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Bartsch L, Fiebig N, Strauß S, Angermaier A, Smith CA, Reuter U, Fleischmann R. Translation of Multidimensional Health Locus of Control Scales, Form C in Patients with Headache. J Clin Med 2024; 13:4239. [PMID: 39064279 PMCID: PMC11278222 DOI: 10.3390/jcm13144239] [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: 04/17/2024] [Revised: 06/23/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
The MHLC-C is a condition-specific instrument measuring the internal and external loci of control beliefs, adaptable to various health conditions. Translated into Swedish and Chinese, this study aims to translate the MHLC-C into German using the FACID-Method. The English version is validated and reliable; the German version requires these validation steps.
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Affiliation(s)
- Luise Bartsch
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (L.B.)
| | - Nadja Fiebig
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (L.B.)
| | - Sebastian Strauß
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (L.B.)
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (L.B.)
| | - Craig A. Smith
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, TN 37203, USA
| | - Uwe Reuter
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (L.B.)
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (L.B.)
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2
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Gómez-Sánchez E, Hernández-Gómez A, Guzmán-Flores JM, Alonso-Castro AJ, Serafín-Higuera NA, Balderas-Peña LMA, Franco-de la Torre L, Isiordia-Espinoza MA. Celecoxib Decreases the Need for Rescue Analgesics after Total Knee Arthroplasty: A Meta-Analysis. Clin Pract 2024; 14:461-472. [PMID: 38525714 PMCID: PMC10961807 DOI: 10.3390/clinpract14020035] [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: 12/11/2023] [Revised: 01/30/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
This systematic review and meta-analysis aimed to evaluate the analgesic efficacy and adverse effects of celecoxib after total knee arthroplasty. Keywords in the PubMed and Scopus databases were used to find article abstracts. Each included clinical trial was assessed using the Cochrane Collaboration risk of bias tool, and we extracted data on postoperative pain assessment using the Visual Analogue Scale (VAS) at rest, ambulation, and active range of motion, rescue analgesic intake, and adverse effects. Inverse variance tests with mean differences were used to analyze the numerical variables. The Mantel-Haenszel statistical method and the odds ratio were used to evaluate the dichotomous data. According to this qualitative assessment (n = 482), two studies presented conclusions in favor of celecoxib (n = 187), one showed similar results between celecoxib and the placebo (n = 44), and three clinical trials did not draw conclusions as to the effectiveness of celecoxib versus the placebo (n = 251). Moreover, the evaluation of the rescue analgesic intake showed that the patients receiving celecoxib had a lower intake compared to patients receiving a placebo (n = 278, I2 = 82%, p = 0.006, mean difference = -6.89, 95% IC = -11.76 to -2.02). In conclusion, the pooled analysis shows that administration of celecoxib alone results in a decrease in rescue analgesic consumption compared to a placebo after total knee surgery.
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Affiliation(s)
- Eduardo Gómez-Sánchez
- División de Disciplinas Clínicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico UDG-CA-874 Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (E.G.-S.); (L.M.-A.B.-P.)
| | - Adriana Hernández-Gómez
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (A.H.-G.); (J.M.G.-F.)
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
| | - Juan Manuel Guzmán-Flores
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (A.H.-G.); (J.M.G.-F.)
| | - Angel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato 36250, Mexico;
| | | | - Luz Ma.-Adriana Balderas-Peña
- División de Disciplinas Clínicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico UDG-CA-874 Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (E.G.-S.); (L.M.-A.B.-P.)
- Unidad de Investigación Biomédica 02, UMAE Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico
| | - Lorenzo Franco-de la Torre
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
| | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
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3
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Basedau H, Ornello R, Matteis ED, Davaasuren B, Kadyrova B, Vuralli D, Bozhenko M, Azizova I, Bitsadze N, Eralieva E, Ashina M, Mitsikostas D, Puledda F. Placebo and nocebo in the treatment of migraine: How much does real world effectiveness depend on contextual effects? Cephalalgia 2023; 43:3331024231218392. [PMID: 38041833 DOI: 10.1177/03331024231218392] [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] [Indexed: 12/04/2023]
Abstract
PURPOSE Treatments in medicine impact individuals beyond their intended effects, due to phenomena such as the placebo and nocebo effects. The placebo effect arises from the positive expectation of a treatment being beneficial, while the nocebo effect stems from the negative expectation of a treatment causing harm. Both in real-world practice and clinical trials, treatments can lead to outcomes unrelated to their intended mechanism of action, which we categorize as placebo and nocebo responses. These responses, combined with the inherent fluctuation in a condition's natural progression, regression to the mean, and random comorbidities, make up a significant part of the therapeutic experience. Particularly in pain management, placebo and nocebo effects play a substantial role. By addressing modifiable contextual factors such as patient expectations, lifestyle choices, and the therapeutic relationship, healthcare providers can enhance the effectiveness of migraine treatments, paving the way for a more comprehensive, individualized approach to patient care. We must also consider non-modifiable factors like personal experiences, beliefs, and information from social media and the internet. CONCLUSION This review offers a summary of our current understanding of the placebo and nocebo effects in migraine management.
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Affiliation(s)
- Hauke Basedau
- Department of Systems Neuroscience, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Begimai Kadyrova
- Department of Special Clinical Disciplines, International School of Medicine of International University of Kyrgyzstan, Bishkek, Kyrgyzstan
| | - Doga Vuralli
- Department of Neurology and Algology, Neuropsychiatry Center, Neuroscience and Neurotechnology Center of Excellence (NÖROM), Gazi University, Ankara, Turkey
| | - Myroslav Bozhenko
- Department of Neurology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Ilaha Azizova
- Neurological Clinic "New Medical Technologies", Baku, Azerbaijan
| | | | | | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Dimos Mitsikostas
- Department of Neurology Α, Aegintion Hospital, National and Kapidistrian University of Athens, Athens, Greece
| | - Francesca Puledda
- Headache Group, Wolfson SPaRC, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Louro R, Gouveia E Melo R, Ruivo J, Almeida AG, Pinto FJ, Caldeira D. Incidence of muscle symptoms in placebo arm among statin-intolerant patients: a systematic review with meta-analysis. Expert Rev Cardiovasc Ther 2023; 21:887-894. [PMID: 37916684 DOI: 10.1080/14779072.2023.2274502] [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: 06/21/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Statins are highly used in cardiovascular prevention. Statin intolerance is the most significant cause of decreased adherence, translating into a higher cardiovascular risk. This systematic review aims to estimate the incidence of muscle adverse events in patients with a history of statin intolerance receiving placebo. METHODS Database search was performed in CENTRAL, MEDLINE, and EMBASE until March 2023. This systematic review included blinded randomized control trials enrolling patients with a history of statin intolerance who received a placebo. A random-effects meta-analysis was performed. Results were presented in percentages, with 95% confidence intervals (95% CI). RESULTS Overall, eight studies with 8095 patients with a history of statin intolerance receiving placebo were included. The muscle adverse events incidence rate was 21.34% (95% CI 13.26-30.63%, 8 studies), and discontinuation due to adverse muscle events was 6.12% (95% CI 1.22-13.70%, 3 studies). The incidence was higher in subcutaneous placebo/sham (41.67%, 1 study) compared to oral placebo studies (22.95%, 6 studies). CONCLUSION In patients previously labeled as statin-intolerant, about a fifth of the patients exhibited muscle symptoms when receiving a placebo. This highlights the importance of ruling out non-statin-related symptoms to further optimize statin therapy for cardiovascular risk improvement.
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Affiliation(s)
- Rita Louro
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ryan Gouveia E Melo
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Vascular Surgery, Heart and Vessels Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jorge Ruivo
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana G Almeida
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiology Department, Hospital Universitário de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - Fausto J Pinto
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiology Department, Hospital Universitário de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - Daniel Caldeira
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiovascular da Universidade de Lisboa - CCUL (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Cardiology Department, Hospital Universitário de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Iannone LF, Burgalassi A, Vigani G, Tabasso G, De Cesaris F, Chiarugi A, Geppetti P. Switching anti-CGRP(R) monoclonal antibodies in multi-assessed non-responder patients and implications for ineffectiveness criteria: A retrospective cohort study. Cephalalgia 2023; 43:3331024231160519. [PMID: 36918752 DOI: 10.1177/03331024231160519] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND A pharmacological class effect was initially proposed for monoclonal antibodies against the calcitonin gene related peptide pathway. However, preliminary evidence shows that switching patients who were non-responding to one monoclonal antibody to another could provide some benefit. Herein, we assess treatment response to an anti-calcitonin gene related peptide/receptor monoclonal antibody in patients who have failed to respond to anti-calcitonin gene related peptide/ligand monoclonal antibodies calcitonin gene related peptide/ligand monoclonal antibodies and vice versa. In addition, we select non-responders to the first anti- monoclonal antibody by three or five more stringent variables. METHODS Retrospective cohort study including outpatients treated consecutively with two anti-calcitonin gene related peptide monoclonal antibodies. Ineffectiveness to the first monoclonal antibody was assessed using three (MIDAS score, monthly headache days, and analgesic monthly days) variables or five (monthly headache days, MIDAS score, analgesic monthly days, analgesic monthly number and HIT-6 score) variables in the same cohort of patients. The primary endpoints were the absolute change from baseline in monthly headache days, response rate, and persistence in medication overuse at three months of treatment with the second anti-CGRP mAb. RESULTS In patients selected by three variables, a sustained reduction in monthly headache days, analgesic monthly days, MIDAS and HIT-6 scores was observed at month-3 of treatment with the second monoclonal antibody. Ten (45.4%) patients achieved at least a ≥30% response rate. No difference was reported switching anti-CGRP mAb against ligand or receptor. In the patient subgroup selected by five variables, only HIT-6 was reduced from baseline at month-3. However, a trend toward a reduction in monthly headache days, analgesic monthly days, and MIDAS score was observed at month-3. CONCLUSIONS Switching anti-calcitonin gene related peptide monoclonal antibodies in selected patients might be an option to achieve or improve clinical benefit. More studies are required to establish the effectiveness of switching these treatments.
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Affiliation(s)
- Luigi Francesco Iannone
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy.,Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Burgalassi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Giulia Vigani
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giorgio Tabasso
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Francesco De Cesaris
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Chiarugi
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy.,Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
| | - Pierangelo Geppetti
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy.,Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
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Artemenko AR, Abramov VG, Konovalova ZN, Korenko AN, Krasavina DA, Kurenkov AL, Latysheva NV, Naprienko MV, Orlova OR, Filatova EG, Shevchenko VS, Yakovleva PN. [Botulinum toxin type A (Relatox) in the treatment of chronic migraine in adults: results of phase IIIb, randomized, one-blind, multicenter, active-controlled, parallel-group trial]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:89-99. [PMID: 37315247 DOI: 10.17116/jnevro202312305189] [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: 06/16/2023]
Abstract
OBJECTIVE To access the efficacy and safety of the first Russian botulinum toxin type A (Relatox) as a headache prophylaxis in adult with chronic migraine (CM). MATERIAL AND METHODS The randomized, one-blind, multicenter, active-controlled, parallel-group trial study involved 209 patients with CM aged from 19 to 65 years. The patients were randomized to injections of the Russian botulinum toxin type A - Relatox (n=101) or onabotulinumtoxinA injections - Botox (n=108). The duration of the study was 16 weeks, which included five visits of patients every 4 weeks. Relatox and Botox were injected once into seven muscle groups of the head and neck at a dose of 155-195 units. Primary efficacy variable was mean change from baseline in frequency of headache days after 12 weeks. Secondary efficacy variables were mean changes from the baseline to week 12 in frequency of migraine days, acute headache pain medication intakes days; headache intensity; proportion of patients achieving ≥50% reduction from baseline in headache days, the proportion of the patients with medication overuse, the proportion of the patients with severe (≥60) Headache Impact Test-6 score and with a severe (≥21) MIDAS score. RESULTS Analyses demonstrated a large mean decrease from baseline in frequency of headache days, without statistically significant between-group differences Relatox vs Botox at week 12 (-10.89 vs -10.06; p=0.365) and at other time points. Significant differences from baseline were also observed for all secondary efficacy variables at all time points without differences between the groups. The proportion of patients achieving ≥50% reduction from baseline in headache days was 75.0% and 70% in the Relatox and Botox groups, respectively (OR, CI 95% 1.58 [0.84; 3.02], p=0.155). Adverse events (AE) occurred in 15.8% of Relatox patients and 15.7% of Botox patients (p=1.000). No unexpected AE were identified. CONCLUSION The results demonstrate that the first Russian botulinum toxin type A (Relatox) is an effective prophylactic treatment for CM in adult patients. Relatox led to significant improvements from baseline in multiple measures of headache symptoms, headache-related disability and quality of life. For the first time, a comparative analysis of two botulinum toxin type A products in parallel groups showed no less (not inferior) efficacy and safety of Relatox relative to Botox in the treatment of CM in adults.
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Affiliation(s)
- A R Artemenko
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- LLC Medical Center «Practical Neurology», Moscow, Russia
| | - V G Abramov
- Federal Siberian Scientific and Clinical Center, Krasnoyarsk, Russia
| | - Z N Konovalova
- LLC Central Institute of Botulinotherapy and Actual Neurology, Moscow, Russia
| | - A N Korenko
- LLC «Professorial Clinic «Oda», St. Petersburg, Russia
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - D A Krasavina
- LLC «Professorial Clinic «Oda», St. Petersburg, Russia
- Staint Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - A L Kurenkov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- National Medical Research Center for Children's Health, Moscow, Russia
| | - N V Latysheva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- LLC «Cephalgologist», Moscow, Russia
| | - M V Naprienko
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- LLC «Cephalgologist», Moscow, Russia
| | - O R Orlova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- LLC Central Institute of Botulinotherapy and Actual Neurology, Moscow, Russia
| | - E G Filatova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- LLC «Cephalgologist», Moscow, Russia
| | - V S Shevchenko
- LLC Medical Center «Practical Neurology», Moscow, Russia
- National Medical Research Center «Treatment and Rehabilitation Center», Moscow, Russia
| | - P N Yakovleva
- LLC Central Institute of Botulinotherapy and Actual Neurology, Moscow, Russia
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7
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Schmidt K, Berding T, Kleine-Borgmann J, Engler H, Holle-Lee D, Gaul C, Bingel U. The beneficial effect of positive treatment expectations on pharmacological migraine prophylaxis. Pain 2022; 163:e319-e327. [PMID: 34010939 DOI: 10.1097/j.pain.0000000000002341] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/07/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Migraine is one of the leading causes of years lived with disability and considered to be a major global health concern. Pharmacological preventive treatment often causes side effects that limit the adherence to longer-term treatment regimens. Both experimental and clinical evidence suggests that positive expectations can modulate pain and analgesic treatment effects. However, the role of expectations in migraine prophylactic treatment has not systematically been investigated. Here, we examined the influence of treatment expectation before commencing pharmacological preventive treatment on its efficacy and tolerability in N = 134 episodic (30%) and chronic migraine (70%) patients in a prospective, longitudinal observational study over the course of 6 months. The migraine prophylaxis reduced the number of headache and migraine days with acceptable tolerability. Positive treatment expectation was associated with a generally lower number of headache and migraine days and a stronger reduction in headache days over the course of the treatment in chronic but not in episodic migraine patients. Moreover, patients with prior treatment showed a stronger reduction in headache days with higher expectation as compared to patients without prior experience. Our results underscore the relevance of further exploring the role of treatment expectation and its systematic modulation in patients with migraine and other pain conditions.
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Affiliation(s)
- Katharina Schmidt
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Tobias Berding
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Julian Kleine-Borgmann
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro-and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Dagny Holle-Lee
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
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8
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Gorantla S, Gopireddy MMR, Bhat A, Ayyasamy L, Jaishankar SKJ, Kherallah B, Nersesyan H. Placebo response with subcutaneous injections in calcitonin gene-related peptide receptor monoclonal antibody migraine preventative trials – A systematic review and meta-analysis. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221120103] [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: The majority of CGRP monoclonal antibodies for migraine prevention are administered subcutaneously. Therefore, we attempted to calculate the pooled placebo response with subcutaneous placebo injections in this systematic review and meta-analysis. Methods: We identified 16 randomized controlled trials that met our inclusion and exclusion criteria through a comprehensive search in five electronic databases (PubMed Central, EMBASE, MEDLINE, Cochrane library and clinicaltrials.gov ). The risk of bias was assessed for all included studies. Random effects model was used to calculate pooled mean monthly migraine days and 50% response rates. Results: A total of 4240 subjects were included from 16 studies in this meta-analysis. The pooled mean monthly migraine day reduction with subcutaneous placebo injections was 2.15 (95% CI: 1.60–2.69). The pooled proportion of patients achieving a 50% reduction in mean monthly headache days was 26% (95% CI: 20%–31%). Placebo response accounted for more than 50% of therapeutic gain in our study. Conclusion: A substantial placebo response was noted with subcutaneous injections in migraine CGRP monoclonal antibody clinical trials. This meta-analysis may serve as a reference point to calculate sample size in clinical trials using subcutaneous interventions for migraine prevention. We registered our study at PROSPERO (CRD42020185300).
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Affiliation(s)
- Sasikanth Gorantla
- University of Illinois College of Medicine at Peoria and Illinois Neurological Institute, OSF Healthcare, Peoria, IL, USA
| | | | - Archana Bhat
- Evidencian Research Associates, Bangalore, India
| | | | | | - Bassil Kherallah
- University of Illinois College of Medicine at Peoria and Illinois Neurological Institute, OSF Healthcare, Peoria, IL, USA
| | - Hrachya Nersesyan
- University of Illinois College of Medicine at Peoria and Illinois Neurological Institute, OSF Healthcare, Peoria, IL, USA
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9
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Overeem LH, Peikert A, Hofacker MD, Kamm K, Ruscheweyh R, Gendolla A, Raffaelli B, Reuter U, Neeb L. Effect of antibody switch in non-responders to a CGRP receptor antibody treatment in migraine: A multi-center retrospective cohort study. Cephalalgia 2021; 42:291-301. [PMID: 34644203 PMCID: PMC8988456 DOI: 10.1177/03331024211048765] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Switching between antibody classes might be a treatment option in migraine patients who have not responded to one class of a CGRP-(receptor) monoclonal antibody (mAb), but there are no efficacy data so far. In this real-world analysis, we assessed the treatment response to a CGRP-mAb in patients that have previously failed the CGRP-receptor-mAb erenumab. METHODS We analyzed retrospective headache diary data of 78 patients with migraine who switched between CGRP-mAbs classes at four German headache centers either due to lack of efficacy or intolerable side effects. Among these, we identified 25 patients who did not respond to erenumab after three treatment cycles (defined as <30% reduction of monthly headache days) and had complete headache documentation at least one month before and during both treatments. We assessed the ≥30% responder rate at month three after switching from erenumab to a CGRP-mAb (galcanezumab or fremanezumab) (primary endpoint). Secondary endpoints included ≥50% responder rate, monthly headache days, and monthly days with acute medication use. In an exploratory subgroup analysis patients were stratified for daily and non-daily headache. RESULTS The switch from erenumab to a CGRP-mAb led to a ≥30% response in one-third (32%) of the patients after three treatment cycles. A ≥50% response was achieved in 12% of the patients. Monthly headache days were reduced in month three compared to baseline (20.8 ± 7.1 to 17.8 ± 9.1; p = 0.009). Stratified analysis revealed that no patient with daily headache (n = 9) responded to the treatment switch, while a 30% response was achieved by 50% of patients with non-daily headache (n = 16). CONCLUSION Our findings demonstrate that a relevant proportion of erenumab non-responders might benefit from a treatment switch to a CGRP-mAb. Switching seems to be a promising treatment option especially in migraine patients with non-daily headache.
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Affiliation(s)
| | | | - Maxi Dana Hofacker
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Kamm
- Department of Neurology, Ludwig Maximilians University Munich, Munich, Germany
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University Munich, Munich, Germany
| | | | - Bianca Raffaelli
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Universitätsmedizin Greifswald, Greifswald, Germany
| | - Lars Neeb
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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10
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Bryson A. Temporary resolution of hemicrania continua following ipsilateral ear piercing. BMJ Neurol Open 2021; 3:e000193. [PMID: 34632387 PMCID: PMC8477251 DOI: 10.1136/bmjno-2021-000193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hemicrania continua is an uncommon subtype of trigeminal autonomic cephalgia that exhibits dramatic therapeutic response to indomethacin. Unfortunately, indomethacin is associated with a range of adverse effects, including neuropsychiatric complications, which limits its use in many patients. Although no other effective pharmacologic agents exist, there is emerging evidence for interventional treatments such as occipital nerve and vagus nerve stimulation, which may act by modulating neural activity within the trigeminovascular system. CASE We present a 30-year-old woman with long-standing refractory hemicrania continua who suffered adverse effects to indomethacin. She experienced temporary, but near-complete, symptom resolution following piercing of the crus of the ear helix ipsilateral to her headache, whereas contralateral piercing produced no benefit. CONCLUSIONS To our knowledge, this case is the first to describe a therapeutic benefit following ear piercing in a patient with trigeminal autonomic cephalgia. We argue that symptom relief was obtained through a similar mechanism to occipital or vagus nerve stimulation.
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Affiliation(s)
- Alexander Bryson
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
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11
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Tepper SJ, Ashina M, Reuter U, Hallström Y, Broessner G, Bonner JH, Picard H, Cheng S, Chou DE, Zhang F, Klatt J, Mikol DD. Reduction in acute migraine-specific and non-specific medication use in patients treated with erenumab: post-hoc analyses of episodic and chronic migraine clinical trials. J Headache Pain 2021; 22:81. [PMID: 34301173 PMCID: PMC8299690 DOI: 10.1186/s10194-021-01292-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/10/2021] [Indexed: 01/13/2023] Open
Abstract
Background In patients with migraine, overuse of acute medication, including migraine-specific medication (MSM) such as triptans and ergots, can lead to adverse health outcomes, including development of medication overuse headache. Here, we examined the effect of erenumab on reducing acute medication use, in particular MSM, in patients with episodic migraine (EM) and chronic migraine (CM). Methods The current post-hoc analyses were based on data from the double-blind treatment phase (DBTP) of two erenumab studies, a pivotal EM (N = 955) and a pivotal CM (N = 667) trial, and their respective extensions. Patients were administered subcutaneous placebo or erenumab (70 or 140 mg) once monthly. Daily acute headache medication use (including MSM and non-MSM) was recorded using an electronic diary during a 4-week pretreatment baseline period until the end of the treatment period. Outcome measures included change in monthly acute headache medication days (HMD) in acute headache medication users at baseline, and changes in monthly MSM days (MSMD) in MSM users at baseline and non-MSMD in non-MSM users at baseline. Results In total, 60 and 78 % of patients (all acute headache medication users) with EM and CM used MSM at baseline, respectively. For acute headache medication users, the change in mean monthly acute HMD over Months 4, 5 and 6 compared with the pre-DBTP was 1.5, 2.5, and 3.0 for placebo, erenumab 70 mg and 140 mg, respectively for the EM study. The respective change in monthly MSMD in MSM users was 0.5, 2.1 and 2.8, and in monthly non-MSMD in non-MSM users was 2.3, 2.6, and 2.7. In the acute headache medication users at baseline, the change in monthly acute HMD at Month 3 compared with pre-DBTP was 3.4, 5.5, and 6.5 for placebo, erenumab 70 mg and 140 mg, respectively for the CM study. The respective change in monthly MSMD in MSM users was 2.1, 4.5, and 5.4, and in monthly non-MSMD in non-MSM users was 5.9, 6.4, and 6.6. Reductions in MSMD versus placebo were sustained in the extension periods of both studies. Erenumab was also associated with a higher proportion of MSM users achieving ≥ 50 %, ≥ 75 and 100 % reduction from baseline in monthly MSMD versus placebo in both EM and CM. Conclusions In both EM and CM, treatment with erenumab is associated with a significant and sustained reduction in the use of acute headache medication, in particular MSM. Trial registrations NCT02456740; NCT02066415; NCT02174861.
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Affiliation(s)
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Jo H Bonner
- Mercy Clinic Neurology and Headache Centre, Saint Louis, MO, USA
| | | | | | | | | | - Jan Klatt
- Novartis Pharma AG, CH-4002, Basel, Switzerland
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12
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Roland SB, Pripp AH, Msomphora MR, Kvarstein G. The efficacy of botulinum toxin A treatment for tension-type or cervicogenic headache: a systematic review and meta-analysis of randomized, placebo-controlled trials. Scand J Pain 2021; 21:635-652. [PMID: 34090319 DOI: 10.1515/sjpain-2021-0038] [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: 02/19/2021] [Accepted: 05/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The pathogeneses of chronic tension-type headache (CTTH) and cervicogenic headache (CEH) are not well established. Peripheral activation or sensitization of myofascial nociceptors is suggested as a potential mechanism and injections of botulinum toxin (BONTA) have thus been used in the treatment for both headache conditions. BONTA inhibits the release of acetylcholine at the neuromuscular junction and inhibits contraction of skeletal muscles. If the pain is precipitated by increased tone in cervical muscles, local injections of BONTA could represent a prophylactic measure. However, the treatment is still controversial, and a thorough assessment of the current evidence is required. This review aims to assess the evidence of BONTA injection as a prophylactic treatment for CTTH and CEH by reviewing and examining the quality of placebo-controlled, randomized trials. METHODS Data sources: we searched in the following databases: PubMed (including Medline), Embase, Cochrane Central register of Controlled Trials, Cinahl, Amed, SCOPUS and Google Scholar including other repository sources. Both MeSH and free keywords were used in conducting the systematic search in the databases. The search covered publications from the root of the databases to November 2020. STUDY ELIGIBILITY CRITERIA The review included RCTs, comparing single treatment of BONTA with placebo on patients with CTTH or CEH above 18 years of age, by measuring pain severity/relief or headache frequency. DATA EXTRACTION The following data were extracted: year of publication, country, setting, trial design, number of participants, injection procedure, BONTA dosages, and clinical outcome measures. STUDY APPRAISAL To assess validity and quality, and risk of bias, the Oxford Pain Validity Scale, Modified Jadad Scale, last version of Cochrane Collaboration's tool for assessing risk of bias (RoB 2), and the CONSORT 2010 Checklist were used. The trials were assessed, and quality scored independently by two of the reviewers. A quantitative synthesis and meta-analyses of headache frequency and intensity were performed. RESULTS We extracted 16 trials, 12 on prophylactic BONTA treatment for CTTH and four on CEH. Of these 12 trials (8 on CTTH and 4 on CEH) were included in the quantitative synthesis. A majority of the trials found no significant difference on the primary outcome measure when BONTA treatment was compared with placebo. Three "positive" trials, reporting significant difference in favor of BONTA treatment, but two of these were hampered by low validity and quality scores and high risk of bias. CONCLUSIONS There is no clear clinical evidence supporting prophylactic treatment with BONTA for CTTH or CEH.
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Affiliation(s)
- Sissel Breivold Roland
- Department of Orthopedics, Finnmark Hospital Trust, Hammerfest, Norway.,Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Pain Clinic, Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Mbachi Ruth Msomphora
- Research and Publishing Support, Department of Library services, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunnvald Kvarstein
- Pain Clinic, Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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13
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Koechlin H, Kossowsky J, Lam TL, Barthel J, Gaab J, Berde CB, Schwarzer G, Linde K, Meissner K, Locher C. Nonpharmacological Interventions for Pediatric Migraine: A Network Meta-analysis. Pediatrics 2021; 147:peds.2019-4107. [PMID: 33688031 DOI: 10.1542/peds.2019-4107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Migraine is a common neurologic disorder in children and adolescents. However, a comparison of multiple nonpharmacological treatments is lacking. OBJECTIVE To examine whether nonpharmacological treatments are more effective than waiting list and whether there are differences between interventions regarding efficacy. DATA SOURCES Systematic review and network meta-analysis of studies in Medline, Cochrane, Embase, and PsycINFO published through August 5, 2019. STUDY SELECTION Randomized controlled trials of nonpharmacological treatments in children and adolescents diagnosed with episodic migraine. DATA EXTRACTION Effect sizes, calculated as standardized mean differences (SMDs) for the primary outcome efficacy, were assessed in a random-effects model. RESULTS Twelve studies (N = 576) were included. When interventions were classified into groups on the basis of similarity of treatment components, self-administered treatments, biofeedback, relaxation, psychological treatments, and psychological placebos were significantly more effective than waiting list with effect sizes ranging between SMD = 1.14 (95% confidence interval, 0.09 to 2.19) for long-term psychological placebos to SMD = 1.44 (95% confidence interval, 0.26 to 2.62) for short-term self-administered treatments. However, when all interventions were examined individually (ie, 1 node per intervention), none were significantly more effective compared with waiting list, mainly because of lack of statistical power. LIMITATIONS Because of our focus on pediatric migraine, only a small number of studies could be included. CONCLUSIONS Our findings reveal that components of nonpharmacological interventions are effective in treating pediatric migraine. Some effects have to be interpreted carefully because they are based on small studies. Future researchers should identify factors associated with individual responses in large, multicentered studies.
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Affiliation(s)
- Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Contributed equally as co-first authors
| | - Joe Kossowsky
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Contributed equally as co-first authors
| | - Thanh Lan Lam
- Institute of Medical Psychology, LMU Munich, Munich, Germany
| | | | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, University of Freiburg, Breisgau, Germany
| | - Klaus Linde
- Institute of General Practice and Health Services Research, School of Medicine, Technical University Munich, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, LMU Munich, Munich, Germany.,Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland; .,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Faculty of Health, University of Plymouth, Plymouth, United Kingdom; and.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
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14
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The Efficacy of Percutaneous Patent Foramen Ovale Closure on Migraine: a Meta-Analysis of Randomized Controlled Trials and Observational Studies. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6643266. [PMID: 33748272 PMCID: PMC7954613 DOI: 10.1155/2021/6643266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 11/24/2022]
Abstract
Objectives Whether patent foramen ovale (PFO) closure is effective on migraine is controversial. This article was aimed at assessing the efficacy of PFO closure on migraine based on randomized controlled trials (RCTs) and observational studies. Methods We searched PubMed, Embase, and Cochrane databases up to October 2020 evaluating PFO closure versus control in patients with migraine, then conducted a meta-analysis of all RCTs and observational studies, respectively. The main outcomes were (1) respond rate: complete cessation of migraine; (2) reduction in the frequency of migraine attacks per month; and (3) reduction in migraine days per month. Results Seven studies (3 RCTs and 4 observational studies), containing 887 migraine patients, were identified. (1) The respond rate of PFO closure on migraine was significantly higher than control group both in RCT subgroup and observational studies subgroup (OR 3.86, 95% CI 1.35-11.04, P = 0.01 in RCTs; OR 8.28, 95% CI 2.31-29.67, P = 0.001 in observational studies). (2) Reduction in frequency of migraine attacks was higher in PFO closure group compared with control group in the RCT subgroup analysis (mean difference (MD) = 0.57, 95% CI 0.23-0.90, P = 0.0009). (3) Reduction in migraine days was also higher in PFO closure group compared with control group in the RCT subgroup analysis (MD = 1.33, 95% CI 0.35-2.31, P = 0.008). Conclusions PFO closure might be suitable for migraine patients, especially for migraine with aura, by cessation of migraine headaches or reducing migraine attacks and migraine days.
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15
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Yiangou A, Mitchell JL, Fisher C, Edwards J, Vijay V, Alimajstorovic Z, Grech O, Lavery GG, Mollan SP, Sinclair AJ. Erenumab for headaches in idiopathic intracranial hypertension: A prospective open-label evaluation. Headache 2020; 61:157-169. [PMID: 33316102 PMCID: PMC7898289 DOI: 10.1111/head.14026] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022]
Abstract
Objective To determine the effectiveness of erenumab in treating headaches in idiopathic intracranial hypertension (IIH) in whom papilledema had resolved. Background Disability in IIH is predominantly driven by debilitating headaches with no evidence for the use of preventative therapies. Headache therapy in IIH is an urgent unmet need. Methods A prospective, open‐label study in the United Kingdom was conducted. Adult females with confirmed diagnosis of IIH now in ocular remission (papilledema resolved) with chronic headaches (≥15 days a month) and failure of ≥3 preventative medications received erenumab 4‐weekly (assessments were 3‐monthly). The primary end point was change in monthly moderate/severe headache days (MmsHD) from baseline (30‐day pretreatment period) compared to 12 months. Results Fifty‐five patients, mean (SD) age 35.3 (9) years and mean duration of headaches 10.4 (8.4) years with 3.7 (0.9) preventative treatment failures, were enrolled. Mean baseline MmsHD was 16.1 (4.7) and total monthly headache days (MHD) was (29) 2.3. MmsHD reduced substantially at 12 months by mean (SD) [95% CI] 10.8 (4.0) [9.5, 11.9], p < 0.001 and MHD reduced by 13.0 (9.5) [10.2, 15.7], p < 0.001. Crystal clear days (days without any head pain) increased by 13.1 (9.5) [9.6, 15.3], p < 0.001, headache severity (scale 0–10) fell by 1.3 (1.7) [0.9, 1.9], p < 0.001, and monthly analgesic days reduced by 4.3 (9.2) [1.6, 6.9], p = 0.002. All these measures had improved significantly by 3 months, with a consistent significant response to 12 months. Headache impact test‐6 score and quality of life Short Form‐36 Health Survey significantly improved at 12 months. Sensitivity analysis revealed similar results for patients with and without a prior migraine diagnosis (28/55 (52%) patients) or those with or without medication overuse (27/55 (48%) patients). Conclusions This study provides evidence for the effectiveness of erenumab to treat headaches in IIH patients with resolution of papilledema. It provides mechanistic insights suggesting that calcitonin gene‐related peptide is likely a modulator driving headache and a useful therapeutic target.
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Affiliation(s)
- Andreas Yiangou
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James L Mitchell
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claire Fisher
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Julie Edwards
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vivek Vijay
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Zerin Alimajstorovic
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Olivia Grech
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Gareth G Lavery
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology Unit, Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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16
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Qi Y, Zhang Y, Luo X, Cheng G, Du Y, Liu R, Xie H, Cheng Y, Guo Y, Luo G. Efficacy of patent foramen ovale closure for treating migraine: a prospective follow-up study. J Investig Med 2020; 69:7-12. [PMID: 32928904 PMCID: PMC7803887 DOI: 10.1136/jim-2020-001323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/25/2022]
Abstract
This study aims to evaluate the potential of percutaneous patent foramen ovale (PFO) closure to improve the headache in patients with migraine and PFO, and discuss the difference between the randomized controlled trials (RCTs) and the single-center studies. Patients of migraine with a large shunt of PFO, who experienced ≥2 headache attacks per month and failed ≥2 categories of standardized medication, underwent PFO closure in First Affiliated Hospital of Xi'an Jiao Tong University. The clinical outcomes, including frequency and duration of headache attacks, Headache Impact Test (HIT-6) score, and Visual Analogue Scale (VAS) score, were evaluated at 3, 6, and 12 months of follow-up after the PFO closure. The different efficacies of the clinical outcomes between patients with and without aura as well as different grades of PFO were also evaluated, respectively. 134 patients with migraine (39 male and 95 female) with PFO were enrolled, whose average age was 39.21±11.37 years. After PFO closure, there was a significant reduction in frequency and duration of headache attacks, HIT-6 score, and VAS score at 3, 6, and 12 months’ follow-up (p<0.001). Migraine was completely relieved in 54 (40.30%) patients during 12 months’ follow-up. The frequency of migraine was reduced by >50% in 44 (32.84%) patients at 3 months’ follow-up and increased to 48 (35.82%) at 12 months’ follow-up. 31.03% patients remained residual shunt after 6 months of closure with varying improvements of headache. This study confirmed that PFO closure can effectively reduce frequency and duration of migraine and improve quality of life, but the definitive indications and long-term effect still need further research.
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Affiliation(s)
- Yi Qi
- Department of Neurology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Yushun Zhang
- Department of Structural Heart Disease, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Xiaohui Luo
- Department of Structural Heart Disease, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Gesheng Cheng
- Department of Structural Heart Disease, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Yajuan Du
- Department of Structural Heart Disease, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Rui Liu
- Department of Neurology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Hui Xie
- Department of Neurology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Yawen Cheng
- Department of Neurology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Yichen Guo
- Department of Neurology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Guogang Luo
- Department of Neurology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi, China
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17
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Quintas S, García-Azorín D, Heredia P, Talavera B, Gago-Veiga AB, Guerrero ÁL. Wearing Off Response to OnabotulinumtoxinA in Chronic Migraine: Analysis in a Series of 193 Patients. PAIN MEDICINE 2020; 20:1815-1821. [PMID: 30657951 DOI: 10.1093/pm/pny282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Long-term real-life studies have supported a cumulative effect of OnabotulinumtoxinA (OnabotA) for the prophylactic treatment of chronic migraine (CM) during consecutive cycles, and individual adaptations have been described to improve clinical response. METHODS This was a cohort longitudinal retrospective study of consecutive adult patients from the Headache Unit of the Hospital Clínico Universitario de Valladolid and the Hospital Universitario de La Princesa (Madrid) on OnabotA treatment for chronic migraine from May 2012 to December 2017. All patients were followed for 24 weeks. Full-length response to OnabotA was defined as ≥50% reduction in headache days for at least 12 weeks, and wearing off response was defined as a clinical response but with duration shorter than 10 weeks. We have analyzed the incidence and clinical predictors of this wearing off response. RESULTS A total of 193 patients were included, of whom 91 (47.1%) were considered full-length responders and 45 (23.3%) wearing off responders. No statistically significant clinical predictors (including demographic variables and baseline headache characteristics) of full-length response or wearing off response were detected in our study. An increase in dose during the second treatment cycle was attempted in 68.9% of the wearing off patients, achieving a longer duration of response of up to 12 weeks in 74.2%. CONCLUSIONS Wearing off response to OnabotA during the first treatment cycle is not uncommon in patients with CM. Increasing the dose in subsequent cycles could improve clinical response, but further multicenter long-term studies are needed to establish predictors and solutions to this problem.
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Affiliation(s)
- Sonia Quintas
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Patricia Heredia
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Blanca Talavera
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ángel L Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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18
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Crespi J, Bratbak D, Dodick DW, Matharu M, Solheim O, Gulati S, Berntsen EM, Tronvik E. Open‐Label, Multi‐Dose, Pilot Safety Study of Injection of OnabotulinumtoxinA Toward the Otic Ganglion for the Treatment of Intractable Chronic Cluster Headache. Headache 2020; 60:1632-1643. [DOI: 10.1111/head.13889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Joan Crespi
- Department of Neurology St. Olav's University Hospital Trondheim Norway
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
| | - Daniel Bratbak
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Department of Neurosurgery St. Olav's University Hospital Trondheim Norway
| | - David W. Dodick
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Department of Neurology Mayo Clinic Phoenix AZ USA
| | - Manjit Matharu
- UCL Queen Square Institute of Neurology The National Hospital of Neurology and Neurosurgery London UK
| | - Ole Solheim
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Department of Neurosurgery St. Olav's University Hospital Trondheim Norway
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Department of Neurosurgery St. Olav's University Hospital Trondheim Norway
| | - Erik Magnus Berntsen
- Department of Radiology and Nuclear Medicine St. Olav's University Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Faculty of Medicine Norwegian University of Science and Technology Trondheim Norway
| | - Erling Tronvik
- Department of Neurology St. Olav's University Hospital Trondheim Norway
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
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19
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Liampas I, Siokas V, Brotis A, Vikelis M, Dardiotis E. Endogenous Melatonin Levels and Therapeutic Use of Exogenous Melatonin in Migraine: Systematic Review and Meta‐Analysis. Headache 2020; 60:1273-1299. [DOI: 10.1111/head.13828] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Ioannis Liampas
- Department of Neurology University Hospital of Larissa School of Medicine, University of Thessaly Larissa Greece
| | - Vasileios Siokas
- Department of Neurology University Hospital of Larissa School of Medicine, University of Thessaly Larissa Greece
| | - Alexandros Brotis
- Department of Neurosurgery University Hospital of Larissa School of Medicine, University of Thessaly Larissa Greece
| | - Michail Vikelis
- Headache Clinic Mediterraneo Hospital Glyfada Greece
- Glyfada Headache Clinic Glyfada Greece
| | - Efthimios Dardiotis
- Department of Neurology University Hospital of Larissa School of Medicine, University of Thessaly Larissa Greece
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20
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Kokoti L, Drellia K, Papadopoulos D, Mitsikostas DD. Placebo and nocebo phenomena in anti- CGRP monoclonal antibody trials for migraine prevention: a meta-analysis. J Neurol 2020; 267:1158-1170. [PMID: 31919565 DOI: 10.1007/s00415-019-09673-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/17/2022]
Abstract
High placebo and low nocebo phenomena mirror high positive expectations for a novel treatment, among other reasons. In a meta-analysis aimed to identify placebo and nocebo phenomena in the placebo-controlled randomized trials (RCTs) with the monoclonal antibodies targeting the calcitonin gene-related peptide pathway (anti-CGRP mAbs) all the placebo-treated patients were pooled and compared with the placebo-treated patients in RCTs with topiramate and onabotulinum toxin A (OBTA). In episodic migraine (EM), the proportion of placebo-treated patients who achieved the 50% responder rate (placebo) was 32.7% (95% CI 28.6%-37.0%) in anti-CGRP mAbs vs. 24.4% (95% CI 20.5%-28.5%) in topiramate trials. The proportion of dropouts due to adverse events in placebo-treated patients (nocebo) was 1.9% (95% CI 1.4%-2.6%) in anti-CGRP mAbs vs. 9.9% (95% CI 7.7%-12.3%) in topiramate RCTs. In chronic migraine (CM), the placebo 50% responder rate was 23.6% (95% CI 11.2%-38.8%) in anti-CGRP mAbs RCTs vs. 36.4% (95% CI 32.6%-39.3%) in RCTs with OBTA. The nocebo dropout in anti-CGRP mAbs and OBTA RCTs was 1.4% (95% CI 0.8%-2.1%) and 0.9 (95% CI 0.3%-1.7%), respectively. The stronger placebo and weaker nocebo phenomena in RCTs with anti-CGRP mAbs vs. those with topiramate in the prophylaxis of EM, may decisively determine anti-CGRP mAbs treatment success. No differences were detected between the anti-CGRP mAbs and OBTA in the treatment of CM.
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Affiliation(s)
- Lili Kokoti
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72-74 V. Sofia's Avenue, 11528, Athens, Greece
| | - Konstantina Drellia
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72-74 V. Sofia's Avenue, 11528, Athens, Greece
| | | | - Dimos D Mitsikostas
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72-74 V. Sofia's Avenue, 11528, Athens, Greece.
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21
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Ruff DD, Ford JH, Tockhorn-Heidenreich A, Stauffer VL, Govindan S, Aurora SK, Terwindt GM, Goadsby PJ. Efficacy of galcanezumab in patients with episodic migraine and a history of preventive treatment failure: results from two global randomized clinical trials. Eur J Neurol 2019; 27:609-618. [PMID: 31692188 PMCID: PMC7155018 DOI: 10.1111/ene.14114] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/04/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The efficacy of galcanezumab, a monoclonal antibody for migraine prevention, has been demonstrated in two pivotal trials in patients with episodic migraine. METHODS EVOLVE-1 and EVOLVE-2 were identical phase 3, randomized, double-blind, placebo-controlled studies in patients with episodic migraine. Mean migraine headache days per month at baseline was 9. Patients were randomized 2:1:1 to monthly injections of placebo, galcanezumab 120 mg/240 mg during the 6-month double-blind treatment period. Key efficacy outcomes were assessed in subgroups amongst patients for whom, previously, for efficacy and/or safety/tolerability reasons (i) one or more (≥1) preventives failed, (ii) two or more (≥2) preventives failed and (iii) preventives were never used, or used but not failed (no prior failure). RESULTS In an integrated analysis of EVOLVE studies, galcanezumab 120 mg/240 mg versus placebo led to larger overall mean (SE) reductions in monthly migraine headache days across 6 months in patients with prior preventive failures (P < 0.001): ≥1 failure: 120 mg: -4.0 (0.4); 240 mg: -4.2 (0.5); placebo: -1.3 (0.4); ≥2 failures: 120 mg: -3.1 (0.7); 240 mg: -3.8 (0.8); placebo: -0.5 (0.6). Similar results were observed amongst patients with no prior failure, but the placebo response was larger: 120 mg: -4.7 (0.2); 240 mg: -4.5 (0.2); placebo: -3.0 (0.2) (P < 0.001 versus placebo). Significant improvements were observed with galcanezumab versus placebo for ≥50% and ≥75% reduction in monthly migraine headache days. CONCLUSION In patients with episodic migraine treated with galcanezumab, those with ≥1 or ≥2 prior preventive failures had significantly larger improvements, versus placebo, in efficacy outcomes. Similar results were observed in patients with no prior failure, with a larger placebo response.
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Affiliation(s)
- D D Ruff
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J H Ford
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - S Govindan
- Eli Lilly Services India Private Limited, Bengaluru, India
| | - S K Aurora
- Eli Lilly and Company, Indianapolis, IN, USA
| | - G M Terwindt
- Leiden University Medical Center, Leiden, The Netherlands
| | - P J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College London, London, UK
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22
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Yu S, Ran Y, Wan Q, Yang X, Chen H, Wang H, Hu X, Mao S, Yu T, Luo G, Gao X, Li X, Zhou M, Li Y. Efficacy and Safety of Toutongning Capsule in Patients with Migraine: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. J Altern Complement Med 2019; 25:1215-1224. [PMID: 31553228 DOI: 10.1089/acm.2018.0500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Ye Ran
- Department of Neurology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Qi Wan
- Department of Neurology, Jiangsu Province Hospital, Nanjing, P.R. China
| | - Xiaosu Yang
- Department of Neurology, Xiangya Hospital Central South University, Changsha, P.R. China
| | - Huisheng Chen
- Department of Neurology, The General Hospital of Shenyang Military, Shenyang, P.R. China
| | - Hebo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, P.R. China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Shanping Mao
- Department of Neurology, Hubei General Hospital, Wuhan, P.R. China
| | - Tingming Yu
- Department of Neurology, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Guogang Luo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Xuguang Gao
- Department of Neurology, Peking University People's Hospital, Beijing, P.R. China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yu Li
- Department of Neurology, Fuling Center Hospital of Chongqing City, Chongqing, P.R. China
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23
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Sakai F, Takeshima T, Tatsuoka Y, Hirata K, Lenz R, Wang Y, Cheng S, Hirama T, Mikol DD. A Randomized Phase 2 Study of Erenumab for the Prevention of Episodic Migraine in Japanese Adults. Headache 2019; 59:1731-1742. [PMID: 31612482 PMCID: PMC6900095 DOI: 10.1111/head.13652] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 01/03/2023]
Abstract
Objective A phase 2, double‐blind, placebo‐controlled study to evaluate the efficacy and safety of erenumab for the prevention of episodic migraine in Japanese patients was conducted. Background Previous global clinical studies have demonstrated the efficacy of erenumab in the prevention of migraine. Methods Patients were randomized to placebo or erenumab 28, 70, or 140 mg administered subcutaneously once per month for 6 months. The primary endpoint was change from baseline in mean monthly migraine days over months 4‐6 of the double‐blind treatment phase. Secondary endpoints included the proportion of patients achieving ≥50% reduction from baseline in mean monthly migraine days (≥50% response) and change from baseline in mean monthly acute migraine‐specific medication treatment days (MSMD) and mean Headache Impact Test (HIT‐6™) scores. Efficacy outcomes were also determined at months 1, 2, and 3. Results Four hundred and seventy five patients were randomized 2:1:2:2 to placebo and erenumab 28, 70, and 140 mg, respectively. Greater reductions in monthly migraine days were observed for erenumab vs placebo with differences of –1.25 (95% CI: –2.10 to –0.41; P = .004), –2.31 (95% CI: –3.00 to –1.62; P < .001), and –1.89 (95% CI: –2.58 to –1.20; P < .001) days for erenumab 28, 70, and 140 mg. The odds of having a ≥50% response were 3.2, 5.6, and 4.7 times greater for erenumab 28 mg (95% CI: 1.30‐7.88; P = .009), 70 mg (95% CI: 2.60‐12.06; P < .001), and 140 mg (95% CI: 2.24‐9.99; P < .001) than for placebo. Greater reductions from baseline in mean acute monthly MSMD were observed for erenumab vs placebo with differences of –1.07 (95% CI: –1.80 to –0.35; P = .004), –2.07 (95% CI: –2.66 to –1.49; P < .001), and –2.04 (95% CI: –2.63 to –1.45; P < .001) days for erenumab 28, 70, and 140 mg. Erenumab 70 and 140 mg also resulted in greater improvements in HIT‐6™ scores. The safety profile was similar across treatment groups. The most common adverse event was nasopharyngitis, which occurred in 29.4% of patients in the placebo group and 28.9%‐33.3% of patients in the erenumab groups. Conclusion Monthly subcutaneous injections of erenumab 70 mg demonstrated statistically significant and numerically maximal efficacy with a favorable safety profile, suggesting that erenumab is a potential new therapy for migraine prevention in Japan.
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Affiliation(s)
| | - Takao Takeshima
- Headache Center, Department of Neurology, Tominaga Hospital, Osaka, Japan
| | | | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Robert Lenz
- Global Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Yi Wang
- Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA, USA
| | - Sunfa Cheng
- Global Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Toshiyasu Hirama
- Research & Development, Amgen Astellas BioPharma K.K., Tokyo, Japan
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24
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Skljarevski V, Oakes TM, Zhang Q, Ferguson MB, Martinez J, Camporeale A, Johnson KW, Shan Q, Carter J, Schacht A, Goadsby PJ, Dodick DW. Effect of Different Doses of Galcanezumab vs Placebo for Episodic Migraine Prevention: A Randomized Clinical Trial. JAMA Neurol 2019; 75:187-193. [PMID: 29255900 DOI: 10.1001/jamaneurol.2017.3859] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Importance Galcanezumab (LY2951742), a monoclonal antibody against calcitonin gene-related peptide (CGRP), is one of a novel class of new medicines for migraine prevention. Objective To assess whether at least 1 dose of galcanezumab was superior to placebo for episodic migraine prevention. Design, Setting, and Participants A randomized clinical trial was conducted in the United States (July 7, 2014, to August 19, 2015) in clinics of 37 licensed physicians with a specialty including, but not limited to, psychiatry, neurology, internal medicine, and primary care. Subcutaneous injections of galcanezumab, 5, 50, 120, or 300 mg, or placebo were given monthly during the 3-month treatment period. A total of 936 patients were assessed; 526 did not meet study entry or baseline criteria and 410 patients were randomly assigned to receive placebo or galcanezumab. Analyses were conducted on an intent-to-treat population, which included all patients who were randomized and received at least 1 dose of study drug. Interventions Short-term migraine treatments were allowed as needed except for opioids or barbiturates. Main Outcomes and Measures To determine if at least 1 of the 4 doses of galcanezumab tested was superior to placebo for migraine prevention measured by the mean change from baseline in the number of migraine headache days 9 weeks to 12 weeks after randomization. Results Of the 936 patients assessed, 410 met entry criteria (aged 18-65 years with 4-14 migraine headache days per month and migraine onset prior to age 50 years) and were randomized to receive placebo or galcanezumab. For the primary end point, galcanezumab, 120 mg, significantly reduced migraine headache days compared with placebo (99.6% posterior probability -4.8 days; 90% BCI, -5.4 to -4.2 days vs 95% superiority threshold [Bayesian analysis] -3.7 days; 90% BCI, -4.1 to -3.2 days). Adverse events reported by 5% or more of patients in at least 1 galcanezumab dose group and more frequently than placebo included injection-site pain, upper respiratory tract infection, nasopharyngitis, dysmenorrhea, and nausea. Conclusions and Relevance Monthly subcutaneous injections of galcanezumab, both 120 mg and 300 mg, demonstrated efficacy (repeated-measures analysis) for the preventive treatment of migraine and support further development in larger phase 3 studies. All dosages were safe and well tolerated for the preventive treatment of episodic migraine. Trial Registration clinicaltrials.gov Identifier: NCT02163993.
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Affiliation(s)
| | | | - Qi Zhang
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | | | | | | | | | | | - Peter J Goadsby
- National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK.,Department of Neurology, University of California, San Francisco
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona
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25
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Crespi J, Bratbak D, Dodick DW, Matharu M, Jamtøy KA, Tronvik E. Pilot Study of Injection of OnabotulinumtoxinA Toward the Sphenopalatine Ganglion for the Treatment of Classical Trigeminal Neuralgia. Headache 2019; 59:1229-1239. [PMID: 31342515 PMCID: PMC6771650 DOI: 10.1111/head.13608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 01/29/2023]
Abstract
Background The sphenopalatine ganglion (SPG) has previously been targeted in trigeminal neuralgia (TN), but its role in this condition has not been established. Objective To investigate the safety of injecting onabotulinumtoxinA (BTA) toward the SPG using the MultiGuide® in 10 patients with refractory classical TN, and collect preliminary efficacy data. Methods Twenty‐five international units (IU) of BTA were injected toward the SPG in a prospective, open‐label study in 10 patients with refractory classical TN. All patients were recruited and treated on an out‐patient basis at St. Olav's University Hospital in Trondheim (Norway). Primary outcome: adverse events (AEs). Primary efficacy outcome: number of TN attacks at weeks 5‐8 after injection compared to baseline. A treatment responder was predefined as at least 50% reduction in the median number of attacks per day between baseline and weeks 5‐8. Other efficacy outcomes were intensity of attacks (numeric rating scale, 0 to 10) and functional level (1 to 4; 1 best and 4 worst) at weeks 5‐8 after injection compared to baseline. Percentage of the day with concomitant persistent pain was registered at baseline and at weeks 1‐4, 6, 8, and 12 after injection. Patient global impression of change (PGIC) was ascertained at month 3. Results For the primary endpoint, we analyzed data for all 10 patients. For efficacy outcomes we analyzed data for 9 patients (1 patient violated protocol). We registered 13 AEs, none of which were serious. The median number of TN attacks during the 4‐week baseline and weeks 5‐8 after injection was 5.5 (range: 1.0‐51.5) and 5 (range: 0‐225.0), respectively (P = .401). Four patients were treatment responders. The median intensity of attacks at baseline and weeks 5‐8 after injection was 6 (range: 3.0‐8.5) and 3 (range: 0.0‐9.0) respectively (P = .024). The median functional level at baseline was 2 (range: 1.0‐3.3) and at month 2, 1 (range 1.0‐4.0; P = .750). Median percentage of the day with concomitant persistent pain was 75% (minimum 37.5%, maximum 100%) at baseline and 18.75% (minimum 0%, maximum 100%) at week 8 (P = .023). Conclusions Injection of BTA toward the SPG using the MultiGuide® in patients with TN appears to be safe and well tolerated. This study was negative for the main efficacy endpoint (reduction in the number of attacks from baseline to weeks 5‐8). Further studies examining the role of the SPG in TN are necessary.
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Affiliation(s)
- Joan Crespi
- Department of Neurology, St. Olav's University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway.,Norwegian Advisory Unit on Headaches, Trondheim, Norway
| | - Daniel Bratbak
- Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway.,Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
| | - David W Dodick
- Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway.,Mayo Clinic, Scottsdale, Arizona, USA
| | - Manjit Matharu
- UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Kent Are Jamtøy
- Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway.,Department of Maxillofacial Surgery, St. Olav's University Hospital, Trondheim, Norway
| | - Erling Tronvik
- Department of Neurology, St. Olav's University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway.,Norwegian Advisory Unit on Headaches, Trondheim, Norway
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26
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The safety and preventive effects of a supraorbital transcutaneous stimulator in Japanese migraine patients. Sci Rep 2019; 9:9900. [PMID: 31289281 PMCID: PMC6617446 DOI: 10.1038/s41598-019-46044-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
Cefaly (Cefaly Technology, Seraing, Belgium) is a device that stimulates the bilateral supraorbital nerve transcutaneously. A previous study in Europe proved that Cefaly was an effective and safe device as a preventive therapy for migraine. However, there have been no studies on this device in Asia. We examined the safety and preventive effect of Cefaly for migraine. One-hundred patients were prospectively collected from four headache units in Japan. The inclusion criteria were as follows: 18–75 years of age, migraine with and without aura, and at least 2 attacks per month. A 4-week baseline period was followed by 12-week treatment period. The primary end point was the change from baseline in the number of migraine days at 12 weeks. The secondary end points include the changes of the number of migraine attacks, all headache days, acute medicine consumption days and headache severity. After treatment, a questionnaire survey on the satisfaction of the treatment was administered to the patients. The Friedmann test was used to assess the changes between baseline period and after treatment, and Mann-Whitney U test was used for the comparison of efficacy between chronic migraine and episodic migraine, with and without prophylactic treatment or medication overuse. After 12 weeks of treatment, Cefaly use significantly decreased the number of migraine days (8.16 vs. 6.84; p = 0.0036). Only three subjects (3.0%) dropped out due to the adverse effects; however, no serious adverse events were observed. The compliance of this study was very high at 90.0%. Furthermore, a significant decrease was observed in the number of migraine attacks (5.33 vs. 3.94; p = 0.0002) and the intake of acute antimigraine drugs (8.75 vs. 7.83; p = 0.0166). Cefaly is considered to be a safe and highly tolerable effective device for Japanese patients. Trial registration: This study was retrospectively registered to UMIN-CTR(UMIN000033333) on 10 July 2018.
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Ruff DD, Ford JH, Tockhorn-Heidenreich A, Sexson M, Govindan S, Pearlman EM, Wang SJ, Khan A, Aurora SK. Efficacy of galcanezumab in patients with chronic migraine and a history of preventive treatment failure. Cephalalgia 2019; 39:931-944. [DOI: 10.1177/0333102419847957] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Efficacy of galcanezumab in chronic migraine has been demonstrated in a pivotal Phase 3 study. Here, we assess efficacy in patients who have failed ≥2 and ≥1 prior migraine preventives for efficacy and/or safety reasons, and in those who never failed. Study design/methods REGAIN (NCT02614261) was a Phase 3, randomized, double-blind, placebo-controlled study in patients with chronic migraine. Patients were randomized 2:1:1 to receive placebo, galcanezumab 120 mg/240 mg once monthly during a double-blind treatment period lasting three months. Subgroup analyses were conducted among patients who failed ≥2 and ≥1 prior preventives and who never failed previously. Outcomes assessed were change from baseline in number of monthly migraine headache days, proportion of patients with ≥50% and ≥75% response (reduction in monthly migraine headache days), change in number of monthly migraine headache days with acute medication use and change in patient functioning per Migraine-Specific Quality of Life Questionnaire Role Function Restrictive (MSQ RF-R) domain score. Results Treatment with galcanezumab versus placebo resulted in significant improvements ( p < 0.01) in overall reduction (Months 1–3) from baseline in the number of monthly migraine headache days in patients with prior failures (LS mean change [SE]: ≥2 prior failures: galcanezumab 120 mg: −5.35 (0.71); galcanezumab 240 mg: −2.77 (0.66); placebo: −1.01 (0.54); ≥1 prior failures: galcanezumab 120 mg: −5.53 (0.60), galcanezumab 240 mg: −3.53 (0.59); placebo: −2.02 (0.49). Similarly, significant results were seen with galcanezumab versus placebo for ≥50% and ≥75% response rates, reductions in acute medication use and improvements in MSQ RF-R domain score. In the subgroup with no prior preventive failures, results were statistically significant for the 240 mg galcanezumab group versus placebo on all outcome measures, and for the 120 mg group on the reduction in migraine headache days with acute medication use. There was also a higher placebo response observed in the patients with no prior preventive failures. Conclusion Galcanezumab is consistently efficacious versus placebo in reducing monthly migraine headache days and several other key outcomes in patients with chronic migraine who have failed ≥2 or ≥1 preventives previously. In the subgroup with no prior failures, greater numerical differences were seen with galcanezumab, but statistical separation from placebo varied by dose and outcome. Clinicaltrials.gov identifier number NCT02614261.
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Affiliation(s)
| | | | | | | | - Sriram Govindan
- Eli Lilly Services India Private Limited, Bengaluru, Karnataka, India
| | | | - Shuu-Jiun Wang
- Brain Research Center, National Yang-Ming University, Taipei
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei
| | - Arif Khan
- Northwest Clinical Research Center, Bellevue, WA, USA
- Duke University School of Medicine, Durham, NC, USA
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28
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Goadsby PJ, Paemeleire K, Broessner G, Brandes J, Klatt J, Zhang F, Picard H, Lenz R, Mikol DD. Efficacy and safety of erenumab (AMG334) in episodic migraine patients with prior preventive treatment failure: A subgroup analysis of a randomized, double-blind, placebo-controlled study. Cephalalgia 2019; 39:817-826. [PMID: 30982348 DOI: 10.1177/0333102419835459] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Erenumab was effective and well tolerated in a pivotal clinical trial of episodic migraine that included subjects both naïve to, and those who had failed, previous preventives. Here we evaluated the efficacy and safety of erenumab (70 mg or 140 mg) versus placebo in the subgroup of patients who had previously failed preventive treatment(s): ≥1 or ≥2 prior failed migraine preventive categories, and in patients who had never failed. METHODS Prespecified subgroup analyses evaluated change from baseline to months 4-6 (the primary endpoint of the blinded study phase) in monthly migraine days, achievement of ≥50% and ≥75% reduction in monthly migraine days, and change from baseline in acute migraine-specific medication days. Adverse events were also evaluated. RESULTS Treatment with both doses of erenumab resulted in greater reductions in monthly migraine days at months 4-6 (treatment difference versus placebo [95% CI], never failed subgroup: -0.9 [-1.5, -0.3] for 70 mg and -1.3 [-1.9, -0.7] for 140 mg; ≥1 prior failed medication categories subgroup: -2.0 [-2.8, -1.2] for 70 mg and -2.5 [-3.4, -1.7] for 140 mg; ≥2 prior failed medication categories subgroup: -1.3 [-2.6, 0.0] for 70 mg and -2.7 [-4.0, -1.4] for 140 mg). Similar results were observed in the monthly acute migraine-specific medication days endpoint, and in the achievement of ≥50% and ≥75% reduction in monthly migraine days. For the ≥50% reduction in monthly migraine day endpoint, placebo response in the no prior treatment failed group was 32.6%, in the ≥1 failed treatment 17.5%, and in the ≥2 failed treatments 11.1%. CONCLUSION Erenumab showed consistent efficacy in episodic migraine patients who had failed prior preventive treatments and was well tolerated across subgroups. The data suggest prior patients with prior treatment failures have lower placebo response rates.
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Affiliation(s)
- Peter J Goadsby
- 1 NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, UK.,2 SLaM Biomedical Research Centre, King's College London, UK
| | - Koen Paemeleire
- 3 Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Gregor Broessner
- 4 Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan Brandes
- 5 Nashville Neuroscience Group and Vanderbilt University School of Neurology, Nashville, TN, USA
| | - Jan Klatt
- 6 Novartis Pharma AG, Basel, Switzerland
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29
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Stauffer VL, Wang S, Voulgaropoulos M, Skljarevski V, Kovacik A, Aurora SK. Effect of Galcanezumab Following Treatment Cessation in Patients With Migraine: Results From 2 Randomized Phase 3 Trials. Headache 2019; 59:834-847. [PMID: 30942898 PMCID: PMC6593785 DOI: 10.1111/head.13508] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 12/14/2022]
Abstract
Objective We examined the efficacy and safety of galcanezumab after treatment cessation in randomized double‐blind, placebo‐controlled, migraine prevention studies (EVOLVE‐1; EVOLVE‐2). Background Galcanezumab is indicated for migraine prevention in adults. Methods Adults with episodic migraine were enrolled into EVOLVE‐1 and EVOLVE‐2, which randomized 858 and 915 patients, respectively, to galcanezumab 120 mg (an initial 240‐mg loading dose), galcanezumab 240 mg, or placebo, administered subcutaneously once monthly for 6 months. After treatment completion or discontinuation, patients entered a 4‐month posttreatment period. Efficacy and safety from the posttreatment periods are reported. Results Overall, 740 patients (EVOLVE‐1) and 830 (EVOLVE‐2) patients entered the posttreatment periods, about 95% and 96% of patients, respectively, completed. In EVOLVE‐1, change from pre‐randomization baseline in monthly migraine headache days decreased over the posttreatment period from (mean [SE]) 5.2 (0.4) days (Month 6) to 4.1 (0.4) days (Month 10) for 120 mg and from 5.3 (0.4) days (Month 6) to 3.8 (0.4) days (Month 10) for 240 mg, and was stable for placebo (3.4 [0.3] days [Month 6] to 3.3 [0.3] days [Month 10]); differences between each galcanezumab dose group and placebo were statistically significant at each month, except for galcanezumab 240 mg at Month 10 (120 mg vs placebo: P < .001 Months 1‐6, P = .007 Month 7, P = .044 Month 8, P = .016 Month 9, and P = .042 Month 10; 240 mg vs placebo: P < .001 Months 1–7, P = .015 Month 8, P = .021 Month 9, and P = .238 Month 10). EVOLVE‐2 showed similar results. In both trials, there were no statistically significant differences between treatment groups and placebo for time‐to‐first loss of 50% response. During the posttreatment periods, 1.6% (EVOLVE‐1) and 2.3% (EVOLVE‐2) of patients initiated migraine preventive treatments. At Month 10, quality of life among galcanezumab‐treated patients was similar to those taking placebo. The most common posttreatment emergent adverse event was upper respiratory tract infections. There were no discontinuations due to adverse events during the posttreatment periods. Conclusions Galcanezumab treatment effects were reduced during the posttreatment periods, but did not return to baseline. There were no unexpected adverse events after galcanezumab cessation.
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Affiliation(s)
| | - Shufang Wang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | | | | | - Amy Kovacik
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Sheena K Aurora
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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Odell J, Clark C, Hunnisett A, Ahmed OH, Branney J. Manual therapy for chronic migraine: a pragmatic randomised controlled trial study protocol. Chiropr Man Therap 2019; 27:11. [PMID: 30962877 PMCID: PMC6436233 DOI: 10.1186/s12998-019-0232-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/03/2019] [Indexed: 01/02/2023] Open
Abstract
Introduction Chronic migraine is a largely refractory condition affecting between 1 and 2.2% of the overall population worldwide, with females more affected than males. There are also high health and socioeconomic costs associated both for the individual and society. The mainstay of chronic migraine management is pharmacological, but the options available have limited efficacy and there are often unwanted side effects. There is some evidence for manual therapy as a treatment option for migraine, but its effectiveness for chronic migraine is unknown. Therefore, we have designed a pragmatic randomised control trial to investigate whether adding manual therapy to the tertiary specialist treatment of chronic migraine improves patient-reported outcomes. Methods A pragmatic, randomised controlled trial in a hospital tertiary headache clinic. Participants will be randomised into one of two groups: treatment as usual or treatment as usual plus manual therapy. The primary outcome measure will be a change in the Headache Impact Test score. Secondary outcomes will also be measured over the 12-week study period including changes in headache frequency, migraine specific quality of life and reductions in relevant medicine consumption. The manual therapy group will have five treatment sessions each lasting 30 min. The recruitment target of 64 participants will allow power at 80% with p = 0.05 using minimal clinical difference for Headache Impact Test of 3.7 and includes provision for a 10% dropout rate. Recruitment will take place between August 2018 and February 2019. The results will form part of a doctoral study and be published in peer-reviewed journals and presented at national/international conferences. Discussion Current pharmacological approaches have limited effects in the management of chronic migraine and there is a requirement to improve treatment options and reduce the health and economic burden of the condition. Manual therapy has been shown to be effective in other chronic pain conditions as well as other primary headaches. This study will explore the effectiveness of manual therapy as an adjunctive approach to the management of chronic migraine. Trial registration The trial has received a favourable opinion from the UK Health Research Authority (IRAS 228901) and is registered at ClinicalTrials.gov.number NCT03395457. Registered 1st March 2018.
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Affiliation(s)
- Jim Odell
- Bournemouth University, Royal London House, Christchurch Road, Bournemouth, BH1 3LT UK
| | - Carol Clark
- Bournemouth University, Royal London House, Christchurch Road, Bournemouth, BH1 3LT UK
| | - Adrian Hunnisett
- BPP University, McTimoney College, Kimber Road, Abingdon, OX14 1BZ UK
| | - Osman Hassan Ahmed
- Bournemouth University, Royal London House, Christchurch Road, Bournemouth, BH1 3LT UK
| | - Jonathan Branney
- Bournemouth University, Royal London House, Christchurch Road, Bournemouth, BH1 3LT UK
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Pokladnikova J, Stefancikova M, Haviger J, Bishop FL, Wang B, Guan X, Musil F. Effect of expectation on short- and long-term treatment response to Acupuncture in migraine patients. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Förderreuther S, Zhang Q, Stauffer VL, Aurora SK, Láinez MJA. Preventive effects of galcanezumab in adult patients with episodic or chronic migraine are persistent: data from the phase 3, randomized, double-blind, placebo-controlled EVOLVE-1, EVOLVE-2, and REGAIN studies. J Headache Pain 2018; 19:121. [PMID: 30594122 PMCID: PMC6755564 DOI: 10.1186/s10194-018-0951-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/10/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Maintenance of effect following treatment with galcanezumab compared to placebo in adult patients with episodic or chronic migraine was evaluated. METHODS In 2 similarly designed studies of patients with episodic migraine (6 months) and 1 study of patients with chronic migraine (3 months), patients randomized in a 1:1:2 ratio received a subcutaneous injection of galcanezumab 120 mg/month (after an initial loading dose of 240 mg) or 240 mg/month or placebo. Maintenance of effect during the double-blind phase was evaluated based on a comparison of the percentages of galcanezumab- and placebo-treated patients with maintenance of 30, 50, 75, and 100% response (defined as ≥30, ≥50, ≥75, and 100% reduction from baseline in monthly migraine headache days [MHD]) at an individual patient level. Logistic regression analyses were used for between treatment comparisons. RESULTS A total of 1773 adult patients with episodic migraine (n = 444 for galcanezumab 120 mg; n = 435 for galcanezumab 240 mg; n = 894 for placebo for 2 studies pooled) and 1113 patients with chronic migraine (n = 278 for galcanezumab 120 mg; n = 277 for galcanezumab 240 mg; n = 558 for placebo) were evaluated. In patients with episodic migraine, ≥50% response was maintained in 41.5 and 41.1% of galcanezumab-treated patients (120 mg and 240 mg, respectively) for ≥3 consecutive months (until patient's endpoint) and 19.0 and 20.5%, respectively, for 6 consecutive months and was significantly greater than the 21.4 and 8.0% of placebo-treated patients at ≥3 and 6 months consecutively (P < 0.001). Approximately 6% of galcanezumab-treated patients maintained ≥75% response all 6 months versus 2% of placebo-treated patients. Few galcanezumab-treated patients maintained 100% response. In patients with chronic migraine, 29% of galcanezumab-treated patients maintained ≥30% response all 3 months compared to 16% of placebo patients while ≥50% response was maintained in 16.8 and 14.6% of galcanezumab-treated patients (120 mg and 240 mg) and was greater than placebo (6.3%; p < 0.001). Few patients maintained ≥75% response. CONCLUSIONS Treatment with galcanezumab 120 mg or 240 mg demonstrated statistically significant and clinically meaningful persistence of effect in patients with episodic migraine (≥3 and 6 consecutive months) and in patients with chronic migraine (for 3 months). STUDY IDENTIFICATION AND TRIAL REGISTRATION Study Identification: EVOLVE-1 (I5Q-MC-CGAG); EVOLVE-2 (I5Q-MC-CGAH); REGAIN (I5Q-MC-CGAI) TRIAL REGISTRATION: ClinicalTrials.gov ; NCT02614183 (EVOLVE-1); NCT02614196 (EVOLVE-2); NCT02614261 (REGAIN).
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Affiliation(s)
| | | | | | - Sheena K. Aurora
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Miguel J. A. Láinez
- Hospital Clínico Universitario, Universidad Católica de Valencia, Valencia, Spain
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Reuter U, Goadsby PJ, Lanteri-Minet M, Wen S, Hours-Zesiger P, Ferrari MD, Klatt J. Efficacy and tolerability of erenumab in patients with episodic migraine in whom two-to-four previous preventive treatments were unsuccessful: a randomised, double-blind, placebo-controlled, phase 3b study. Lancet 2018; 392:2280-2287. [PMID: 30360965 DOI: 10.1016/s0140-6736(18)32534-0] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND A substantial proportion of patients with migraine does not respond to, or cannot tolerate, oral preventive treatments. Erenumab is a novel CGRP-receptor antibody with preventive efficacy in migraine. We assessed its efficacy and tolerability in patients with episodic migraine in whom previous treatment with two-to-four migraine preventives had been unsuccessful. METHODS LIBERTY was a 12-week, double-blind, placebo-controlled randomised study at 59 sites in 16 countries. Eligible patients were aged 18-65 years and had a history of episodic migraine with or without aura for at least 12 months, had migraine for an average of 4-14 days per month during the 3 months before screening, and had been treated unsuccessfully (in terms of either efficacy or tolerability, or both) with between two and four preventive treatments. Eligible participants were randomly assigned (1:1) to receive either erenumab 140 mg (via two 70 mg injections) or placebo every 4 weeks subcutaneously for 12 weeks. Randomisation was by interactive response technology and was stratified by monthly frequency of migraine headache (4-7 vs 8-14 migraine days per month) during the baseline phase. Cenduit generated the randomisation list and assigned participants to groups. Participants, investigators, people doing various assessments, and the study sponsor were masked to treatment assignment. The primary endpoint was the proportion of patients achieving a 50% or greater reduction in the mean number of monthly migraine days during weeks 9-12. Efficacy was measured in the full analysis set, which included all randomly assigned patients who started their assigned treatment and completed at least one post-baseline monthly migraine day measurement. Safety and tolerability were assessed by recording adverse events and by physical examination, assessment of vital signs, clinical laboratory assessments, and electrocardiography. Safety was assessed in all randomly assigned patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT03096834. The trial is closed to new participants, but the open-label extension phase is ongoing. FINDINGS Between March 20, 2017, and Oct 27, 2017, 246 participants were randomly assigned, 121 to the erenumab group and 125 to the placebo group. 95 of 246 (39%) participants had previously unsuccessfully tried two preventive drugs, 93 (38%) had tried three, and 56 (23%) had tried four. At week 12, 36 (30%) patients in the erenumab had a 50% or greater reduction from baseline in the mean number of monthly migraine days, compared with 17 (14%) in the placebo group (odds ratio 2·7 [95% CI 1·4-5·2]; p=0·002). The tolerability and safety profiles of erenumab and placebo were similar. The most frequent treatment-emergent adverse event was injection site pain, which occurred in seven (6%) participants in both groups. INTERPRETATION Compared with placebo, erenumab was efficacious in patients with episodic migraine who previously did not respond to or tolerate between two and four previous migraine preventive treatments. Erenumab might be an option for patients with difficult-to-treat migraine who have high unmet needs and few treatment options. FUNDING Novartis Pharma.
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Affiliation(s)
- Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Peter J Goadsby
- NIHR-Wellcome Trust, King's Clinical Research Facility, King's College London, London, UK
| | - Michel Lanteri-Minet
- Pain Department and FHU InvoPain, CHU Nice-Université Côte d'Azur, Nice, France; INSERM U1107 Migraine and Trigeminal Pain, Auvergne University, Clermont-Ferrand, France
| | | | | | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
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Damien J, Colloca L, Bellei-Rodriguez CÉ, Marchand S. Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 139:255-296. [PMID: 30146050 DOI: 10.1016/bs.irn.2018.07.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accumulating evidence reveal important applications of endogenous pain modulation assessment in healthy controls and in patients in clinical settings, as dysregulations in the balance of pain modulatory circuits may facilitate pain and promote chronification of pain. This article reviews data on pain modulation, focusing on the mechanisms and translational aspects of pain modulation from conditioned pain modulation (CPM) to placebo and nocebo effects in experimental and clinical pain. The specific roles of expectations, learning, neural and neurophysiological mechanisms of the central nervous system are briefly reviewed herein. The interaction between CPM and placebo systems in pain inhibitory pathways is highly relevant in the clinic and in randomized controlled trials yet remains to be clarified. Examples of clinical implications of CPM and its relationship to placebo and nocebo effects are provided. A greater understanding of the role of pain modulation in various pain states can help characterize the manifestation and development of chronic pain and assist in predicting the response to pain-relieving treatments. Placebo and nocebo effects, intrinsic to every treatment, can be used to develop personalized therapeutic approaches that improve clinical outcomes while limiting unwanted effects.
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Affiliation(s)
- Janie Damien
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States; Departments of Psychiatry and Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Carmen-Édith Bellei-Rodriguez
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Serge Marchand
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Fonds de Recherche du Québec-Santé (FRQS), Montréal, QC, Canada.
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Ashina M, Tepper S, Brandes JL, Reuter U, Boudreau G, Dolezil D, Cheng S, Zhang F, Lenz R, Klatt J, Mikol DD. Efficacy and safety of erenumab (AMG334) in chronic migraine patients with prior preventive treatment failure: A subgroup analysis of a randomized, double-blind, placebo-controlled study. Cephalalgia 2018; 38:1611-1621. [DOI: 10.1177/0333102418788347] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background Erenumab was effective and well tolerated in a pivotal clinical trial of chronic migraine. Here, we evaluated efficacy and safety of monthly erenumab (70 mg or 140 mg) versus placebo in the subgroup of patients who had previously failed preventive treatment(s) (≥ 1, ≥ 2 prior failed medication categories) and in patients who had never failed. Methods Subgroup analyses evaluated change from baseline in monthly migraine days; achievement of ≥ 50% and ≥ 75% reduction in monthly migraine days; and change in monthly acute migraine-specific medication days. Adverse events were evaluated for each subgroup. Results Treatment with both doses of erenumab resulted in greater reductions in monthly migraine days (primary endpoint) at Month 3 (treatment difference [95% CI], never failed subgroup: −2.2 [−4.1, −0.3] for 70 mg and −0.5 [−2.4, 1.5] for 140 mg; ≥ 1 prior failed medication categories subgroup: −2.5 [−3.8, −1.2], for 70 mg and −3.3 [−4.6, −2.1] for 140 mg; ≥ 2 prior failed medication categories subgroup: −2.7 [−4.2, −1.2], for 70 mg and −4.3 [−5.8, −2.8] for 140 mg). Similar results were observed in the monthly acute migraine-specific medication days endpoint, and in the achievement of ≥ 50% and ≥ 75% reduction in monthly migraine days. There were no new or unexpected safety issues. Conclusion Erenumab showed consistent efficacy in chronic migraine patients who had failed prior preventive treatments and was well tolerated across subgroups.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stewart Tepper
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jan Lewis Brandes
- Nashville Neuroscience Group and Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Guy Boudreau
- Headache Unit, Neurology Department, University Hospital Center of Montreal, Montreal, QC, Canada
| | - David Dolezil
- Prague Headache Center, DADO MEDICAL s.r.o., Prague, Czech Republic
| | | | | | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Sphenopalatine Ganglion Block for the Treatment of Acute Migraine Headache. PAIN RESEARCH AND TREATMENT 2018; 2018:2516953. [PMID: 29862074 PMCID: PMC5971252 DOI: 10.1155/2018/2516953] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/28/2018] [Indexed: 01/03/2023]
Abstract
Transnasal sphenopalatine ganglion block is emerging as is an attractive and effective treatment modality for acute migraine headaches, cluster headache, trigeminal neuralgia, and several other conditions. We assessed the efficacy and safety of this treatment using the Sphenocath® device. 55 patients with acute migraine headaches underwent this procedure, receiving 2 ml of 2% lidocaine in each nostril. Pain numeric rating scale (baseline, 15 minutes, 2 hours, and 24 hours) and patient global impression of change (2 hours and 24 hours after treatment) were recorded. The majority of patients became headache-free at 15 minutes, 2 hours, and 24 hours after procedure (70.9%, 78.2%, and 70.4%, resp.). The rate of headache relief (50% or more reduction in headache intensity) was 27.3% at 15 minutes, 20% at 2 hours, and 22.2% at 24 hours. The mean pain numeric rating scale decreased significantly at 15 minutes, 2 hours, and 24 hours, respectively. Most patients rated the results as very good or good. The procedure was well-tolerated with few adverse events. This treatment is emerging as an effective and safe option for management of acute migraine attacks.
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Le K, Yu D, Wang J, Ali AI, Guo Y. Is topiramate effective for migraine prevention in patients less than 18 years of age? A meta-analysis of randomized controlled trials. J Headache Pain 2017; 18:69. [PMID: 28721545 PMCID: PMC5515721 DOI: 10.1186/s10194-017-0776-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
Background Mainly based on evidence of success in adults, various medications are commonly used to prevent pediatric migraines. Topiramate has been approved for migraine prevention in children as young as 12 years of age. In this meta-analysis, we aimed to assess the currently published data pertaining to the efficacy of topiramate for migraine prevention in patients less than 18 years of age. Methods We searched PubMed/Medline, Embase and the Cochrane Library (from inception to April 2017) for randomized controlled trials (RCTs) published in English. Two independent investigators performed data extraction and quality evaluation using the Cochrane Collaboration’s tool. The data extracted were analyzed by Review Manager 5.3 software. Results A total of four RCTs matching the inclusion criteria were included, with an aggregate of 465 patients. Of these patients, 329 were included in the topiramate group, and 136 were included in the placebo group. This meta-analysis revealed that compared with placebo, topiramate failed to decrease the number of patients experiencing a ≥ 50% relative reduction in headache frequency (n = 465, RR = 1.26, 95% CI = [0.94,1.67], Z = 1.55, P = 0.12) or the number of headache days (n = 465, MD = −0.77, 95% CI = [−2.31,0.76], Z = 0.99, P = 0.32) but did reduce PedMIDAS scores (n = 205, MD = −9.02, 95% CI = [−17.34, −0.70], Z = 2.13, P = 0.03). Higher rates of side effects and adverse events in the topiramate group than in the placebo group were observed in the included trials. Conclusions Topiramate may not achieve a more effective clinical trial endpoint than placebo in the prevention of migraines in patients less than 18 years of age, and topiramate may lead to more side effects or adverse events in the included patients.
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Affiliation(s)
- Kai Le
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Dafan Yu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Jiamin Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Abdoulaye Idriss Ali
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Yijing Guo
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China.
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Kandasamy R, Lee AT, Morgan MM. Depression of home cage wheel running: a reliable and clinically relevant method to assess migraine pain in rats. J Headache Pain 2017; 18:5. [PMID: 28091820 PMCID: PMC5236037 DOI: 10.1186/s10194-017-0721-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/06/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The development of new anti-migraine treatments is limited by the difficulty inassessing migraine pain in laboratory animals. Depression of activity is one of the few diagnostic criteria formigraine that can be mimicked in rats. The goal of the present study was to test the hypothesis thatdepression of home cage wheel running is a reliable and clinically relevant method to assess migraine painin rats. METHODS Adult female rats were implanted with a cannula to inject allyl isothiocyanate (AITC) onto the dura to induce migraine pain, as has been shown before. Rats recovered from implantation surgery for 8 days in cages containing a running wheel. Home cage wheel running was recorded 23 h a day. AITC and the migraine medication sumatriptan were administered in the hour prior to onset of the dark phase. RESULTS Administration of AITC caused a concentration-dependent decrease in wheel running that lasted 3 h. The duration and magnitude of AITC-induced depression of wheel running was consistent following three repeated injections spaced 48 h apart. Administration of sumatriptan attenuated AITC-induced depressionof wheel running when a large dose (1 mg/kg) was administered immediately following AITC administration. Wheel running patterns did not change when sumatriptan was given to naïve rats. CONCLUSIONS These data indicate that home cage wheel running is a sensitive, reliable, and clinically relevant method to assess migraine pain in the rat.
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Affiliation(s)
- Ram Kandasamy
- Graduate Program in Neuroscience, Washington State University, Pullman, WA, USA. .,Washington State University Vancouver, 14204 NE Salmon Creek Ave, Vancouver, WA, 98686, USA.
| | - Andrea T Lee
- Department of Psychology, Washington State University Vancouver, Vancouver, WA, USA
| | - Michael M Morgan
- Graduate Program in Neuroscience, Washington State University, Pullman, WA, USA.,Department of Psychology, Washington State University Vancouver, Vancouver, WA, USA
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Bratbak DF, Nordgård S, Stovner LJ, Linde M, Dodick DW, Aschehoug I, Folvik M, Tronvik E. Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic migraine. Cephalalgia 2016; 37:356-364. [PMID: 27154997 PMCID: PMC5394468 DOI: 10.1177/0333102416648328] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective The main objective of this pilot study was to investigate the safety of administering onabotulinumtoxinA towards the sphenopalatine ganglion in 10 patients with intractable chronic migraine with an open, uncontrolled design. We also collected efficacy data to provide an indication as to whether future placebo-controlled studies should be performed. Method In a prospective, open-label, uncontrolled study after one-month baseline, we performed bilateral injections of 25 IU onabotulinumtoxinA (total dose 50 IU) toward the sphenopalatine ganglion in a single outpatient session in 10 patients with intractable migraine with a follow-up of 12 weeks. The primary outcome was adverse events and the main efficacy outcome was frequency of moderate and severe headache days in month 2 post-treatment compared to baseline. Results All 10 patients experienced a total of 25 adverse events. The majority of these were different types of local discomfort in the face and jaw, and none were classified as serious. In an intention-to-treat analysis of the main efficacy outcome, a statistically significant reduction of moderate and severe headache days in baseline versus month 2 was observed (16.3 ± 6.2 days baseline versus 7.6 ± 7.6 days month 2, p = 0.009). Eight out of 10 patients experienced an at least 50% reduction of moderate and severe headache days compared to baseline. Conclusion The result warrants randomised, placebo-controlled studies to establish both safety and efficacy of this potential novel treatment of chronic migraine.
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Affiliation(s)
- Daniel Fossum Bratbak
- 1 Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Norway.,2 Department of Neuroscience, NTNU Norwegian University of Science and Technology, Norway
| | - Ståle Nordgård
- 2 Department of Neuroscience, NTNU Norwegian University of Science and Technology, Norway.,3 Department of ENT, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Lars Jacob Stovner
- 2 Department of Neuroscience, NTNU Norwegian University of Science and Technology, Norway.,4 Norwegian Advisory Unit on Headaches, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Mattias Linde
- 2 Department of Neuroscience, NTNU Norwegian University of Science and Technology, Norway.,4 Norwegian Advisory Unit on Headaches, St. Olavs Hospital, Trondheim University Hospital, Norway.,5 Department of Neurology, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - David W Dodick
- 2 Department of Neuroscience, NTNU Norwegian University of Science and Technology, Norway.,6 Department of Neurology, Mayo Clinic, USA
| | - Irina Aschehoug
- 2 Department of Neuroscience, NTNU Norwegian University of Science and Technology, Norway
| | - Mari Folvik
- 7 Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Erling Tronvik
- 2 Department of Neuroscience, NTNU Norwegian University of Science and Technology, Norway.,4 Norwegian Advisory Unit on Headaches, St. Olavs Hospital, Trondheim University Hospital, Norway.,5 Department of Neurology, St. Olavs Hospital, Trondheim University Hospital, Norway
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Tariq N, Tepper SJ, Kriegler JS. Patent Foramen Ovale and Migraine: Closing the Debate--A Review. Headache 2016; 56:462-78. [PMID: 26952049 DOI: 10.1111/head.12779] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 12/26/2015] [Accepted: 12/27/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND A link between patent foramen ovale (PFO) and migraine as well as the utility of closure of PFO and its effect on migraine have been subjects of debate. The present review is an effort to gather the available evidence on this topic and formulate recommendations. METHODS A systematic search of electronic databases (Medline, Embase, Cochrane Library) was performed. A separate search in associated reference lists of identified studies was done. Observational studies and clinical trials published in English using the International Headache Society criteria for diagnosis of migraine were included in the analysis. The search was performed in 3 categories: prevalence of migraine in patients with PFO, prevalence of PFO in migraine patients, and effect of PFO closure and its effect on migraine. The quality of evidence and strength of recommendations during review of these studies was analyzed. RESULTS About 14 observational studies with 2602 subjects who had PFO were identified. Migraine prevalence ranged from 16% to 64%. Another 20 studies reported 2444 patients with migraine; the prevalence of PFO ranged from 15% to 90%. About 20 observational studies (1194 patients) that examined the effect of PFO closure on migraine were identified. Resolution of migraine was reported in 10% to 83% of patients, improvement in 14% to 83%, no change in 1% to 54%, and worsening in 4% to 8%. The overall quality of these observational studies was poor. Finally, 3 randomized clinical trials included a total of 238 patients who underwent PFO closure compared with 234 patients in the control groups. All 3 trials failed to meet their primary end points defined as migraine resolution and greater than 50% reduction in migraine days at 1 year. In 2 of the clinical trials, there was some benefit noted in a small subset of migraine patients with aura, but the numbers were too small to extrapolate the findings to the general migraine population. CONCLUSIONS There is no good quality evidence to support a link between migraine and PFO. Closure of PFO for migraine prevention does not significantly reduce the intensity and severity of migraine. We do not recommend the routine use of this procedure in current practice.
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Affiliation(s)
- Nauman Tariq
- Michigan Headache and Neurological Institute Ringgold standard institution - Neurology, Ann Arbor, Michigan, USA
| | - Stewart J Tepper
- Dartmouth College Geisel School of Medicine Ringgold standard institution - Neurology, Hanover, New Hampshire, USA
| | - Jennifer S Kriegler
- Cleveland Clinic - Center for Neurological Restoration, Cleveland, Ohio, USA
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Brief intervention by general practitioners for medication-overuse headache, follow-up after 6 months: a pragmatic cluster-randomised controlled trial. J Neurol 2015; 263:344-353. [DOI: 10.1007/s00415-015-7975-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 01/03/2023]
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Ahmed F, Zafar HW, Buture A, Khalil M. Does analgesic overuse matter? Response to OnabotulinumtoxinA in patients with chronic migraine with or without medication overuse. SPRINGERPLUS 2015; 4:589. [PMID: 26543724 PMCID: PMC4628076 DOI: 10.1186/s40064-015-1386-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 11/10/2022]
Abstract
Chronic migraine affects 2 % of the population and has substantial impact on quality of life and considerable burden on healthcare resources. 50-80 % patients with chronic migraine have excessive consumption of analgesic medications. Withdrawal of analgesics is often advised before commencing preventive treatments. However, some headache experts recommend preventive treatments alongside analgesic withdrawal. 434 patients with chronic migraine attending the Hull Headache Clinic who received OnabotulinumtoxinA as preventive treatment were stratified to those with or without analgesic overuse. Data was collected through a dedicated headache diary and analysed for headache and migraine days reduction and for an increment in headache-free days in the month post treatment. The data shows no difference in the therapeutic outcome in patients with or without analgesic overuse with substantial reduction in headache and migraine days and an increment in headache-free days in both groups in a real-life clinical setting. OnabotulinumtoxinA is equally effective in patients with chronic migraine with or without analgesic overuse.
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Affiliation(s)
- Fayyaz Ahmed
- Department of Neurology, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Hassan W. Zafar
- Department of Neurology, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Alina Buture
- Department of Neurology, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Modar Khalil
- Department of Neurology, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
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44
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Vestibular migraine in an otolaryngology clinic: prevalence, associated symptoms, and prophylactic medication effectiveness. Otol Neurotol 2015; 36:133-8. [PMID: 25251304 DOI: 10.1097/mao.0000000000000596] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the prevalence of vestibular migraine (VM) in patients consulting to an otolaryngology clinic, the neuro-otological associated symptoms, and the effect of prophylactic antimigrainous medication on VM symptom improvement. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral otolaryngology clinic. SUBJECTS AND METHODS We used the diagnostic criteria from the Bárány Society and the International Headache Society to allocate patients to a subgroup: VM, possible VM, and atypical VM. MAIN OUTCOME MEASURE The prevalence of VM, percentages of associated neurotological symptoms, and percentages of effectiveness of prophylactic medication. RESULTS Sixty-five (16%) patients were selected from the total patient population (n = 407) from which 4.2% were assigned to the definite VM group, 5.7% to the probable VM group, and 6.1% to the atypical VM group. We found a significantly different distribution between the groups for photophobia (p = 0.035), ear pressure (p = 0.023), and scotoma (p = 0.015). Thirty patients were administered with flunarizine and 68% responded with an improvement in VM symptoms (p < 0.001). For propranolol, 31 patients were treated and there was an improvement of symptoms in 73% (p < 0.001). Remarkable was the fact that these percentages were not significantly different between the subgroups. CONCLUSION VM is a common disorder presenting in a dizziness clinic, and detailed history taking is important to assess VM-associated symptoms and thus to prevent underdiagnosis. The latter is very important because our study shows that the majority of patients, regardless of VM subtype, can benefit from a prophylactic treatment, but further prospective studies are necessary.
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Abstract
Chronic migraine (CM) is a severe disabling condition with a few available evidence-based management options. OnabotulinumtoxinA (onaBoNTA) is approved for use in a number of disorders. Its benefits and potential use in migraine were observed incidentally while treating patients cosmetically for wrinkles. The mechanism of action of onaBoNTA in CM is not fully understood, but there is evidence that this involves axonal transport via sensory fibers. The Phase III REsearch Evaluating Migraine Prophylaxis Therapy trials have established the efficacy as well as the long-term safety and tolerability of onaBoNTA in CM. This review will discuss the evidence behind its use in this setting.
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Affiliation(s)
- Rubesh Gooriah
- Department of Neurology, Hull Royal Infirmary, Kingston Upon Hull, UK
| | - Fayyaz Ahmed
- Department of Neurology, Hull Royal Infirmary, Kingston Upon Hull, UK
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A Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial to Evaluate the Efficacy and Safety of Duliang Soft Capsule in Patients with Chronic Daily Headache. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:694061. [PMID: 26101536 PMCID: PMC4460254 DOI: 10.1155/2015/694061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/03/2015] [Accepted: 05/03/2015] [Indexed: 02/05/2023]
Abstract
Objective. To investigate the efficacy and safety of traditional Chinese medicine Duliang soft capsule (DSC) in prophylactic treatment for patients with chronic daily headache (CDH). Methods. A multicenter, double-blind, randomized, placebo-controlled clinical study was conducted at 18 Chinese clinical centers. The participants received either DSC or placebo for 4 weeks. The primary efficacy measure was headache-free rate (HFR) in a 4-week period between the pretreatment and posttreatment stages. The secondary efficacy measures were the decrease of headache days, the duration of headache attacks, the frequency of analgesic usage, quality of life, disability, and the headache severity (VAS scores). The accompanying symptoms and adverse events were also assessed. Results. Of 584 CDH patients assessed, 468 eligible patients were randomized. 338 patients received DSC, while 111 patients were assigned in the placebo group. Following treatment, there was a 16.56% difference in HFR favoring DSC over placebo (P < 0.01). Significant differences were also observed between DSC and placebo groups in the secondary measures. However, no statistical difference was found between the two groups in the associated symptoms. No severe adverse effects were observed in the study. Conclusions. DSC might be an effective and well-tolerated option for the prophylactic treatment of patients with CDH.
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Boudreau GP, Grosberg BM, McAllister PJ, Lipton RB, Buse DC. Prophylactic onabotulinumtoxinA in patients with chronic migraine and comorbid depression: An open-label, multicenter, pilot study of efficacy, safety and effect on headache-related disability, depression, and anxiety. Int J Gen Med 2015; 8:79-86. [PMID: 25733924 PMCID: PMC4340374 DOI: 10.2147/ijgm.s70456] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Chronic migraine is associated with significant headache-related disability and psychiatric comorbidity. OnabotulinumtoxinA (BOTOX®) is effective and well tolerated in the prophylactic treatment of chronic migraine. This study aimed to provide preliminary data on the efficacy and safety of prophylactic onabotulinumtoxinA in patients with chronic migraine and comorbid depressive symptoms. Methods This was a prospective, open-label, multicenter pilot study. Eligible patients met International Classification of Headache Disorders 2nd edition Revision criteria for chronic migraine and had associated depressive symptoms, including Patient Health Questionnaire depression module scores of 5–19. Eligible participants received 155 units of onabotulinumtoxinA, according to the PREEMPT protocol, at baseline and week 12. Assessments included headache frequency, the Headache Impact Test™, the Migraine Disability Assessment, the Beck Depression Inventory®-II, the nine-item Patient Health Questionnaire depression module, and the seven-item Generalized Anxiety Disorder questionnaire. Adverse events were also monitored. Results Overall, 32 participants received treatment. At week 24, there were statistically significant mean (standard deviation [SD]) improvements relative to baseline in the number of headache/migraine-free days (+8.2 [5.8]) (P<0.0001) and in the number of headache/migraine days (−8.2 [5.8]) (P<0.0001) per 30-day period. In addition, there were significant improvements in Headache Impact Test scores (−6.3 [6.9]) (P=0.0001) and Migraine Disability Assessment scores (−44.2 [67.5]) (P=0.0058). From baseline to week 24, statistically significant improvements were also seen in Beck Depression Inventory-II (−7.9 [6.0]) (P<0.0001), Patient Health Questionnaire depression module (−4.3 [4.7]) (P<0.0001), and Generalized Anxiety Disorder questionnaire (−3.5 [5.0]) (P=0.0002) scores. No serious adverse events were reported. Adverse events considered related to treatment occurred in 30% of patients and were mild or moderate. Conclusion Prophylactic onabotulinumtoxinA was well tolerated in patients with chronic migraine and comorbid depression, and was effective in reducing headache frequency, impact, and related disability, which led to statistically significant improvements in depression and anxiety symptoms.
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Affiliation(s)
- Guy P Boudreau
- Clinique de la Migraine et Céphalées, Département de Neurologie, Centre Hospitalier de L'Université de Montréal, Hôpital Notre-Dame, Montreal, QC, Canada
| | - Brian M Grosberg
- Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter J McAllister
- New England Institute for Neurology and Headache, Stamford, and The Frank H Netter School of Medicine at Quinnipiac University, Hamden, CT, USA
| | - Richard B Lipton
- Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dawn C Buse
- Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Bittar C, Nascimento OJM. Placebo and nocebo effects in the neurological practice. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:58-63. [PMID: 25608129 DOI: 10.1590/0004-282x20140180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/10/2014] [Indexed: 12/12/2022]
Abstract
Knowledge of placebo and nocebo effects is essential to identify their influence on the results in clinical practice and clinical trials, and thereby properly interpret their results. It is known that the gold standard of clinical trials research is the double-blind, placebo-controlled, randomized clinical study. The objective of this review is to distinguish specific from non-specific effects, so that the presence of positive effects in the group that received placebo (placebo effect) and the presence of adverse effects in the group receiving placebo (nocebo effect) lead to confounding in interpreting the results. Placebo and nocebo effects have been considered in neurological diseases such as depression, pain, headache, multiple sclerosis, epilepsy. As placebo and nocebo effects are also present in clinical practice, the purpose of this review is to draw attention to their influence on neurological practice, calling attention to the development of measures that can minimize them.
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Affiliation(s)
- Caroline Bittar
- Departamento de Neurologia, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Osvaldo J M Nascimento
- Departamento de Neurologia, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Dodick DW, Goadsby PJ, Silberstein SD, Lipton RB, Olesen J, Ashina M, Wilks K, Kudrow D, Kroll R, Kohrman B, Bargar R, Hirman J, Smith J. Safety and efficacy of ALD403, an antibody to calcitonin gene-related peptide, for the prevention of frequent episodic migraine: a randomised, double-blind, placebo-controlled, exploratory phase 2 trial. Lancet Neurol 2014; 13:1100-1107. [PMID: 25297013 DOI: 10.1016/s1474-4422(14)70209-1] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) is crucial in the pathophysiology of migraine. We assessed the safety, tolerability, and efficacy of ALD403, a genetically engineered humanised anti-CGRP antibody, for migraine prevention. METHODS In this randomised, double-blind, placebo-controlled, exploratory, proof-of-concept phase 2 trial, patients aged 18-55 years with five to 14 migraine days per 28-day period were randomly assigned (1:1) via an interactive web response system to receive an intravenous dose of ALD403 1000 mg or placebo. Site investigators, patients, and the sponsor were masked to treatment allocation during the study. The primary objective was to assess safety at 12 weeks after infusion. The primary efficacy endpoint was the change from baseline to weeks 5-8 in the frequency of migraine days, as recorded in patient electronic diaries. Patients were followed up until 24 weeks for exploratory safety and efficacy analyses. Safety and efficacy analyses were done by intention to treat. This study is registered with ClinicalTrials.gov, NCT01772524. FINDINGS Between Jan 28, 2013, and Dec 23, 2013, of 174 patients randomly assigned at 26 centres in the USA, 163 received either ALD403 (n=81) or placebo (n=82). Adverse events were experienced by 46 (57%) of 81 patients in the ALD403 group and 43 (52%) of 82 in the placebo group. The most frequent adverse events were upper respiratory tract infection (placebo 6 [7%] patients vs ALD403 7 [9%] patients), urinary tract infection (4 [5%] vs 1 [1%]), fatigue (3 [4%] vs 3 [4%]), back pain (4 [5%] vs 3 [4%]), arthralgia (4 [5%] vs 1 [1%]), and nausea and vomiting (2 [2%] vs 3 [4%]). Six serious adverse events were reported by three patients and were judged to be unrelated to study drug: in the ALD403 group, one patient had four serious adverse events and one had one serious adverse event, and in the placebo group, one patient had one serious adverse event. There were no differences in vital signs or laboratory safety data between the two treatment groups. The mean change in migraine days between baseline and weeks 5-8 was -5·6 (SD 3·0) for the ALD403 group compared with -4·6 (3·6) for the placebo group (difference -1·0, 95% CI -2·0 to 0·1; one-sided p=0·0306). INTERPRETATION No safety concerns were noted with an intravenous dose of ALD403 1000 mg. This study also provides preliminary evidence for the efficacy of ALD403 in the preventive treatment of migraine in patients with a high monthly frequency of migraine days. FUNDING Alder Biopharmaceuticals.
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Affiliation(s)
| | - Peter J Goadsby
- NIHR-Wellcome Trust Clinical Research Facility, King's College London, London, UK; Department of Neurology, University of California, San Francisco, CA, USA
| | - Stephen D Silberstein
- Department of Neurology, Thomas Jefferson University, Jefferson Headache Center, Philadelphia, PA, USA
| | - Richard B Lipton
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jes Olesen
- Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Robin Kroll
- Women's Clinical Research Center, Seattle, WA, USA
| | | | | | - Joe Hirman
- Pacific Northwest Statistical Consulting, Woodinville, WA, USA
| | - Jeff Smith
- Alder BioPharmaceuticals, Bothell, WA, USA
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