 2-h pain freedom and 2-h absence of most bothersome migraine-associated symptom. RESULTS Overall, 3358 participants were randomized in the ACHIEVE trials (n = 2901 safety population; n = 2682 modified intent-to-treat population). In the safety population, 11% of participants were categorized as moderate-high (n = 311), 32% low (n = 920), and 58% no cardiovascular risk factors (n = 1670). The proportion of ubrogepant participants reporting a treatment-emergent adverse event was comparable across risk categories and similar to placebo. The treatment effects of ubrogepant versus placebo were consistent across cardiovascular risk categories for all efficacy outcomes. CONCLUSION The safety and efficacy of ubrogepant for the acute treatment of a single migraine attack did not differ by the presence of major cardiovascular risk factors. No evidence of increased treatment-emergent adverse events or cardiac system organ class adverse events with ≥2 major cardiovascular risk factors and no safety concerns were identified.Trial Registration: ACHIEVE I ClinicalTrials.gov number, NCT02828020; ACHIEVE II ClinicalTrials.gov number, NCT02867709.
Collapse
|
43
|
Ashina M, Buse DC, Ashina H, Pozo-Rosich P, Peres MFP, Lee MJ, Terwindt GM, Halker Singh R, Tassorelli C, Do TP, Mitsikostas DD, Dodick DW. Migraine: integrated approaches to clinical management and emerging treatments. Lancet 2021; 397:1505-1518. [PMID: 33773612 DOI: 10.1016/s0140-6736(20)32342-4] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed clinical management. First, we discuss the efficacy, tolerability, and safety profile of various pharmacological therapies for acute and preventive treatment of migraine. Second, we review the current knowledge on non-pharmacological therapies, such as neuromodulation and biobehavioural approaches, which can be used for a multidisciplinary approach to clinical management. Third, we emphasise that any effective treatment strategy starts with building a therapeutic plan tailored to individual clinical characteristics, preferences, and needs. Finally, we explore the outlook of emerging mechanism-based treatments that could address unmet challenges in clinical management of migraine.
Collapse
Affiliation(s)
- Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache Research Group, Vall d'Hebron Institute of Research, Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mario F P Peres
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Headache Science Centre, Institute for Research, Hospitalization and Healthcare, Mondino Foundation, Pavia, Italy
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dimos D Mitsikostas
- First Neurology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
44
|
DeJulio PA, Perese JK, Schuster NM, Oswald JC. Lasmiditan for the acute treatment of migraine. Pain Manag 2021; 11:437-449. [PMID: 33840206 DOI: 10.2217/pmt-2021-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Migraine is a leading cause of morbidity and disability worldwide. Triptans were the first migraine-specific drug class developed and have proven efficacy in treatment of this neurological disease. They are however contraindicated in patients with cardiovascular disease and possibly others, owning to their vasoconstrictive properties. This review will focus on lasmiditan, which has been called the first 'ditan' and 'neurally acting anti-migraine agent', designed to selectively agonize the serotonin 5-HT1F receptor subtype, providing anti-migraine effects without concomitant vasoconstriction. To date, lasmiditan has proven safe and effective for the acute treatment of migraine in two Phase II and four Phase III trials. Post hoc analysis revealed that the majority of treatment-emergent adverse events were CNS-related, mild-to-moderate in severity and self-limiting. The US FDA label recommends that patients not drive or operate machinery until at least 8 h after taking each dose of lasmiditan.
Collapse
Affiliation(s)
- Paul A DeJulio
- Department of Emergency Medicine, The Ohio State University, OH 43210, USA.,Department of Internal Medicine, The Ohio State University, OH 43210, USA
| | - Joshua K Perese
- Department of Emergency Medicine, Loma Linda University Medical Center, CA 92354, USA
| | - Nathaniel M Schuster
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health, CA 92103, USA
| | - Jessica C Oswald
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health, CA 92103, USA.,Department of Emergency Medicine, UC San Diego Health, CA 92103, USA
| |
Collapse
|
45
|
Blumenfeld AM, Goadsby PJ, Dodick DW, Hutchinson S, Liu C, Finnegan M, Trugman JM, Szegedi A. Efficacy of ubrogepant based on prior exposure and response to triptans: A post hoc analysis. Headache 2021; 61:422-429. [PMID: 33749826 PMCID: PMC8252782 DOI: 10.1111/head.14089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/18/2020] [Accepted: 01/24/2021] [Indexed: 01/03/2023]
Abstract
Objective To determine the potential efficacy of ubrogepant for acute treatment of migraine based on historical experience with triptans. Background Although triptans have improved migraine treatment, their efficacy and tolerability may limit their utility in some individuals. Ubrogepant is a small‐molecule, oral calcitonin gene–related peptide receptor antagonist approved by the Food and Drug Administration for acute treatment of migraine in adults. Methods This post hoc analysis of pooled data from the pivotal trials ACHIEVE I and II, identically designed, randomized, double‐blind, phase 3, single‐attack trials of ubrogepant in adults with a history of migraine with/without aura, examined the efficacy and tolerability of ubrogepant 50 mg versus placebo based on participants’ historical experience with triptans: triptan responder, triptan‐insufficient responder, and triptan naïve. Co‐primary efficacy endpoints were pain freedom and absence of most bothersome migraine‐associated symptom (MBS) 2 h post initial dose. Adverse events (AEs) within historical triptan experience subgroups were evaluated. Results In the pooled analysis population (n = 1799), 682 (placebo, n = 350; ubrogepant 50 mg, n = 332), 451 (placebo, n = 223; ubrogepant, n = 228), and 666 (placebo, n = 339; ubrogepant, n = 327) participants were triptan responders, triptan‐insufficient responders, and triptan‐naïve, respectively. Response rates on co‐primary efficacy endpoints were higher for ubrogepant versus placebo across all groups. Treatment‐by‐subgroup interaction p values based on odds ratios for pain freedom (p = 0.290) and absence of MBS (p = 0.705) indicated no significant impact of historical triptan experience on ubrogepant efficacy. AE incidence for ubrogepant did not differ appreciably across historical triptan experience subgroups. Conclusions Ubrogepant efficacy and tolerability did not differ for the acute treatment of migraine in participants classified as triptan responders, triptan‐insufficient responders, and triptan‐naïve based on their historical experience with triptans.
Collapse
Affiliation(s)
- Andrew M Blumenfeld
- The Neurology Center, Headache Center of Southern California, Carlsbad, CA, USA
| | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College, London, UK.,University of California, Los Angeles, CA, USA
| | | | - Susan Hutchinson
- Department of Headache, Orange County Migraine and Headache Center, Irvine, CA, USA
| | | | | | | | | |
Collapse
|
46
|
Ferrari A, Rustichelli C. Rational Use of Lasmiditan for Acute Migraine Treatment in Adults: A Narrative Review. Clin Ther 2021; 43:654-670. [PMID: 33608115 DOI: 10.1016/j.clinthera.2021.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This narrative review provides an update on the research that led to the development of ditans and lasmiditan for the acute treatment of migraine in adults and discusses the potential advantages and disadvantages of lasmiditan in clinical use. METHODS The electronic databases PubMed, Scopus, and ClinicalTrials.gov were searched from database inception through January 9, 2021, to identify relevant studies. Search results were assessed for their overall relevance to this review. FINDINGS Because part of the effect of the triptans is mediated by the serotonin 1F receptors, which are not present in the smooth muscle, a pure agonist of these receptors, lasmiditan, was developed. Lasmiditan is hypothesized to act on antinociceptive pathways and inhibit the calcitonin gene-related peptide release. Lasmiditan was approved by the US Food and Drug Administration in 2019 based on the results of 2 pivotal trials that found a significant difference from placebo in the percentage of patients who achieved freedom from pain and most bothersome symptom at 2 h. The main concern of lasmiditan derives from its central nervous system-related adverse effects, mainly dizziness and paraesthesia, probably attributable to its high blood brain barrier penetration. These central nervous system adverse effects impair driving performance for hours and might be suboptimal for individuals with migraine who want to quickly stop the migraine attack to resume their activities as soon as possible. IMPLICATIONS Despite the advantage of being beneficial in the acute treatment of migraine without vasocostrictive action, lasmiditan also presents limitations, in particular the central nervous system adverse effects. Moreover, head-to-head trials against triptans and gepants are indispensable to determine the better option for patients.
Collapse
Affiliation(s)
- Anna Ferrari
- Unit of Medical Toxicology, Headache Centre and Drug Abuse, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy
| | - Cecilia Rustichelli
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| |
Collapse
|
47
|
Mojadidi MK, Kumar P, Mahmoud AN, Elgendy IY, Shapiro H, West B, Charles AC, Mattle HP, Sorensen S, Meier B, Silberstein SD, Tobis JM. Pooled Analysis of PFO Occluder Device Trials in Patients With PFO and Migraine. J Am Coll Cardiol 2021; 77:667-676. [PMID: 33573735 DOI: 10.1016/j.jacc.2020.11.068] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although observational studies have shown percutaneous patent foramen ovale (PFO) closure to be a safe means of reducing the frequency and duration of migraine, randomized clinical trials have not met their primary efficacy endpoints. OBJECTIVES The authors report the results of a pooled analysis of individual participant data from the 2 randomized trials using the Amplatzer PFO Occluder to assess the efficacy and safety of percutaneous device closure as a therapy for episodic migraine with or without aura. METHODS The authors analyzed individual patient-level data from 2 randomized migraine trials (the PRIMA [Percutaneous Closure of Patent Foramen Ovale in Migraine With Aura] and PREMIUM [Prospective Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects with Migraine and PFO Using the Amplatzer PFO Occluder Compared to Medical Management] studies). Efficacy endpoints were mean reduction in monthly migraine days, responder rate (defined as ≥50% reduction in monthly migraine attacks), mean reduction in monthly migraine attacks, and percentage of patients who experienced complete cessation of migraine. The safety endpoint was major procedure- and device-related adverse events. RESULTS Among 337 subjects, 176 were randomized by blocks to device closure and 161 to medical treatment only. At 12-month follow-up, the analysis met 3 of the 4 efficacy endpoints: mean reduction of monthly migraine days (-3.1 days vs. -1.9 days; p = 0.02), mean reduction of monthly migraine attacks (-2.0 vs. -1.4; p = 0.01), and number of subjects who experienced complete cessation of migraine (14 [9%] vs. 1 [0.7%]; p < 0.001). For the safety analysis, 9 procedure-related and 4 device-related adverse events occurred in 245 subjects who eventually received devices. All events were transient and resolved. CONCLUSIONS This pooled analysis of patient-level data demonstrates that PFO closure was safe and significantly reduced the mean number of monthly migraine days and monthly migraine attacks, and resulted in a greater number of subjects who experienced complete migraine cessation.
Collapse
Affiliation(s)
- Mohammad K Mojadidi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
| | - Preetham Kumar
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Ahmed N Mahmoud
- Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hilary Shapiro
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Brian West
- Division of Cardiology, Sharp Rees-Stealy Medical Group, San Diego, California, USA
| | - Andrew C Charles
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Heinrich P Mattle
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | | | - Bernhard Meier
- Department of Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Stephen D Silberstein
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jonathan M Tobis
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
48
|
Cady R, Gottschalk C, Pavlovic J. Redefining Expectations for Migraine Prevention. Neurology 2021. [DOI: 10.17925/usn.2021.17.suppl.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
With the advent of new preventive migraine treatments, such as calcitonin gene-related peptide inhibitor monoclonal antibodies, there is a need to ensure realistic treatment expectations, and to carefully consider therapeutic options. Current treatment guidelines suggest that reductions in mean monthly headache days of ≥50% from baseline should be considered evidence of treatment efficacy, although in some patients, benefits can be seen at lower thresholds. However, patients may expect greater reductions in migraine attacks, so setting realistic expectations is important for treatment success. As treatment side effects and a lack of efficacy are the main reasons for treatment discontinuation, possible side effects should be discussed, and the individual goals of patients considered. Current American Headache Society guidelines suggest candidacy for preventive migraine treatment is primarily based on the frequency of attacks in the USA, with treatment recommended for patients who have ≥4 migraine days per month. However, even fewer than 4 monthly headache days per month can have a severe impact on overall health-related quality of life in addition to impairment during individual episodes. Finally, the use of acute therapy should be carefully monitored and considered when treatment decisions are being made, to ensure optimization of use, and to avoid overuse and progression to chronic migraine. These considerations indicate that patient needs are multifaceted and that management decisions need to be crafted on a case-by-case basis.
Collapse
|
49
|
Hirata K, Ueda K, Komori M, Ye W, Kim Y, Cotton S, Jackson J, Treuer T. Unmet Needs in Japanese Patients Who Report Insufficient Efficacy with Triptans for Acute Treatment of Migraine: Retrospective Analysis of Real-World Data. Pain Ther 2020; 10:415-432. [PMID: 33306190 PMCID: PMC8119538 DOI: 10.1007/s40122-020-00223-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Migraine attacks notably impact people's daily lives, health-related quality of life (HRQoL), and ability to work. Triptans are widely used as acute medication for a migraine attack but are ineffective, poorly tolerated, or contraindicated in some patients. HRQoL and work productivity are therefore likely to pose particular problems for patients whose migraine attacks do not respond sufficiently to triptan acute treatment. This real-world study aimed to determine whether migraine-related HRQoL, disability, and work productivity differed between triptan insufficient responders (TIRs) and sufficient responders (TSRs) receiving this acute treatment for migraine in Japan. METHODS This was a retrospective analysis of 2017 Adelphi Migraine Disease Specific Programme cross-sectional survey data collected from physicians and their consulting patients with migraine in Japan. Patients had to be receiving a triptan as their sole acute prescribed medication for migraine. TIRs were defined as patients who achieved headache pain freedom within 2 h of taking triptan acute treatment in no more than three of five migraine attacks. Differences in outcomes between TIRs and TSRs were examined in adjusted analyses using a multivariable general linear model. RESULTS Of 200 patients receiving a triptan as their sole prescribed acute treatment for migraine, 88 (44.0%) were classed as TIRs. Migraine-Specific Quality of Life Questionnaire scores were significantly lower-indicating poorer HRQoL-among TIRs than TSRs, as were mean EuroQol 5-dimension utility and visual analog scale scores (p < 0.05 for comparisons). TIRs also reported significantly (p ≤ 0.003) greater impairment than TSRs across all Work Productivity and Activity Impairment domains, with the exception of work time missed. Migraine disability was higher among TIRs than TSRs. CONCLUSION Migraine attacks had a negative impact on the HRQoL, disability, and work productivity of people with migraine in Japan reporting insufficient efficacy with acute triptan treatment, highlighting the need for more effective acute treatment options.
Collapse
Affiliation(s)
- Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | | | | | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Yongin Kim
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | |
Collapse
|
50
|
Leroux E, Buchanan A, Lombard L, Loo LS, Bridge D, Rousseau B, Hopwood N, Matthews BR, Reuter U. Evaluation of Patients with Insufficient Efficacy and/or Tolerability to Triptans for the Acute Treatment of Migraine: A Systematic Literature Review. Adv Ther 2020; 37:4765-4796. [PMID: 32990921 PMCID: PMC7595976 DOI: 10.1007/s12325-020-01494-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Use of triptans for acute treatment of migraine is associated with insufficient efficacy and/or tolerability in approximately 30-40% of people. We conducted a systematic literature review (SLR) to synthesize definitions, terminology, subsequent treatment outcomes, and characteristics associated with this subpopulation. METHODS A comprehensive SLR was conducted to identify studies, published from Jan 1995 to May 2019, which focused on insufficient efficacy and/or tolerability to triptans. RESULTS Thirty-five publications were identified, of which 22 described randomized controlled trials and open-label studies, and 13 described observational studies. Across studies, multiple objectives and a high amount of variability in methodologies and outcomes were noted. The most commonly applied measures of efficacy were headache pain freedom and pain relief at 2 h. Ten studies assessed efficacy of switching or optimizing treatment in patients with historical insufficient efficacy or tolerability to previous triptan treatment and demonstrated varying levels of success. Factors associated with increased risk of triptan insufficient efficacy included severe baseline headache severity, photophobia, phonophobia, nausea, and depression. CONCLUSIONS Irrespective of the methodology or definition used to identify people with insufficient efficacy and/or tolerability to triptans, study results support the assertion that a high unmet need remains for effective acute treatment of migraine.
Collapse
Affiliation(s)
| | | | | | - Li Shen Loo
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|