1
|
Tepper SJ, Dodick DW, Lanteri-Minet M, Dolezil D, Gil-Gouveia R, Lucas C, Piasecka-Stryczynska K, Szabó G, Mikol DD, Chehrenama M, Chou DE, Yang Y, Paiva da Silva Lima G. Efficacy and Safety of Erenumab for Nonopioid Medication Overuse Headache in Chronic Migraine: A Phase 4, Randomized, Placebo-Controlled Trial. JAMA Neurol 2024:2823594. [PMID: 39283627 PMCID: PMC11406451 DOI: 10.1001/jamaneurol.2024.3043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
Importance Patients with chronic migraine and medication overuse headaches (CM-MOH) represent a particularly burdened subpopulation. This trial provides first, to our knowledge, American Academy of Neurology class I evidence for a preventive therapy in CM-MOH. Objective To assess erenumab efficacy and safety in patients with nonopioid CM-MOH. Design, Settings, and Participants This randomized, double-blind, parallel-group, placebo-controlled trial took place at 67 centers in North America, Europe, and Australia from October 7, 2019, to November 2, 2022. This report reflects the primary analysis conducted in January 2023, using a database snapshot from December 1, 2022, which contains the complete dataset of the double-blind treatment period (DBTP). Participants included adults with CM-MOH who had 1 or more preventive treatment failure(s). There were 992 participants screened and 620 participants enrolled (584 in nonopioid cohort and 36 in opioid cohort). Interventions Erenumab, 70 mg, 140 mg, or placebo, once monthly for 24 weeks. Main Outcomes and Measures The primary end point was MOH remission at month 6. Secondary end points included change from baseline in mean monthly acute headache medication days (AHMD) at month 6 and sustained MOH remission throughout the DBTP. Safety end points were adverse events and changes in vital signs. Results The primary analysis population included 584 participants in the nonopioid-treated cohort with a mean age of 44 years and 482 participants were female (82.5%). Baseline demographics and disease characteristics were balanced across groups. At month 6, 134 participants in the erenumab, 140 mg group (69.1%) (odds ratio [OR], 2.01; 95% CI, 1.33-3.05; P < .001 vs placebo) and 117 in the erenumab, 70 mg group (60.3%) (OR, 1.37; 95% CI, 0.92-2.05; P = .13 vs placebo) achieved MOH remission vs 102 participants in the placebo group (52.6%). AHMD use was also reduced in the erenumab groups vs placebo. Least squares mean (standard error) change from baseline in average monthly AHMD was -9.4 (0.4) days in the erenumab, 140 mg group (difference from placebo, -2.7; 95% CI, -3.9 to -1.6; P < .001) and -7.8 (0.4) days in the erenumab, 70 mg group (difference from placebo, -1.2; 95% CI, -2.4 to -0.1; P = .03), vs -6.6 (0.4) days in the placebo group. MOH remission throughout the DBTP was sustained in 119 participants (61.3%,) 96 participants (49.5%), and 73 participants (37.6%) in the erenumab, 140 mg, 70 mg, and placebo groups, respectively. Adverse events were consistent with the known safety profile of erenumab. Treatment-emergent adverse events incidence in the combined erenumab group was 66.8% (259 participants; constipation 15.2% (59 participants) and COVID-19 13.9% (54 participants) were most common. Conclusions and Relevance In this study, monthly, 140 mg, erenumab injections safely and effectively achieved MOH remission in patients with nonopioid CM-MOH within 6 months. Trial Registration ClinicalTrials.gov Identifier: NCT03971071.
Collapse
Affiliation(s)
- Stewart J Tepper
- The New England Institute for Neurology and Headache, Stamford, Connecticut
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona
- Atria Academy of Science and Medicine, New York, New York
| | - Michel Lanteri-Minet
- Pain Department and FHU InovPain, Centre Hospitalier Universitaire de Nice-Côte Azur and University, Nice, France
- Inserm U1107, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
| | - David Dolezil
- Prague Headache Center, DADO MEDICAL sro, Prague, Czech Republic
| | - Raquel Gil-Gouveia
- Neurology Department, Hospital da Luz, Luz Saude, Lisboa, Portugal
- Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisboa, Portugal
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Goadsby PJ, Friedman DI, Holle-Lee D, Demarquay G, Ashina S, Sakai F, Neel B, Gandhi P, Dabruzzo B, Smith JH, Liu Y, Trugman JM. Efficacy of Atogepant in Chronic Migraine With and Without Acute Medication Overuse in the Randomized, Double-Blind, Phase 3 PROGRESS Trial. Neurology 2024; 103:e209584. [PMID: 38924724 PMCID: PMC11254449 DOI: 10.1212/wnl.0000000000209584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Atogepant is an oral, calcitonin gene-related peptide receptor antagonist approved for the preventive treatment of migraine. We evaluated the efficacy of atogepant for the preventive treatment of chronic migraine (CM) in participants with and without acute medication overuse. METHODS This subgroup analysis of the phase 3, 12-week, randomized, double-blind, placebo-controlled PROGRESS trial evaluated adults with a ≥1-year history of CM, ≥15 monthly headache days (MHDs), and ≥8 monthly migraine days (MMDs) during the 4-week baseline period. Participants were randomized (1:1:1) to placebo, atogepant 30 mg twice daily (BID), or atogepant 60 mg once daily (QD) for 12 weeks and were analyzed by acute medication overuse status (triptans/ergots for ≥10 days per month, simple analgesics for ≥15 days per month, or combinations of triptans/ergots/simple analgesics for ≥10 days per month). Outcomes included change from baseline in mean MMDs, MHDs, and monthly acute medication use days; ≥50% reduction in mean MMDs across 12 weeks; and patient-reported outcome (PRO) measures. RESULTS Of 755 participants in the modified intent-to-treat population, 500 (66.2%) met baseline acute medication overuse criteria (placebo, n = 169 [68.7%]; atogepant 30 mg BID, n = 161 [63.6%]; atogepant 60 mg QD, n = 170 [66.4%]). The least squares mean difference (LSMD) (95% CI) from placebo in MMDs was -2.7 (-4.0 to -1.4) with atogepant 30 mg BID and -1.9 (-3.2 to -0.6) with atogepant 60 mg QD. Mean MHDs (LSMD [95% CI] -2.8 [-4.0 to -1.5] and -2.1 [-3.3 to -0.8]) and mean acute medication use days (LSMD [95% CI] -2.8 [-4.1 to -1.6] and -2.6 [-3.9 to -1.3]) were reduced and a higher proportion of participants achieved ≥50% reduction in MMDs (odds ratio [95% CI] 2.5 [1.5-4.0] and 2.3 [1.4-3.7]) with atogepant 30 mg BID and atogepant 60 mg QD. There was a 52.1%-61.9% reduction in the proportion of atogepant-treated participants meeting acute medication overuse criteria over 12 weeks. Atogepant improved PRO measures. Similar results were observed in the subgroup without acute medication overuse. DISCUSSION Atogepant was effective in participants with CM, with and without acute medication overuse, as evidenced by reductions in mean MMDs, MHDs, and acute medication use days; reductions in the proportion of participants meeting acute medication overuse criteria; and improvements in PROs. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT03855137. Submitted: February 25, 2019; first patient enrolled: March 11, 2019. clinicaltrials.gov/ct2/show/NCT03855137. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that atogepant reduces mean MMDs, MHDs, and monthly acute medication use days in adult patients with or without medication overuse.
Collapse
Affiliation(s)
- Peter J Goadsby
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Deborah I Friedman
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Dagny Holle-Lee
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Genevieve Demarquay
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Sait Ashina
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Fumihiko Sakai
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Brian Neel
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Pranav Gandhi
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Brett Dabruzzo
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Jonathan H Smith
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Yingyi Liu
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| | - Joel M Trugman
- From the NIHR King's Clinical Research Facility (P.J.G.), King's College London, United Kingdom; Department of Neurology (P.J.G.), University of California, Los Angeles; Key-Whitman Eye Center (D.I.F.), Dallas, TX; Department of Neurology (D.H.-L.), West German Headache and Vertigo Center Essen, University of Essen, Germany; Department of Neurology (G.D.), Hospices Civils de Lyon, Lyon Neuroscience Research Center, France; BIDMC Comprehensive Headache Center (S.A.), Beth Israel Deaconess Medical Center; Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine (S.A.), Harvard Medical School, Boston, MA; International Headache Society Global Patient Advocacy Coalition Executive Committee (F.S.), Saitama International Headache Center, Saitama Neuropsychiatric Institute, Japan; AbbVie (B.N.), Irvine, CA; AbbVie (P.G., B.D., J.M.T.), Madison, NJ; and AbbVie (J.H.S., Y.L.), North Chicago, IL
| |
Collapse
|
3
|
Buse DC, Cady R, Starling AJ, Buzby M, Spinale C, Steinberg K, Lenaburg K, Kymes S. Headache/migraine-related stigma, quality of life, disability, and most bothersome symptom in adults with current versus previous high-frequency headache/migraine and medication overuse: results of the Migraine Report Card survey. BMC Neurol 2024; 24:232. [PMID: 38965567 PMCID: PMC11223432 DOI: 10.1186/s12883-024-03732-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND High-frequency headache/migraine (HFM) and overuse of acute medication (medication overuse [MO]) are associated with increased disability and impact. Experiencing both HFM and MO can potentially compound impacts, including stigma; however, evidence of this is limited. The objective of this report was to evaluate self-reported stigma, health-related quality of life (HRQoL), disability, and migraine symptomology in US adults with HFM + MO from the Harris Poll Migraine Report Card survey. METHODS US adults (≥ 18 yrs., no upper age limit) who screened positive for migraine per the ID Migraine™ screener completed an online survey. Participants were classified into "current HFM + MO" (≥ 8 days/month with headache/migraine and ≥ 10 days/month of acute medication use over last few months) or "previous HFM + MO" (previously experienced HFM + MO, headaches now occur ≤ 7 days/month with ≤ 9 days/month of acute medication use). Stigma, HRQoL, disability, and most bothersome symptom (MBS) were captured. The validated 8-item Stigma Scale for Chronic Illnesses (SSCI-8) assessed internal and external stigma (scores ≥ 60 are clinically significant). Raw data were weighted to the US adult population. Statistically significant differences were determined by a standard t-test of column proportions and means at the 90% (p < 0.1) and 95% (p < 0.05) confidence levels. RESULTS Participants (N = 550) were categorized as having current (n = 440; mean age 41.1 years; 54% female; 57% White, not Hispanic; 24% Hispanic; 11% Black, not Hispanic) or previous (n = 110; mean age 47.2 years; 49% female; 75% White, not Hispanic; 13% Hispanic; 4% Black, not Hispanic) HFM + MO. Compared to those with previous HFM + MO (21%), adults with current HFM + MO were more likely to experience clinically significant levels of stigma (47%). Men with current HFM + MO (52% compared to men with previous HFM + MO [25%] and women with current [41%] or previous [18%] HFM + MO), non-Hispanic Black (51% compared to White, not Hispanic [45%] and Hispanic [48%] current HFM + MO groups and White, not Hispanic previous HFM + MO [12%]), current HFM + MO aged 18-49 years (50% compared to those with current HFM + MO aged ≥ 50 years [33%] and those with previous HFM + MO aged 18-49 [34%] and ≥ 50 years [4%]), and employed respondents (53% current and 29% previous compared to those not employed [32% current and 12% previous]) reported higher rates of clinically significant stigma. Those with current HFM + MO were more likely to have worse HRQoL and disability due to headache/migraine. Respondents aged ≥ 50 years with current HFM + MO were more likely than respondents aged 18-49 years with current HFM + MO to indicate that their overall quality of life (66% vs. 52%) and their ability to participate in hobbies/activities they enjoy were negatively impacted by headache/migraine (61% vs. 49%). Pain-related symptoms were identified as the MBS. CONCLUSIONS Together these data suggest that current and previous HFM + MO can be associated with undesirable outcomes, including stigma and reduced HRQoL, which were greatest among people with current HFM + MO, but still considerable for people with previous HFM + MO.
Collapse
Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C12, Bronx, NY, 10461, USA.
| | - Roger Cady
- RK Consults, Ozark, MO, USA
- Missouri State University, Springfield, MO, USA
- Axon Therapeutics, San Diego, CA, USA
| | | | - Meghan Buzby
- Coalition for Headache and Migraine Patients (CHAMP), San Rafael, CA, USA
| | | | | | | | | |
Collapse
|
4
|
Scheffler A, Basten J, Menzel L, Binz D, Becker WA, Breunung V, Schenk H, Kleinschnitz C, Nsaka M, Lindner D, Holle D. Persistent effectiveness of CGRP antibody therapy in migraine and comorbid medication overuse or medication overuse headache - a retrospective real-world analysis. J Headache Pain 2024; 25:109. [PMID: 38965463 PMCID: PMC11225246 DOI: 10.1186/s10194-024-01813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Management of patients with migraine who have concomitant medication overuse (MO) or medication overuse headache (MOH) is a major problem in clinical practice. Detoxification of acute analgesics before or during initiation of prophylactic therapy has long been recommended although this concept has recently been questioned. Additionally, relapse after detoxification is a common problem. This real-world study analyses the initial and sustained effectiveness of prophylactic migraine therapy with CGRP (receptor) antibodies without prior detoxification in patients with comorbid MO or MOH for up to one year. METHODS A retrospective real-world analysis was performed on 291 patients (episodic migraine (EM) with MO (EM-MO; n = 35), EM without MO (EM-noMO; n = 77), chronic migraine (CM) with MOH (CM-MOH; n = 109), CM without MOH (CM-noMOH; n = 70). All patients began treatment with either erenumab (n = 173), fremanezumab (n = 70) or galcanezumab (n = 48) without prior detoxification. Data were available for up to 12 months of treatment. Responder rates for monthly headache days (MHD), monthly migraine days (MMD) and monthly acute medication intake (AMD) were analysed. RESULTS All groups showed a significant reduction in MHD, MMD and AMD at the last observed time point compared to baseline. In patients with CM and MOH, 60.6% (66/109) no longer fulfilled the definition of MO or MOH and a further 13.8% (15/109) had only EM-MO. In the EM cohort, 89% (31/35) of MO patients lost their MO during therapy. MHD and AMD 30% responder rates were comparable for CM-MOH and CM-noMOH (MHD: CM-MOH: 56.0% vs. CM-noMOH: 41.4%, p = 0.058, AMD: CM-MOH: 66.1% vs. CM-noMOH: 52.9%, p = 0.077). MMD responder rate did not differ significantly (after Bonferroni adjustment) (CM-MOH: 62.4% vs. CM-noMOH: 47.1%, p = 0.045, α = 0.017). After successful initiation of therapy, 15.4% of the initial CM-MOH patients relapsed and met the criterion for CM-MOH at the end of follow-up. There were no antibody specific differences in response to therapy. CONCLUSIONS Our data confirms the effectiveness of CGRP antibody treatment in migraine patients with additional MOH or MO in a real-world setting. Low relapse rates after initial successful therapy support an early start of CGRP antibody treatment in patients with MOH or MO. TRIAL REGISTRATION No registration, retrospective analysis.
Collapse
MESH Headings
- Humans
- Migraine Disorders/drug therapy
- Female
- Male
- Headache Disorders, Secondary/drug therapy
- Retrospective Studies
- Middle Aged
- Adult
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Calcitonin Gene-Related Peptide Receptor Antagonists/administration & dosage
- Calcitonin Gene-Related Peptide Receptor Antagonists/adverse effects
- Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Comorbidity
- Treatment Outcome
Collapse
Affiliation(s)
- Armin Scheffler
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Jale Basten
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Universitätsstraße 105, Bochum, 44789, Germany
| | - Lennart Menzel
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Dominik Binz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Wolfgang Alexander Becker
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Vincent Breunung
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Hannah Schenk
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Michael Nsaka
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Diana Lindner
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Dagny Holle
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| |
Collapse
|
5
|
Buse DC, Krasenbaum LJ, Seminerio MJ, Packnett ER, Carr K, Ortega M, Driessen MT. Real-world Impact of Fremanezumab on Migraine-Related Health Care Resource Utilization in Patients with Comorbidities, Acute Medication Overuse, and/or Unsatisfactory Prior Migraine Preventive Response. Pain Ther 2024; 13:511-532. [PMID: 38472655 PMCID: PMC11111425 DOI: 10.1007/s40122-024-00583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Fremanezumab, a humanized monoclonal antibody targeting calcitonin gene-related peptide, is indicated for preventive treatment of migraine in adults. Real-world evidence assessing the effect of fremanezumab on migraine-related medication use, health care resource utilization (HCRU), and costs in patient populations with comorbidities, acute medication overuse (AMO), and/or unsatisfactory prior migraine preventive response (UPMPR) is needed. METHODS Data for this US, retrospective claims analysis were obtained from the Merative® MarketScan® Commercial and supplemental databases. Eligible adults with migraine initiated fremanezumab between 1 September 2018 and 30 June 2019 (date of earliest fremanezumab claim is the index date), had ≥ 12 months of continuous enrollment prior to initiation (preindex period) and ≥ 6 months of data following initiation (postindex period; variable follow-up after 6 months), and had certain preindex migraine comorbidities (depression, anxiety, and cardiovascular disease), potential AMO, or UPMPR. Changes in migraine-related concomitant acute and preventive medication use, HCRU, and costs were assessed pre- versus postindex. RESULTS In total, 3193 patients met the eligibility criteria. From pre- to postindex, mean (SD) per patient per month (PPPM) number of migraine-related acute medication and preventive medication claims (excluding fremanezumab), respectively, decreased from 0.97 (0.90) to 0.86 (0.87) (P < 0.001) and 0.94 (0.74) to 0.81 (0.75) (P < 0.001). Migraine-related outpatient and neurologist office visits, emergency department visits, and other outpatient services PPPM decreased pre- versus postindex (P < 0.001 for all), resulting in a reduction in mean (SD) total health care costs PPPM from US$541 (US$858) to US$490 (US$974) (P = 0.003). Patients showed high adherence and persistence rates, with mean (SD) proportion of days covered of 0.71 (0.29), medication possession ratio of 0.74 (0.31), and persistence duration of 160.3 (33.2) days 6 months postindex. CONCLUSIONS Patients with certain migraine comorbidities, potential AMO, and/or UPMPR in a real-world setting had reduced migraine-related medication use, HCRU, and costs following initiation of fremanezumab. Graphical abstract available for this article.
Collapse
Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | | | | | | | - Karen Carr
- Teva Branded Pharmaceuticals, Parsippany, NJ, USA
| | - Mario Ortega
- Teva Branded Pharmaceuticals, Parsippany, NJ, USA
| | - Maurice T Driessen
- Teva Pharmaceuticals, Piet Heinkade 107, 1019 BR, Amsterdam, Netherlands.
| |
Collapse
|
6
|
Argoff C, Herzog SP, Smith RM, Kotak SV, Sopina L, Saltarska Y, Soni-Brahmbhatt S, Khan FA. Real-world effectiveness and satisfaction with intravenous eptinezumab treatment in patients with chronic migraine: REVIEW, an observational, multi-site, US-based study. J Headache Pain 2024; 25:65. [PMID: 38664605 PMCID: PMC11044317 DOI: 10.1186/s10194-024-01764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Despite recent advancements in migraine treatment, some patients continue to endure significant disease burden. Due to the controlled nature of randomized trials in migraine prevention, many real-world patients with comorbidities or prior exposure to certain therapies are excluded. Capturing evidence of the effectiveness of treatment in real-world clinical settings can further shape treatment paradigms. The objective of this study was to develop a comprehensive understanding of both patients' and physicians' real-world experiences with eptinezumab for chronic migraine (CM). METHODS REVIEW (Real-world EVidence and Insights into Experiences With eptinezumab) is an observational, multi-site (n = 4), US-based study designed to evaluate real-world experiences of patients treated with eptinezumab and their treating physicians. Patients were ≥ 18 years of age, with a diagnosis of CM, who had completed ≥ 2 consecutive eptinezumab infusion cycles (≥ 6 months of exposure). The study included a retrospective chart review, a patient survey, and a semi-structured physician interview that assessed patient and/or physician satisfaction with elements of daily living / well-being, migraine symptomology, and perspectives of the eptinezumab infusion experience. RESULTS Of the 94 patients enrolled, 83% (78/94) were female, the mean age was 49.2 years, and the mean time since migraine diagnosis was 15.4 years. Before eptinezumab treatment, patients experienced a mean of 8 self-reported "good" days/month, which increased to 18 after treatment. Most patients took, on average, ≥ 10 days/month of prescription and/or over-the-counter medication (81% [75/93] and 66% [61/93], respectively) to treat migraine attacks before eptinezumab treatment, which dropped to 26% (24/93) and 23% (21/93) following eptinezumab treatment. Prior to receiving eptinezumab, 62% (58/93) of patients indicated being at least slightly concerned about infusions; after eptinezumab infusion, this dropped to 14% (13/93). These patient survey findings were consistent with physician responses. CONCLUSION This real-world evidence study demonstrated high overall satisfaction with the effectiveness of eptinezumab treatment for CM among most patients and their physicians.
Collapse
Affiliation(s)
- Charles Argoff
- Albany Medical Center, 47 New Scotland Ave, 12208, Albany, NY, USA.
| | | | | | | | | | | | | | - Fawad A Khan
- The McCasland Family Comprehensive Headache Center, Ochsner Neurosciences Institute, New Orleans, LA, USA
- University of Queensland-Ochsner Clinical School, New Orleans, LA, USA
| |
Collapse
|
7
|
Huang J, Wang X, Jin Y, Lou G, Yu Z. Trends and prescribing patterns of antimigraine medicines in nine major cities in China from 2018 to 2022: a retrospective prescription analysis. J Headache Pain 2024; 25:62. [PMID: 38654177 PMCID: PMC11036710 DOI: 10.1186/s10194-024-01775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The objective of this study was to investigate the trends and prescribing patterns of antimigraine medicines in China. METHODS The prescription data of outpatients diagnosed with migraine between 2018 and 2022 were extracted from the Hospital Prescription Analysis Cooperative Project of China. The demographic characteristics of migraine patients, prescription trends, and corresponding expenditures on antimigraine medicines were analyzed. We also investigated prescribing patterns of combination therapy and medicine overuse. RESULTS A total of 32,246 outpatients who were diagnosed with migraine at 103 hospitals were included in this study. There were no significant trend changes in total outpatient visits, migraine prescriptions, or corresponding expenditures during the study period. Of the patients who were prescribed therapeutic medicines, 70.23% received analgesics, and 26.41% received migraine-specific agents. Nonsteroidal anti-inflammatory drugs (NSAIDs; 28.03%), caffeine-containing agents (22.15%), and opioids (16.00%) were the most commonly prescribed analgesics, with corresponding cost proportions of 11.35%, 4.08%, and 19.61%, respectively. Oral triptans (26.12%) were the most commonly prescribed migraine-specific agents and accounted for 62.21% of the total therapeutic expenditures. The proportion of patients receiving analgesic prescriptions increased from 65.25% in 2018 to 75.68% in 2022, and the proportion of patients receiving concomitant triptans decreased from 29.54% in 2018 to 21.55% in 2022 (both P < 0.001). The most frequently prescribed preventive medication classes were calcium channel blockers (CCBs; 51.59%), followed by antidepressants (20.59%) and anticonvulsants (15.82%), which accounted for 21.90%, 34.18%, and 24.15%, respectively, of the total preventive expenditures. Flunarizine (51.41%) was the most commonly prescribed preventive drug. Flupentixol/melitracen (7.53%) was the most commonly prescribed antidepressant. The most commonly prescribed anticonvulsant was topiramate (9.33%), which increased from 6.26% to 12.75% (both P < 0.001). A total of 3.88% of the patients received combined therapy for acute migraine treatment, and 18.63% received combined therapy for prevention. The prescriptions for 69.21% of opioids, 38.53% of caffeine-containing agents, 26.61% of NSAIDs, 13.97% of acetaminophen, and 6.03% of triptans were considered written medicine overuse. CONCLUSIONS Migraine treatment gradually converges toward evidence-based and guideline-recommended treatment. Attention should be given to opioid prescribing, weak evidence-based antidepressant use, and medication overuse in migraine treatment.
Collapse
Affiliation(s)
- Jing Huang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Xinwei Wang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Yiyi Jin
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Guodong Lou
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd East Qingchun Road, Hangzhou, Zhejiang Province, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd East Qingchun Road, Hangzhou, Zhejiang Province, China.
| |
Collapse
|
8
|
Starling AJ, Cady R, Buse DC, Buzby M, Spinale C, Steinberg K, Lenaburg K, Kymes S. Harris Poll Migraine Report Card: population-based examination of high-frequency headache/migraine and acute medication overuse. J Headache Pain 2024; 25:26. [PMID: 38408888 PMCID: PMC10895775 DOI: 10.1186/s10194-024-01725-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Migraine is a disabling neurologic disease that can fluctuate over time in severity, frequency, and acute medication use. Harris Poll Migraine Report Card was a US population-based survey to ascertain quantifiable distinctions amongst individuals with current versus previous high-frequency headache/migraine and acute medication overuse (HFM+AMO). The objective of this report is to compare self-reported experiences in the migraine journey of adults with HFM+AMO to those who previously experienced HFM+AMO but currently have a sustained reduction in headache/migraine frequency and acute medication use. METHODS An online survey was available to a general population panel of adults (≥18 years) with migraine per the ID Migraine™ screener. Respondents were classified into "current HFM+AMO" (within the last few months had ≥8 headache days/month and ≥10 days/month of acute medication use; n=440) or "previous HFM+AMO" (previously had HFM+AMO, but within the last few months had ≤7 headache days/month and ≤9 days/month of acute medication use; n=110). Survey questions pertained to demographics, diagnosis, living with migraine, healthcare provider (HCP) communication, and treatment. RESULTS Participants in the current HFM+AMO group had 15.2 monthly headache days and 17.4 days of monthly acute medication use in last few months compared to 4.2 and 4.1 days for the previous HFM+AMO group, respectively. Overall, current preventive pharmacologic treatment use was low (15-16%; P>0.1 for current vs previous) in both groups. Previous HFM+AMO respondents reported better current acute treatment optimization. More respondents with current (80%) than previous HFM+AMO (66%) expressed concern with their current health (P<0.05). More than one-third of both groups wished their HCP better understood their mental/emotional health (current 37%, previous 35%; P>0.1 for current vs previous) and 47% (current) to 54% (previous) of respondents worried about asking their HCP too many questions (P>0.1 for current vs previous). CONCLUSION Apart from optimization of acute medication, medical interventions did not significantly differentiate between the current and previous HFM+AMO groups. Use of preventive pharmacological medication was low in both groups. Adults with current HFM+AMO more often had health concerns, yet both groups expressed concerns of disease burden. Optimization of acute and preventive medication and addressing mental/emotional health concerns of patients are areas where migraine care may impact outcomes regardless of their disease burden.
Collapse
Affiliation(s)
| | - Roger Cady
- RK Consults, Ozark, MO, USA
- Missouri State University, Springfield, MO, USA
- Axon-Therapeutics, San Diego, CA, USA
| | - Dawn C Buse
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Meghan Buzby
- Coalition for Headache and Migraine Patients (CHAMP), San Rafael, CA, USA
| | | | | | | | | |
Collapse
|
9
|
Takizawa T, Kitano T, Iijima M, Togo K, Yonemoto N. Treatment patterns and characteristics of patients with migraine: results from a retrospective database study in Japan. J Headache Pain 2024; 25:19. [PMID: 38331739 PMCID: PMC10854051 DOI: 10.1186/s10194-024-01722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Clinical characteristics and treatment practice of patients with migraine in Japan in real-world setting have not been fully investigated. We conducted a retrospective cohort study using claims database to understand the clinical practice of migraine in recent years and to characterize patients potentially not managed well by current treatment options. METHODS Our study used data from the large claims database maintained by JMDC Inc. Patients with diagnosis of headache or migraine between January 1, 2018, and July 31, 2022, were defined as the headache cohort, and those with migraine diagnosis and prescription of migraine treatments among the headache cohort were included in the migraine cohort. In the headache cohort, characteristics of medical facilities and status of imaging tests to distinguish secondary headache were examined. Treatment patterns and characteristics of patients potentially not managed well by acute/preventive treatment were described in migraine cohort. RESULTS In the headache cohort, 989,514 patients were included with 57.0% females and mean age of 40.3 years; 77.0% patients visited clinics (with ≤ 19 bed capacities) for their primary diagnosis, and 30.3% patients underwent imaging tests (computed tomography and/or magnetic resonance imaging). In the migraine cohort, 165,339 patients were included with 65.0% females and mean age of 38.8 years. In the migraine cohort, 95.6% received acute treatment while 20.8% received preventive treatment. Acetaminophen/non-steroidal anti-inflammatory drugs were most common (54.8%) as the initial prescription for migraine treatment followed by triptan (51.4%). First treatment prescription included preventive treatment in 15.6%, while the proportion increased to 82.2% in the fourth treatment prescription. Among patients with more than 12 months of follow-up, 3.7% had prescription patterns suggestive of risk of medication-overuse headache, and these patients were characterized by a higher percentage of females and a higher prevalence of comorbidities. CONCLUSIONS This study revealed that approximately one-fifth of the patients with migraine visiting medical facilities use preventive drugs. The presence of potential patients at risk of medication-overuse headache and the role of clinics in migraine treatment were also described.
Collapse
Affiliation(s)
- Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Kitano
- Health & Venue, Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
| | - Masahiro Iijima
- Internal Medicine & Hospital Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Kanae Togo
- Health & Venue, Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Naohiro Yonemoto
- Health & Venue, Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| |
Collapse
|
10
|
Shewale AR, Brandenburg JA, Burslem K, Lipton RB, Doshi JA. Health care resource utilization and costs associated with diagnosed medication overuse headache and potential acute medication overuse in individuals with migraine. Cephalalgia 2024; 44:3331024241235139. [PMID: 38410849 DOI: 10.1177/03331024241235139] [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: 02/28/2024]
Abstract
OBJECTIVE Estimate health care resource utilization and costs associated with medication overuse headache and potential acute medication overuse. METHODS A retrospective analysis was conducted with Clinformatics Data Mart data (1 January 2019-31 December 2019) that included continuously enrolled commercially insured adults with migraine (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] code G43.xxx). Medication overuse headache was defined as ≥1 inpatient or ≥2 outpatient claims with an ICD-10-CM code G44.41/40 (drug-induced headache). Potential acute medication overuse was defined as possessing sufficient medication for >10 mean treatment days/month for ergots, triptans, opioids, or combination analgesics or >15 mean cumulative days/month for simple prescription analgesics (e.g., acetaminophen, aspirin, other non-opioid analgesics) for >6 consecutive months. All-cause and migraine-related health care resource utilization and costs were compared after adjusting for demographic and clinical characteristics. RESULTS Among 90,017 individuals with migraine, the frequency of medication overuse headache/potential acute medication overuse was 12.6% (diagnosed medication overuse headache: 0.6%; potential acute medication overuse: 12.1%). Adjusted all-cause total costs ($31,235 vs $21,486; difference: $9,749 [P < 0.001]) and adjusted migraine-related total costs ($9,770 vs $6,207; difference: $3,563 [P < 0.001]) were higher in the medication overuse headache/potential acute medication overuse group versus those without medication overuse headache/potential acute medication overuse. CONCLUSIONS Individuals with diagnosed medication overuse headache/potential acute medication overuse had higher all-cause and migraine-related health care resource utilization and costs versus individuals without medication overuse headache/potential acute medication overuse, suggesting that improved migraine management is needed to reduce associated costs.
Collapse
Affiliation(s)
| | | | | | | | - Jalpa A Doshi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
11
|
Dissing AS, Lee XY, Østerberg O, Hammer-Helmich L. Burden of Medication Overuse in Migraine: A Cross-sectional, Population-Based Study in Five European Countries Using the 2020 National Health and Wellness Survey (NHWS). Neurol Ther 2023; 12:2053-2065. [PMID: 37728666 PMCID: PMC10630264 DOI: 10.1007/s40120-023-00545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Overuse of medication to treat migraine attacks can lead to development of a new type of headache or significant worsening of pre-existing headache, known as medication overuse headache. However, data concerning the burden of medication overuse (MO) in migraine are limited. This study aimed to assess the humanistic burden of MO in individuals with migraine from five European countries. METHODS Data are from the 2020 National Health and Wellness Survey-a cross-sectional, population-based survey conducted in France, Germany, Italy, Spain, and the UK. Data were included from adults (≥ 18 years) with a self-reported diagnosis of migraine and at least one migraine attack and one headache in the past 30 days. MO was defined as (i) use of simple analgesics/over-the-counter medications on ≥ 15 days/month; or (ii) use of migraine medication, including combination analgesics, on ≥ 10 days/month. Humanistic burden of MO was assessed using the 12-Item Short-Form Health Survey (SF-12v2), EuroQol 5-Dimensions 5-Levels (EQ-5D), Short-Form 6-Dimensions (SF-6D), and Migraine Disability Assessment (MIDAS). The association of MO with humanistic burden was evaluated using generalized linear models adjusted for potential confounders in the full migraine population and in subgroups defined by headache frequency (monthly headache days [MHDs] 1-3, 4-7, 8-14, or ≥ 15). RESULTS Among individuals with migraine, humanistic burden (SF-12v2, SF-6D, EQ-5D, and MIDAS) was higher in individuals who reported MO (n = 431) versus no MO (n = 3554), even after adjustment for confounding variables (p < 0.001 for all measures). MIDAS and EQ-5D scores were higher in individuals with MO than without, at all levels of headache frequency. For SF-12v2 and SF-6D, differences between groups with/without MO were seen only at lower levels of headache frequency (MHD 1-3 and 4-7). CONCLUSION Among people with migraine, those who report MO face a greater humanistic burden than those without MO, irrespective of headache frequency.
Collapse
Affiliation(s)
| | - Xin Ying Lee
- H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Ole Østerberg
- H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
- Biogen (Denmark) A/S, Glostrup, Denmark
| | | |
Collapse
|
12
|
Lipton RB, Buse DC, Nahas SJ, Tietjen GE, Martin VT, Löf E, Brevig T, Cady R, Diener HC. Risk factors for migraine disease progression: a narrative review for a patient-centered approach. J Neurol 2023; 270:5692-5710. [PMID: 37615752 PMCID: PMC10632231 DOI: 10.1007/s00415-023-11880-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND In individuals with migraine, attacks may increase in frequency, severity, or both. Preventing migraine progression has emerged as a treatment goal in headache subspecialty practice, but there may be less awareness in general neurology or primary care settings where most people with migraine who seek treatment consult. Herein, we review the definition of and risk factors for migraine progression and consider strategies that could reduce its risk. METHODS A group of headache expert healthcare professionals, clinicians, and researchers reviewed published evidence documenting factors associated with increased or decreased rates of migraine progression and established expert opinions for disease management recommendations. Strength of evidence was rated as good, moderate, or based solely on expert opinion, using modified criteria for causation developed by AB Hill. RESULTS Migraine progression is commonly operationally defined as the transition from ≤ 15 to ≥ 15 monthly headache days among people with migraine; however, this does not necessarily constitute a fundamental change in migraine biology and other definitions should be considered. Established and theoretical key risk factors for migraine progression were categorized into five domains: migraine disease characteristics, treatment-related factors, comorbidities, lifestyle/exogenous factors, and demographic factors. Within these domains, good evidence supports the following risk factors: poorly optimized acute headache treatment, cutaneous allodynia, acute medication overuse, selected psychiatric symptoms, extra-cephalic chronic pain conditions, metabolism-related comorbidities, sleep disturbances, respiratory conditions, former/current high caffeine intake, physical inactivity, financial constraints, tobacco use, and personal triggers as risk factors. Protective actions that may mitigate migraine progression are sparsely investigated in published literature; our discussion of these factors is primarily based on expert opinion. CONCLUSIONS Recognizing risk factors for migraine progression will allow healthcare providers to suggest protective actions against migraine progression (Supplementary Fig. 1). Intervention studies are needed to weight the risk factors and test the clinical benefit of hypothesized mitigation strategies that emerge from epidemiological evidence.
Collapse
Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | - Stephanie J Nahas
- Department of Neurology, Thomas Jefferson University, Jefferson Headache Center, Philadelphia, PA, USA
| | - Gretchen E Tietjen
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Vincent T Martin
- University of Cincinnati Headache and Facial Pain Center, Cincinnati, OH, USA
| | - Elin Löf
- H. Lundbeck A/S, Copenhagen, Denmark
| | | | - Roger Cady
- Lundbeck LLC, Deerfield, IL, USA
- RK Consults, Ozark, MO, USA
- Missouri State University, Springfield, MO, USA
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
| |
Collapse
|
13
|
Ashina M, Tepper SJ, Gendolla A, Sperling B, Ettrup A, Josiassen MK, Starling AJ. Long-term effectiveness of eptinezumab in patients with migraine and prior preventive treatment failures: extension of a randomized controlled trial. J Headache Pain 2023; 24:155. [PMID: 37985968 PMCID: PMC10662788 DOI: 10.1186/s10194-023-01688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Eptinezumab demonstrated efficacy in adults with migraine and prior preventive treatment failures in the placebo-controlled phase of the DELIVER clinical trial; its long-term effectiveness in this population has not yet been reported. The objective of this study was to evaluate the long-term effectiveness of eptinezumab in a migraine patient population during the 48-week extension phase of DELIVER. METHODS DELIVER was conducted June 1, 2020 to September 15, 2022. 865 adults with migraine, with documented evidence of 2-4 prior preventive migraine treatment failures and with completion of the 24-week placebo-controlled period of DELIVER received eptinezumab (100 or 300 mg) during the dose-blinded extension, either continuing their randomized dose or, if originally receiving placebo, were randomized 1:1 to an eptinezumab dose (100 or 300 mg). A mixed model for repeated measures was used to evaluate changes from baseline in the number of monthly migraine days (MMDs). RESULTS Of 865 patients entering the extension (eptinezumab 100 mg, n = 433; 300 mg, n = 432), 782 (90.4%) completed and 11 (1.3%) discontinued due to an adverse event. Eptinezumab was associated with early and sustained reductions in migraine frequency. Mean MMDs at baseline were approximately 14 days across groups. Mean (standard error) change from baseline in MMDs over the final dosing interval (weeks 61-72) was -6.4 (0.50) with placebo/eptinezumab 100 mg, -7.3 (0.49) with placebo/eptinezumab 300 mg, -7.1 (0.39) with eptinezumab 100 mg, and -7.0 (0.39) with eptinezumab 300 mg. During weeks 61-72, 63-70% of patients demonstrated ≥ 50% reduction in MMDs, and 36-45% demonstrated ≥ 75% reduction. Headache severity and acute medication use reductions, and patient-reported improvements in most bothersome symptom, disease status, quality of life, and work productivity, were observed. Adverse events were generally mild, transient, and similar in frequency/type to previous eptinezumab trials. CONCLUSIONS The long-term effectiveness and safety/tolerability of eptinezumab in patients with migraine and 2-4 prior preventive treatment failures was demonstrated by high completion rates and migraine-preventive benefits sustained for up to 18 months, implying that eptinezumab is a viable long-term treatment option for patients still seeking successful migraine treatments. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT04418765; URL: https://www. CLINICALTRIALS gov/ct2/show/NCT04418765 ); EudraCT (Identifier: 2019-004497-25; URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2019-004497-25 ).
Collapse
Affiliation(s)
- Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Rigshospitalet Glostrup Valdemar Hansen Vej 5, Glostrup, DK-2600, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Stewart J Tepper
- The New England Institute for Neurology and Headache, Stamford, CT, USA
| | | | | | | | | | | |
Collapse
|
14
|
Dell Agnello G, Buzzoni C, Antenori A, Torelli F, Altamura C, Vernieri F. Galcanezumab in the Treatment of Migraine: A Narrative Review of Real-World Studies. Clin Neuropharmacol 2023; 46:220-228. [PMID: 37962309 DOI: 10.1097/wnf.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Randomized controlled trials (RCTs) have established the efficacy of galcanezumab, an antibody binding calcitonin gene-related peptide (CGRP) ligand, in the preventive treatment of migraine. The objective was to summarize real-world data evaluating galcanezumab in the preventive treatment of migraine, to complement RCT results with evidence observed in clinical practice. METHODS A literature search was conducted to identify real-world studies evaluating galcanezumab in the treatment for patients with migraine. RESULTS Twenty-five studies were identified; some only evaluated galcanezumab, and others used pooled data from multiple anti-CGRP antibodies. The studies recruited diverse patient populations, including patients who had failed multiple prior preventive therapies. Treatment was associated with significant reductions from baseline in monthly migraine days and monthly headache days by 4.3 to 12.9 and 3.1 to 13.9, respectively. These values were numerically greater than those reported in most galcanezumab RCTs. Significant decreases from baseline were evident within the first month of treatment, and efficacy was maintained throughout the follow-up periods, ranging from 3 to 12 months. Galcanezumab was also associated with improvements in other efficacy end points, including decreased headache pain intensity, reduction in analgesic use, and improvements in daily functioning and quality of life. Functionality scores, as assessed by the Migraine Disability Assessment Scale questionnaire, decreased by 27 to 75 points from baseline at 3 to 12 months. Galcanezumab was associated with a low discontinuation rate and higher rates of persistence compared with standard migraine preventive treatments. CONCLUSIONS The results provide complementary data that galcanezumab is effective across the diverse patient populations observed in routine clinical practice.
Collapse
Affiliation(s)
| | | | | | | | - Claudia Altamura
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| |
Collapse
|
15
|
Li D, Abreu J, Tepper SJ. A Brief Review of Gepants. Curr Pain Headache Rep 2023; 27:479-488. [PMID: 37531032 DOI: 10.1007/s11916-023-01142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW Gepants are small molecules that antagonize calcitonin gene-related peptide (CGRP) receptors. Due to their favorable side effect profile and versatility in treating headaches acutely and preventively, gepants are preferred over triptans. We will cover the indications for the four FDA-approved gepants in adults: rimegepant, atogepant, ubrogepant, and zavegepant. This review will illustrate how gepants will continue to revolutionize the acute and preventive treatment of headaches. RECENT FINDINGS Gepants are now available in oral tablet, dissolving tablet, and intra-nasal spray formulations. Recent studies have shown promising utility in treating the pre-headache or prodromal phase. They have favorable tolerability, no evidence for association with medication overuse, and remain a safer alternative in those who have cerebrovascular risk factors. Additional research is needed to explore occurrence of Raynaud's phenomenon in participants treated with gepants, as it has been associated with CGRP monoclonal antibodies, but are not extensively studied in gepants. Gepants are expected to play a significant role in the next generation of migraine treatments.
Collapse
Affiliation(s)
- Diana Li
- Dartmouth Headache Center, Neurology Department, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Jessica Abreu
- Dartmouth Headache Center, Neurology Department, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Stewart J Tepper
- Dartmouth Headache Center, Neurology Department, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| |
Collapse
|
16
|
Rhyne C, Cohen JM, Seminerio MJ, Carr K, Krasenbaum LJ. Burden of migraine with acute medication overuse or psychiatric comorbidities and treatment with CGRP pathway-targeted monoclonal antibodies: A review. Medicine (Baltimore) 2023; 102:e33874. [PMID: 37335663 DOI: 10.1097/md.0000000000033874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Migraine is a complex and often debilitating neurological disease that affects more than 1 billion people worldwide. It is characterized by moderate-to-intense, throbbing headache attacks that are worsened by activity and is associated with nausea, vomiting, and sensitivity to light and sound. Migraine, ranked the second leading cause of years lived with disability by the World Health Organization, can diminish patients' quality of life and bring significant personal and economic burden. Furthermore, migraine patients with a history of acute medication overuse (AMO) or psychiatric comorbidities, such as depression or anxiety, may experience even greater impairment and burden, and their migraine may be more difficult-to-treat. Appropriate treatment of migraine is essential to reduce this burden and improve patient outcomes, especially for those with AMO or psychiatric comorbidities. There are several available preventive treatment options for migraine, though many of these are not migraine-specific and may have limited efficacy and/or poor tolerability. The calcitonin gene-related peptide pathway plays a key role in the pathophysiology of migraine, and monoclonal antibodies that target the calcitonin gene-related peptide pathway have been developed as specific preventive treatments for migraine. Four of these monoclonal antibodies have been approved for the preventive treatment of migraine after demonstrating favorable safety and efficacy profiles. These treatments offer substantial benefits for migraine patients, including those with AMO or common psychiatric comorbidities, by reducing monthly headache days and migraine days, days of acute medication use, and disability measures, as well as improving quality of life.
Collapse
Affiliation(s)
| | - Joshua M Cohen
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA
| | | | - Karen Carr
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA
| | | |
Collapse
|
17
|
Constantinidis TS, Arvaniti C, Fakas N, Rudolf J, Kouremenos E, Giannouli E, Mitsikostas DD. The prevalence and burden of medication overuse headache in Greece. Cephalalgia 2023; 43:3331024231184909. [PMID: 37377005 DOI: 10.1177/03331024231184909] [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: 06/29/2023]
Abstract
OBJECTIVE To estimate the prevalence and burden of medication overuse headache in a representative sample of the Greek population, aged 18-70 years old. METHODS This is a cross-sectional descriptive observational study performed by quantitative computer-assisted telephone interviews, using a standardized 37-item questionnaire for headaches. The prevalence of medication overuse headache was estimated in the general population and compared within the groups formed by factors such as age, gender, diagnosis of headache type, prophylactic treatment used, geographical regions, social class, workdays lost and loss of productivity. RESULTS 1197 (12.0%) participants reported headaches affecting performance out of 10,008 interviewees. The estimated prevalence of medication overuse headache in the general population was 0.7% (95% CI: 0.5-0.9). The female to male ratio was 3.6:1. The proportion of medication overuse headache was largest in the 35-54 age group, followed by the over 55 group. The Aegean islands and Crete were the regions with the highest proportion of medication overuse headache. Among participants with headaches, the proportion of medication overuse headache was 5.8% (95% CI: 4.4%-7.1%); 6.3% (95% CI: 4.7%-7.9%) among females and 4.4% (95% CI: 2.2%-6.6%) among males. In the same headache group, the proportion of medication overuse headache by prophylactic treatment for headache was 19.0% (95% CI: 9.5%-29.1%) for recipients and 5.0% (95% CI: 3.8-6.3) for non-recipients. The mean absenteeism in people with medication overuse headache was 1.0 days/month (95% CI: 0.4-1.6) and the mean presenteeism 6.3 days/month (95% CI: 3.9-8.7). The social class stratification showed a significant effect between the medication overuse headache in the sample of the general population and the C2 class, corresponding to skilled manual labour (OR: 0.7, CI: 0.5-0.9). In people with chronic migraine, and chronic tension type headache, as differentiated by the 37-item questionnaire, the proportion of medication overuse headache in the headache group estimated to be 50.5% (95% CI: 40.8%-60.1%) and 45.9%, (95% CI: 29.9%-62.0%) respectively. The group of people with acute headache medication overuse fulfilling the rest of the diagnostic criteria for medication overuse headache, except from the number of headache days per month (≥15 days/month), had a prevalence of 2.0% (95% CI: 1.75-2.30) and a proportion of 17.0% (95% CI: 14.8%-19.1%) among people with headache. In the episodic types of headache, the proportion of acute headache medication overuse was higher in the subgroup of people with high frequency episodic migraine, 24.9% (95% CI: 18.8%-31.0%), while it was 10.8% (95% CI: 8.2%-13.5%), for the low frequency episodic migraine and 8.5% (95% CI: 5.5%-10.4%), for the episodic tension type headache. CONCLUSION The prevalence of medication overuse headache in the general population in Greece and its proportion among the people with headache belongs to the lower part of the range of the reported literature, while the 3.6:1 female to male ratio is in agreement with it. In the same line, the impact of absenteeism and presenteeism on the workplace renders the condition alarming socio-economic health problem demanding immediate health policy planning.
Collapse
Affiliation(s)
| | | | - Nikolaos Fakas
- Neurology Department, 401 Army General Hospital of Athens, Athens, Greece
| | - Jobst Rudolf
- Department of Neurology, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | | | - Dimos D Mitsikostas
- First Neurology Department, Aeginition Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
18
|
Abstract
Medication overuse headache (MOH) is a secondary headache disorder attributed to overuse of acute headache medications by a person with an underlying headache disorder, usually migraine or tension-type headache. MOH is common among individuals with 15 or more headache days per month. Although MOH is associated with substantial disability and reductions in quality of life, this condition is often under-recognized. As MOH is both preventable and treatable, it warrants greater attention and awareness. The diagnosis of MOH is based on the history and an unremarkable neurological examination, and is made according to the diagnostic criteria of the International Classification of Headache Disorders third edition (ICHD-3). Pathophysiological mechanisms of MOH include altered descending pain modulation, central sensitization and biobehavioural factors. Treatment of MOH includes the use of headache preventive therapies, but essential to success is eliminating the cause, by reducing the frequency of use of acute headache medication, and perhaps withdrawing the overused medication altogether. Appropriate treatment is usually highly effective, leading to reduced headache burden and acute medication consumption.
Collapse
|
19
|
Starling AJ, Cowan RP, Buse DC, Diener HC, Marmura MJ, Hirman J, Brevig T, Cady R. Eptinezumab improved patient-reported outcomes in patients with migraine and medication-overuse headache: Subgroup analysis of the randomized PROMISE-2 trial. Headache 2023; 63:264-274. [PMID: 36633219 DOI: 10.1111/head.14434] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the effect of eptinezumab on patient-reported outcomes in patients with chronic migraine (CM) and medication-overuse headache (MOH). BACKGROUND MOH is a secondary headache disorder commonly occurring in patients with CM and associated with functional and psychological impairments. Medication overuse and monthly headache and migraine days were reduced with eptinezumab compared with placebo as published previously; however, these outcomes do not fully capture the burden of migraine and treatment effect. METHODS PROMISE-2 was a phase 3, randomized, double-blind, placebo-controlled trial in adults with CM. Patients were randomized (1:1:1) to receive eptinezumab 100 mg, eptinezumab 300 mg, or placebo (up to 2 doses, 12 weeks apart). Patients completed the following patient-reported outcomes: 6-item Headache Impact Test (HIT-6), Patient Global Impression of Change (PGIC), patient-identified most bothersome symptom (PI-MBS), and 36-item Short-Form Health Survey (SF-36). RESULTS A total of 431 CM patients (139, 147, and 145 patients in the eptinezumab 100 mg, eptinezumab 300 mg, and placebo groups, respectively) had MOH diagnosed at screening (40.2% of the total PROMISE-2 population [n = 1072]). In CM with MOH patients, both doses of eptinezumab were associated with clinically meaningful improvements in mean HIT-6 total scores by week 4 and remained improved throughout the 24-week study. Responder rates for individual HIT-6 items were greater with eptinezumab than with placebo at all time points. At week 12, almost twice as many eptinezumab-treated patients indicated the PGIC was "much" or "very much" improved (58.5% [79/135, 100 mg] and 67.4% [95/147, 300 mg] vs. 35.8% [48/134, placebo]). Patients in the eptinezumab groups showed numerically greater improvements over placebo in the PI-MBS and SF-36 scores. CONCLUSIONS This subgroup analysis in patients with CM/MOH at baseline suggests that eptinezumab treatment is associated with early, sustained, and clinically meaningful improvements in patient-reported outcomes.
Collapse
Affiliation(s)
| | - Robert P Cowan
- Department of Neurology and Neurological Sciences, Stanford University Headache and Facial Pain Program, Palo Alto, California, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA.,Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Essen, Germany
| | - Michael J Marmura
- Jefferson Headache Center, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Joe Hirman
- Pacific Northwest Statistical Consulting, Inc., Woodinville, WA, USA
| | | | - Roger Cady
- Lundbeck LLC, Deerfield, Illinois, USA.,RK Consults, Ozark, Missouri, USA.,Missouri State University, Springfield, Missouri, USA
| |
Collapse
|
20
|
AlQuliti KW, Alhujeily RM. Medication-overuse headache: clinical profile and management strategies. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2023; 28:13-18. [PMID: 36617449 PMCID: PMC9987632 DOI: 10.17712/nsj.2023.1.20220115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Medication-overuse headache (MOH) is a disabling secondary headache disorder, with challenging consequences for affected patients and health care resources. It is defined as headache that occurs on ≥ 15 days per month in a patient known to have primary headache disorder due to regular overuse of acute or abortive headache medication for more than 3 months. MOH affects 1-2% of the world's population in their productive age. New advances in headache neurosciences and development of new treatment options specific for headache, along with an understanding of the clinical profile and pathophysiological mechanisms of MOH, can help improve patient outcomes and decrease the burden on the health care system. This work will review MOH, identify updated clinical assessments and recent management approaches.
Collapse
Affiliation(s)
- Khalid W AlQuliti
- Division of Neurology, Department of Medicine, College of Medicine, Taibah University, Madinah Al-Munawarah, Kingdom of Saudi Arabia
| | - Rakan M Alhujeily
- Division of Neurology, Department of Medicine, College of Medicine, Taibah University, Madinah Al-Munawarah, Kingdom of Saudi Arabia
| |
Collapse
|
21
|
Lyu S, Zhang CS, Sun J, Weng H, Xue CC, Guo X, Zhang AL. Chinese herbal medicine for migraine management: A hospital-based retrospective analysis of electronic medical records. Front Med (Lausanne) 2022; 9:936234. [PMID: 36438031 PMCID: PMC9684313 DOI: 10.3389/fmed.2022.936234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
Background Migraine is a chronic neurological disease causing significant socioeconomic burden and impaired quality of life. Chinese medicine is commonly used for migraine in China. Clinical trials have generated evidence of the effectiveness of Chinese medicine therapies for migraine. However, little is known about how to use these therapies to treat migraine in real-world clinical settings. Methods In this retrospective study, we analyzed data from the electronic medical records (EMRs) of 2,023 migraine patients who attended the Guangdong Provincial Hospital of Chinese Medicine (GPHCM) between July 2018 and July 2020. Results More than three-quarters (77.21%) of the patients were female. Most (78.20%) of the patients were aged between 18 and 50 years, 18.49% were aged above 50 years, and the remaining 3.31% were under 18 years. Sleep disorders were the most documented comorbidity occurring in 27.29% of patients, and more common in females (29.77%) than male (18.87%). Fatigue was the most frequently reported trigger of migraine attacks among all patients (9.39%), while menstruation was the most common trigger for female patients (10.24%). Less than a quarter of patients (21.01%) reported a history of taking analgesic medication for their migraine. The median treatment duration reported by the patients was 10 days. Chinese herbal medicine (CHM) was the predominant treatment for migraine at the hospital (88.48%), while pharmacotherapies were prescribed to 28.97% of the patients. CHM was prescribed more often as a sole treatment (53.58% of patients) than combined with pharmacotherapies (27.39% of patients). Among patients who reported improvements after taking CHM, the most frequently used herbs were fu ling and chuan xiong, the most frequent patented CHM product was tong tian oral solution, and the main herbal formulae were chuan xiong cha tiao san and yi qi cong ming tang. Conclusion CHM formulae, such as chuan xiong cha tiao san and yi qi cong ming tang, patented CHM product tong tian oral solution, and some herbs are potentially effective treatments for migraine. As such, CHM can be used as an alternative to conventional pharmacotherapies for migraine and is worth further evaluation in randomized controlled trials.
Collapse
Affiliation(s)
- Shaohua Lyu
- The China Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Claire Shuiqing Zhang
- The China Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Jingbo Sun
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Heng Weng
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Charlie Changli Xue
- The China Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinfeng Guo
- Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Xinfeng Guo,
| | - Anthony Lin Zhang
- The China Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
- Anthony Lin Zhang,
| |
Collapse
|
22
|
Cowan RP, Marmura MJ, Diener HC, Starling AJ, Schim J, Hirman J, Brevig T, Cady R. Quantity changes in acute headache medication use among patients with chronic migraine treated with eptinezumab: subanalysis of the PROMISE-2 study. J Headache Pain 2022; 23:115. [PMID: 36068494 PMCID: PMC9446734 DOI: 10.1186/s10194-022-01482-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients with chronic migraine (CM) treated with eptinezumab in the PROMISE-2 trial achieved greater reductions in migraine and headache frequency, impact, and acute headache medication (AHM) use than did patients who received placebo. This post hoc analysis examines relationships between headache frequency reductions and changes in AHM use in patients in PROMISE-2. Methods PROMISE-2 was a double-blind, placebo-controlled trial conducted in adults with CM. Patients were randomized to eptinezumab 100 mg, 300 mg, or placebo, administered intravenously once every 12 weeks for up to two doses. Patients recorded headache/AHM information daily and for each event in an electronic diary; data from all days with daily reports were included. Shifts in headache frequency and AHM use were assessed in the three populations: total CM population, patients with CM and medication-overuse headache (MOH), and patients with CM and MOH who were ≥ 50% responders during treatment (response over weeks 1–24). Results A total of 1072 adults with CM received treatment (eptinezumab, n = 706; placebo, n = 366). Mean baseline headache frequency was 20.5 days; mean baseline AHM days was 13.4; 431 patients had MOH, of which 225 (52.2%) experienced ≥50% response over weeks 1–24. Relative to baseline, the proportion of days with both headache and AHM use decreased 25.1% (eptinezumab) versus 17.0% (placebo) in the total population (N = 1072), 29.2% versus 18.4% in the MOH subpopulation (n = 431), and 38.3% versus 31.5% in the CM with MOH population with ≥50% response subgroup (n = 225) during weeks 1–24. The proportion of days with headache and triptan use decreased 9.1% (eptinezumab) versus 5.8% (placebo), 11.8% versus 7.2%, and 14.5% versus 12.6%, respectively. Reductions in other AHM types were smaller. Conclusions In this post hoc analysis, eptinezumab use in patients with CM was associated with greater decreases in days with headache with AHM overall and with triptans in particular. The magnitude of effect was greater in the subgroup of CM patients with MOH and ≥ 50% response. Trial registration ClinicalTrials.gov Identifier: NCT02974153. Graphical abstract Eptinezumab reduces headache frequency and acute medication use in patients with chronic migraine.![]()
Collapse
Affiliation(s)
| | | | - Hans-Christoph Diener
- Medical Faculty of the University Duisburg-Essen, Institute for Medical Informatics, Biometry and Epidemiology, Essen, Germany
| | | | - Jack Schim
- The Neurology Center of Southern California, Carlsbad, CA, USA
| | - Joe Hirman
- Pacific Northwest Statistical Consulting, Inc., Woodinville, WA, USA
| | | | - Roger Cady
- Lundbeck LLC, Deerfield, IL, USA. .,RK Consults, Ozark, MO, USA. .,Missouri State University, Springfield, MO, USA.
| |
Collapse
|
23
|
Therapies targeting CGRP signaling for medication overuse headache. Curr Opin Neurol 2022; 35:353-359. [PMID: 35674079 DOI: 10.1097/wco.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Medication overuse headache (MOH) affects more than 60 million individuals worldwide causing enormous personal and social burden. Only repurposed drugs are available for MOH that share limited evidence for efficacy. The preclinical data suggesting that activation of the calcitonin gene-related peptide (CGRP) pathway is involved in headache chronification along with clinical evidence that monoclonal antibodies targeting CGRP (anti-CGRP mAbs) have good efficacy in preventing chronic migraine, triggered this review that aims to summarize the current data on the effectiveness and safety of mAbs against CGRP in MOH. RECENT FINDINGS Post hoc analyses of phase-3 trials of erenumab, fremanezumab, galcanezumab, and eptinezumab for the prevention of chronic migraine revealed that patients with MOH benefit from the treatment over placebo. Several real-world studies confirm the efficacy of erenumab and galcanezumab in patients with MO. However, all published trials evaluated treatments in patients with chronic migraine with MO collectively, not in patients with MOH exclusively. SUMMARY The available data indicate that anti-CGRP mAbs represent a good mechanism-based and disease-specific therapeutical option with for MOH as long as detoxification and additional nonpharmaceutical interventions are operated. Future research should focus on long-term-controlled trials in MOH populations exclusively.
Collapse
|
24
|
Schwedt TJ, Robert T, Dodick DW. Treatment of chronic migraine with medication overuse: A perspective. Headache 2022; 62:642-644. [DOI: 10.1111/head.14314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Teri Robert
- Patient Advocate and Educator Washington West Virginia USA
| | - David W. Dodick
- Department of Neurology Mayo Clinic Phoenix Arizona USA
- Atria Institute New York New York USA
| |
Collapse
|
25
|
Gottschalk C, Basu A, Blumenfeld A, Torphy B, Marmura MJ, Pavlovic JM, Dumas PK, Lalvani N, Buse DC. The importance of an early onset of migraine preventive disease control: A roundtable discussion. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221134593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Newly approved migraine preventive therapies have allowed for rapid control of migraine activity, offering potential to minimize the burden of migraine. This report summarizes a roundtable discussion convened to analyze evidence for early onset of prevention, ascertain its clinical relevance, and provide guidance for healthcare professionals in crafting goals and treatment expectations for patients with migraine initiating preventive therapy. Methods: A virtual roundtable meeting of migraine clinicians, researchers, and patient advocates convened in October 2020. Participants reviewed and discussed data summarizing patient and healthcare professional perceptions of migraine prevention and evidence from the peer-reviewed and gray literature to develop corresponding recommendations. Summary: Evidence from clinical studies of anti-calcitonin gene-related peptide monoclonal antibodies (erenumab, fremanezumab, galcanezumab, and eptinezumab) and the chemodenervation agent onabotulinumtoxinA indicate that patients may experience reduction of migraine activity within 7 days of drug administration and early attainment of disease control is associated with improvements in clinically important outcomes. The roundtable of experts proposes that early onset be defined as demonstration of preventive benefits within 1 week of treatment initiation. We recommend focusing discussion with patients around “disease control” and potential benefits of early onset of prevention, so patients can set realistic preventive therapy goals and expectations.
Collapse
Affiliation(s)
| | - Anirban Basu
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Andrew Blumenfeld
- Headache Center of Southern California, The Neurology Center, Carlsbad, CA, USA
| | - Bradley Torphy
- Chicago Headache Center and Research Institute, Chicago, IL, USA
| | - Michael J Marmura
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jelena M Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Nim Lalvani
- American Migraine Foundation, Mount Royal, NJ, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
26
|
Koval'chuk NA, Shagbazian AE, Tabeeva GR. Abuse of medications for the treatment of migraines: results of an online survey. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.11.201146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background. The abuse of headache medications is an important factor in the formation of drug-induced headache.
Aim. To determine the prevalence and nature of drug use among patients with migraine and chronic cephalgic syndrome.
Materials and methods. An Internet survey was conducted among 1598 Internet users, as well as through social networks (Instagram, Facebook, VK) using Google Forms.
Results. 60% of respondents with chronic headache and migraine symptoms did not have a reliable diagnosis. More than 70% of patients choose a drug for pain relief on their own and 62.7% take the drug in every headache attack.
Conclusion. Among patients with chronic headaches and migraines, there is a high percentage of people abusing symptomatic drugs, which indicates a high risk of drug-induced headache formation.
Collapse
|
27
|
Shnayder NA, Sharavii VB, Petrova MM, Moskaleva PV, Pozhilenkova EA, Kaskaeva DS, Tutynina OV, Popova TE, Garganeeva NP, Nasyrova RF. Candidate Genes and Proteomic Biomarkers of Serum and Urine in Medication-Overuse Headache. Int J Mol Sci 2021; 22:9024. [PMID: 34445731 PMCID: PMC8396559 DOI: 10.3390/ijms22169024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023] Open
Abstract
Chronic headache is a topical problem of neurology, psychiatry and general practice. The medication-overuse headache (MOH) is one of the leading pathologies in the structure of chronic headache. However, early diagnosis of the MOH is challenging. We analyzed potential proteomic biomarkers of serum and urine in patients with MOH. METHODS We searched PubMed, Springer, Scopus, Web of Science, ClinicalKey, and Google Scholar databases for English publications over the past 10 years using keywords and their combinations. RESULTS We found and analyzed seven studies that met the search criteria for the purpose of the review, including 24 serum proteomic biomarkers and 25 urine proteomic biomarkers of MOH. Moreover, the candidate genes and locus of the studied serum (vitamin D-binding protein, lipocalin-type prostaglandin D2 synthase, apolipoprotein E, etc.) and urine proteomic biomarkers (uromodulin, alpha-1-microglobulin, zinc-alpha-2-glycoprotein, etc.) of MOH are presented in this review. CONCLUSIONS The serum and urine proteomic biomarkers of MOH can potentially help with the identification of patients with MOH development. Due to the relevance of the problem, the authors believe that further investigation of the MOH proteomic biomarkers in different ethnic and racial groups of patients with primary headache is necessary. In addition, it is important to investigate whether medications of different drug classes influence the levels of serum and urine proteomic biomarkers.
Collapse
Affiliation(s)
- Natalia A. Shnayder
- The Center of Personalized Psychiatry and Neurology, V. M. Bekhterev National Medical Research Center for Neurology and Psychiatry, 192019 Saint-Petersburg, Russia;
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Victoria B. Sharavii
- The International School Medicine of the Future, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Marina M. Petrova
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Polina V. Moskaleva
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Elena A. Pozhilenkova
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Darya S. Kaskaeva
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Olga. V. Tutynina
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Tatiana E. Popova
- The Yakutsk Scientific Center for Complex Medicine Problems, The Department of Epidemiology of Non-Infectious Diseases, 677018 Yakutsk, Russia;
| | - Natalia P. Garganeeva
- The Department of General Medical Practice and Polyclinic Therapy, The Siberian State Medical University, 634050 Tomsk, Russia;
| | - Regina F. Nasyrova
- The Center of Personalized Psychiatry and Neurology, V. M. Bekhterev National Medical Research Center for Neurology and Psychiatry, 192019 Saint-Petersburg, Russia;
| |
Collapse
|