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Fernández-Bravo-Rodrigo J, Cavero-Redondo I, Lucerón-Lucas-Torres M, Martínez-García I, Flor-García A, Barreda-Hernández D, Pascual-Morena C. Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis. Eur J Pharmacol 2024; 976:176702. [PMID: 38823758 DOI: 10.1016/j.ejphar.2024.176702] [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: 02/12/2024] [Revised: 05/04/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Migraine is a common and disabling primary headache disorder. Several drugs targeting calcitonin gene-related peptide (CGRP), such as erenumab (an anti-CGRP receptor mAb), have been developed recently. However, the real-world effects of erenumab are not well understood. OBJECTIVE To assess the clinical effectiveness and safety of erenumab for reducing migraine intensity and frequency in the real world. METHODS A systematic search of PubMed, Scopus, Web of Science and the Cochrane Library was conducted from inception to December 2023. Studies estimating the real-world effect of erenumab on monthly migraine days (MMD), monthly headache days (MHD), headache impact test (HIT-6), number of days in medication (NDM), acute monthly intake (AMI), pain intensity (PI) and safety outcomes were included. Meta-analyses of proportions or mean differences were performed. RESULTS Fifty-three studies were included. At 3-months, the effect was -7.18 days for MMD, -6.89 days for MHD, -6.97 for HIT-6, -6.22 days for NDM, -15.75 for AMI, and -1.71 for PI. Generally, the effect at 6- and 12-months increased slightly and gradually. The MMD/MHD response rates revealed that approximately one-third of patients exhibited a response greater than 30%, while one-sixth demonstrated a response exceeding 50%. Additionally, 3-4% of patients achieved a response rate of 100%. Adverse event rates were 0.34 and 0.43 at 6- and 12-months, respectively. CONCLUSION This study provides strong evidence of the effectiveness and safety of erenumab in the real world; to our knowledge, this is the first real-world meta-analysis specific to erenumab. Erenumab represents a solid therapeutic option for physicians.
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Affiliation(s)
- Jaime Fernández-Bravo-Rodrigo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, 16071, Spain; Pharmacy Service, Hospital Virgen de la Luz, 16002, Cuenca, Spain; Pharmacy Service. Hospital Virgen del Castillo, 30510, Yecla, Murcia, Spain.
| | - Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, 3460000, Chile.
| | | | - Irene Martínez-García
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, 16071, Spain.
| | | | | | - Carlos Pascual-Morena
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, 16071, Spain; Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, 02006, Spain.
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Triller P, Raffaelli B. [Anti-CGRP-based Migraine Medications: A Comprehensive Overview]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:277-282. [PMID: 38547904 DOI: 10.1055/a-2276-2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
In the early 1990s, the neuropeptide calcitonin gene-related peptide (CGRP) was identified as a key messenger in the pathophysiology of migraine and emerged as a treatment target, fundamentally transforming our approach to migraine therapy. While previous prophylactic drugs were non-specific and often caused intolerable side effects, the discovery of CGRP marked the advent of a new era in migraine treatment. The two main classes of CGRP-specific migraine treatments are monoclonal antibodies that bind to CGRP or the CGRP receptor, and CGRP receptor antagonists, the so-called gepants. Extensive clinical trials have conclusively demonstrated the safety, tolerability, and efficacy of monoclonal CGRP(-receptor) antibodies in the prophylactic treatment of both episodic and chronic migraine. The same positive results apply to the use of various gepants. They have proven to be not only an effective alternative to triptans in acute migraine therapy but also promising options for continuous use as prophylactic treatments. In this review, we aim to present the current state of research on CGRP-specific migraine therapy and insights in real-world data from the first years after their launch in clinical practice.
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Affiliation(s)
- Paul Triller
- Klinik für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bianca Raffaelli
- Klinik für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
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Zhao YJ, Ong JJY, Sonu SK, Dang J, Ng CC, Herr KJ, Bose R, Jion YI. A real-world prospective observational study of eptinezumab in Asian patients with migraine. Headache 2024; 64:810-824. [PMID: 38785386 DOI: 10.1111/head.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To evaluate the real-world effectiveness of eptinezumab for migraine prevention in Asian patients. BACKGROUND Eptinezumab is a monoclonal antibody that targets calcitonin gene-related peptide (CGRP), a potent vasodilator with an important role in migraine pathophysiology. Although there is robust clinical evidence from pivotal Phase 3 placebo-controlled trials of the efficacy of eptinezumab for migraine prevention, there are limited data on the real-world effectiveness of eptinezumab in Asian patient cohorts. METHODS This was a non-interventional, prospective, multisite cohort study of adults with migraine (International Classification of Headache Disorders, 3rd edition criteria) in Singapore who were prescribed eptinezumab (100 mg at baseline and Month 3, administered intravenously) and were followed until Month 6. The primary endpoint was change from baseline in monthly migraine days (MMDs) at Month 3 and Month 6. Secondary endpoints were ≥30% and ≥50% responder rates, and change from baseline in the Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), Migraine-Specific Quality of Life (MSQ), patient-identified most bothersome symptom (PI-MBS), acute medication use at Month 3 and Month 6, and safety. RESULTS Enrolled patients (completed = 29/30) had on average 3.4 (SD 2.9) previous preventive treatments; 29/30 of the patients had trialed at least one previous preventive treatment without benefit. Most had previously trialed oral preventives (87%, 26/30) and anti-CGRP (70%, 21/30). Relative to baseline, mean MMDs decreased by 4.3 days (95% CI 2.1-6.4; p < 0.001) at Month 3 and 4.9 days (95% CI 2.1-7.7; p < 0.001) at Month 6. At Month 3 and Month 6, 14/30 (47%) and 15/29 (52%) of the patients were ≥30% responders, and 6/30 (20%) and 8/29 (28%) patients were ≥50% responders, respectively. The number of patients with severe life impairment based on the HIT-6 score (total score 60-78) decreased from 24/30 (80%) at baseline to 19/30 (63%) at Month 3 and 19/29 (66%) at Month 6. The mean MIDAS score decreased by 24.6 points (95% CI 2.82-46.38; p = 0.028) at Month 6, and the mean MSQ score increased by 12.2 points (95% CI 5.18-19.20; p = 0.001) at Month 3 and 13.6 points (95% CI 4.58-22.66; p = 0.004) at Month 6. Most patients reported improvement in the PI-MBS at Month 3 (73%, 22/30) and Month 6 (55%, 16/29). Acute medication use for headache relief decreased by 3.3 days/month (95% CI 1.0-5.6; p = 0.007) at Month 3 and 4.7 days/month (95% CI 1.7-7.7; p = 0.003) at Month 6. Treatment-emergent adverse events (TEAEs) were reported in 16/30 (54%) patients, mostly mild/moderate in severity. No serious TEAEs led to treatment discontinuation. CONCLUSION Quarterly eptinezumab administration was effective and well-tolerated in Asian patients with chronic migraine.
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Affiliation(s)
- Yi Jing Zhao
- Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Jonathan Jia Yuan Ong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
- YLL School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sumit Kumar Sonu
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Jiaojiao Dang
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Chai Ching Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | | | - Rohini Bose
- Lundbeck Singapore Pte. Ltd., Singapore, Singapore
| | - Yasmin Idu Jion
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
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Hong JB, Israel-Willner H, Peikert A, Schanbacher P, Tozzi V, Köchling M, Reuter U, Raffaelli B. Therapeutic patterns and migraine disease burden in switchers of CGRP-targeted monoclonal antibodies - insights from the German NeuroTransData registry. J Headache Pain 2024; 25:90. [PMID: 38825722 PMCID: PMC11145812 DOI: 10.1186/s10194-024-01790-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway have shown good efficacy in migraine prophylaxis. However, a subset of patients does not respond to the first mAb treatment and switches among the available mAbs. The goal of this study is to characterize the switching pattern of migraine patients treated with anti-CGRP(-receptor, -R) mAbs, and to describe the headache burden of those who did not switch, switched once, and switched twice. METHODS This study used real world data from the NeuroTransData Cohort, a registry of migraine patients treated at outpatient neurology clinics across Germany. Patients who had received at least one anti-CGRP(-R) mAb were included. Headache diaries were collected at baseline and during treatment, along with quality of life measures every three months. Results were summarized for the subgroups of patients who did not switch and those with one and two switches. RESULTS Of the 655 eligible patients, 479 did not switch, 135 switched once, 35 twice, and 6 three or more times. The ≥ 50% response rates for monthly migraine days were 64.7%, 50.7%, and 25.0% for the no switch, one switch, and two switches groups in their last treatment cycles, respectively. Quality of life measures improved for the no switch and one switch groups, but not for the two switches group. CONCLUSION Patients who switched among anti-CGRP(-R) mAbs during the course of their treatment still benefited overall but to a lesser extent than those who did not switch. Treatment response in patients who switched twice was markedly lower compared to the no switch and one switch subgroup.
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Affiliation(s)
- Ja Bin Hong
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Heike Israel-Willner
- Neurological Specialist Center Berlin (NFZB), Berlin, Germany.
- NeuroTransData, Neuburg, Germany.
| | - Andreas Peikert
- Neurologicum Bremen, Bremen, Germany
- NeuroTransData, Neuburg, Germany
| | - Peter Schanbacher
- Rewoso AG, Zurich, Switzerland
- Hochschule Furtwangen (HFU), Furtwangen, Germany
| | | | - Monika Köchling
- NeuroTransData, Neuburg, Germany
- NeuroCentrum, Grevenbroich & Dormagen, Germany
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
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Scheffler A, Wenzel P, Bendig M, Gendolla A, Basten J, Kleinschnitz C, Nsaka M, Lindner D, Naegel S, Burow P, Fleischmann R, Holle D. Effectiveness and tolerability of eptinezumab in treating patients with migraine resistant to conventional preventive medications and CGRP (receptor) antibodies: a multicentre retrospective real-world analysis from Germany. J Headache Pain 2024; 25:79. [PMID: 38755541 PMCID: PMC11097519 DOI: 10.1186/s10194-024-01788-1] [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: 04/12/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Eptinezumab is a monoclonal antibody that targets calcitonin gene-related peptide (CGRP mAb) and is used for migraine prophylaxis. Efficacy data are mainly from clinical trials, real-world data are hardly available yet. Reimbursement policy in Germany leads to eptinezumab mainly being used in patients having failed pre-treatment with other CGRP mAb. To date, it is unclear whether eptinezumab is efficacious and well tolerated in this population and how the treatment response differs from patients who are naive to CGRP mAbs. METHODS We analysed clinical routine data of 79 patients (episodic migraine (EM): n = 19; chronic migraine (CM): n = 60) from four different centres in Germany. All patients were treated with eptinezumab (100mg). Differences in monthly headache (MHD), migraine (MMD) and acute medication days (AMD) after three months were analysed. The correlation of response with the number of CGRP mAb failures was evaluated. Significance level has been corrected (alpha = 0.017). RESULTS After three months MHD, MMD and AMD were significantly reduced. In EM, the median reduction for MHD was 4.0 days (IQR: -6.5 to -1.0; p = 0.001), for MMD 3.0 days (IQR: -5.5 to -1.5; p < 0.001) and for AMD 2.0 days (IQR: -5.0 to -0.5; p = 0.006). In CM, median reduction of MHD was 4 days (IQR: -8.0 to 0.0; p < 0.001), 3.0 days (IQR: -6.0 to-1.0; p < 0.001) for MMD and 1.0 day (IQR: -5.0 to 0.0; p < 0.001) for AMD. All patients were resistant to conventional preventive therapies and most to CGRP mAbs. Fourteen patients had never received a CGRP mAb and 65 patients had received at least one mAb without sufficient effectiveness and/or intolerability (one: n = 20, two: n = 28, three: n = 17). There was a significant association between the number of prior therapies and the 30% MHD responder rate (none: 78.6%, one: 45.0%, two: 32.1%, three: 23.5%, p = 0.010). Regarding tolerability, 10.4% (8/77) reported mild side effects. CONCLUSIONS The effectiveness of eptinezumab is significantly reduced in patients who have not previously responded to other CGRP mAbs. However, limitations such as the retrospective nature of the analysis, the small sample size and the short treatment period with only the lower dose of eptinezumab must be considered when interpreting the results.
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Affiliation(s)
- Armin Scheffler
- Department of Neurology and Centre for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Centre, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany.
| | - Pauline Wenzel
- Department of Neurology and Centre for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Centre, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Merle Bendig
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | | | - Jale Basten
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Centre for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Centre, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Michael Nsaka
- Department of Neurology and Centre for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Centre, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Diana Lindner
- Department of Neurology and Centre for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Centre, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Steffen Naegel
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
- Department of Neurology, Alfried-Krupp Krankenhaus, Essen, Germany
| | - Philipp Burow
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
| | | | - Dagny Holle
- Department of Neurology and Centre for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Centre, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
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Wells-Gatnik WD, Martelletti P. Switching CGRP(r) MoAbs in migraine: what evidence? Expert Opin Biol Ther 2024; 24:327-333. [PMID: 38726800 DOI: 10.1080/14712598.2024.2354386] [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: 01/31/2024] [Accepted: 05/08/2024] [Indexed: 05/15/2024]
Abstract
INTRODUCTION Approximately 50% of patients that receive a CGRP(r) MoAb for the preventative treatment of migraine are expected to discontinue therapy. For patients that discontinue CGRP(r) MoAb therapy, few clinical options are available. One potential option is to switch CGRP(r) MoAbs, however, data concerning the efficacy of this intervention is scarce. AREAS COVERED This manuscript aims to summarize all available data concerning the potential efficacy of switching CGRP(r) MoAbs following previous medication discontinuation. Data was sourced by completing a database search for the terms: 'CGRP monoclonal antibody switch OR CGRP monoclonal antibody switching.' EXPERT OPINION While data considering the potential efficacy of CGRP(r) switching continues to grow, our expert opinion supports the most recent European Headache Federation statement regarding CGRP(r) MoAb prescribing practices, concluding that there remains insufficient data to determine the efficacy of this intervention. As this topic is of significant clinical importance, we recommend a call-to-action to expand on current data considering the therapeutic options for patients that discontinue CGRP(r) MoAb therapy.
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Lipton RB. Preventive Treatment of Migraine. Continuum (Minneap Minn) 2024; 30:364-378. [PMID: 38568488 DOI: 10.1212/con.0000000000001418] [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: 04/05/2024]
Abstract
OBJECTIVE This article describes strategies for the preventive treatment of migraine including the emerging role of calcitonin gene-related peptide (CGRP)-targeted therapies and introduces novel paradigms for the preventive treatment of migraine. LATEST DEVELOPMENTS Multiple migraine medications targeting CGRP have been introduced since 2018, including injectable monoclonal antibodies (ie, eptinezumab, erenumab, fremanezumab, and galcanezumab) and oral small-molecule CGRP receptor antagonists (ie, ubrogepant, rimegepant, atogepant, and zavegepant). With the exceptions of ubrogepant and zavegepant, which are approved only as acute treatments, all of these agents have demonstrated efficacy in the preventive treatment of migraine; the monoclonal antibodies and atogepant have evidence of effectiveness in adults with either episodic or chronic migraine. The safety and tolerability profiles of CGRP-targeted therapies in migraine are favorable. ESSENTIAL POINTS The goals of preventive migraine therapy include reducing the frequency, severity, duration, and disability associated with attacks, reducing the need for acute treatment and the risk of medication overuse, enhancing self-efficacy and health-related quality of life, and reducing headache-related distress and interictal burden. Six drugs targeting CGRP (four monoclonal antibodies and two gepants) are now available for the preventive treatment of episodic migraine in adults. The efficacy of CGRP-targeted medications in the acute and preventive treatment of migraine, together with good safety and tolerability, has led to the emergence of new approaches to preventive treatment.
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Suzuki K, Suzuki S, Shiina T, Haruyama Y, Kobayashi S, Shioda M, Hirata K. Real-world effectiveness of erenumab in Japanese patients with migraine. Heliyon 2024; 10:e26568. [PMID: 38420497 PMCID: PMC10900787 DOI: 10.1016/j.heliyon.2024.e26568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/18/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
Background Real-world evidence of erenumab effectiveness in migraine patients in Asia with various comorbidities and multiple previous medication failures is still limited. Methods A 6-month single-center cohort study of 45 patients with episodic or chronic migraine (CM) treated with erenumab was conducted. In the cohort, 60.0% were switching from other calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs), and 66.7% had ≥4 prophylaxis failures. The change in monthly migraine days (MMDs) from baseline and percentages of responders after treatment were calculated. Weekly migraine days (WMDs) were obtained at baseline and at months 1, 2 and 3 and were compared between weeks 2 and 4. Results In total, 36%, 47%, and 63% of patients had a ≥30% response at 1, 3, and 6 months, respectively. The cumulative percentage of patients achieving a ≥30% response over 6 months was 85%. Early responders (average ≥ 30% response at 1-3 months) accounted for 37.8%, 55.6%, and 25.9% of the total, CGRP mAb-naïve, and CGRP mAb-switching groups, respectively. Late responders (average < 30% response at 1-3 months and average ≥ 30% response at 4-6 months) accounted for 46.4%, 37.5%, and 58.8% of nonearly responders in the total, CGRP mAb-naïve, and CGRP mAb-switching groups, respectively. Mild adverse reactions were observed in 5 patients (11.1%). Wearing-off, defined as an increase in the number of WMDs ≥2 between week 2 and week 4, was observed in 2.4-12.5% at months 1-3. Conclusion Erenumab was effective in migraine patients. At least 4-6 months may be preferable for efficacy evaluation in patients switching to erenumab from other CGRP mAbs.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Japan
| | - Shiho Suzuki
- Department of Neurology, Dokkyo Medical University, Japan
| | | | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University, Japan
| | - Saro Kobayashi
- Department of Neurology, Dokkyo Medical University, Japan
| | - Mukuto Shioda
- Department of Neurology, Dokkyo Medical University, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Japan
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Ray JC, Dalic L, Baker J, Cheng S, Hutton EJ, Matharu M. Twelve-month efficacy of CGRP monoclonal antibodies and predictive value of short-term response: results of an Australian multicentre study. BMJ Neurol Open 2024; 6:e000547. [PMID: 38268750 PMCID: PMC10806998 DOI: 10.1136/bmjno-2023-000547] [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: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Clinical trials show that calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are effective preventative treatments for chronic migraine. Their efficacy over longer time periods and in cohorts originally excluded from trials remains uncertain. This study aims to explore the impact of CGRP mAbs in an Australian real-life setting. Methods A multicentre cohort study was performed in the tertiary headache clinics of the Alfred and Austin Hospitals, Melbourne, Australia. Patients were commenced on a CGRP mAb for chronic migraine and asked to keep a headache diary, recorded at 3 monthly appointments for 12 months. Primary outcome was a ≥50% reduction in monthly headache days (MHD). Results From a population of 105 patients, 90 patients commenced galcanezumab and 15 commenced fremanezumab. The ≥50% responder rate of the cohort was 52.4% after 3 months. Over 12 months follow-up, 25.7% of the cohort ceased due to a lack of efficacy and 16.2% ceased due to an adverse event. There was no difference in response or cessation between medications. There was poor agreement in 3-month and 12-month response rates (Cohen's κ=0.130; p=0.171). On subgroup analysis, continuous headache at baseline and number of trialled preventative treatments were the only factors associated with efficacy. Conclusion CGRP mAbs were associated with sustained reductions in MHD over 12-month follow-up in patients with resistant migraine in Australia. Further studies are required to determine treatment options for patients with continuous headache. Poor agreement between outcomes at 3 and 12 months highlights the need to assess some patients at later timepoints.
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Affiliation(s)
- Jason Charles Ray
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Linda Dalic
- Department of Neurology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Josephine Baker
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Shuli Cheng
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Elspeth Jane Hutton
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Manjit Matharu
- University College London Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
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Suzuki S, Suzuki K, Shiina T, Kobayashi S, Shioda M, Hirata K. Switching from calcitonin gene-related peptide monoclonal antibody monthly to fremanezumab quarterly based on the patient's preferred dosing schedule. J Neurol Sci 2023; 455:122786. [PMID: 37993359 DOI: 10.1016/j.jns.2023.122786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Shiho Suzuki
- Department of Neurology, Dokkyo Medical University, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Japan.
| | | | - Saro Kobayashi
- Department of Neurology, Dokkyo Medical University, Japan
| | - Mukuto Shioda
- Department of Neurology, Dokkyo Medical University, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Japan
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Ihara K, Ohtani S, Watanabe N, Takahashi N, Miyazaki N, Takemura R, Hori S, Nakahara J, Takizawa T. Switching between anti-calcitonin gene-related peptide monoclonal antibodies: A comparison of monthly and quarterly dosing. J Neurol Sci 2023; 453:120811. [PMID: 37757639 DOI: 10.1016/j.jns.2023.120811] [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: 08/20/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Anti-calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs) have dramatically changed preventive treatment options for patients with migraine. Although there is emerging real-world evidence on the use of CGRPmAbs globally, the change in efficacy and safety after switching between CGRPmAbs owing to patients' frequency of hospital visits preference remains unknown. METHODS We conducted a single-centre, retrospective, real-world study of patients with migraine who first received galcanezumab for 3 or 4 months and then switched to fremanezumab at Keio University Hospital. We investigated changes in monthly migraine days (MMD), responder rate, and adverse effects such as injection site reactions. RESULTS MMD increased only by 0.7 (95% CI, -4.1-5.5; p = 0.748) after 4 months of treatment with fremanezumab (6.1, 95% CI, 2.3-9.9) compared to before switching (5.4, 95% CI, 2.2-8.6). Furthermore, switching from galcanezumab to fremanezumab produced only minor adverse events, such as injection site reactions. CONCLUSIONS After switching from galcanezumab to fremanezumab out of the desire to visit the hospital less often, the reduction in MMD compared to baseline was sustained, and no serious adverse effects were observed.
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Affiliation(s)
- Keiko Ihara
- Department of Neurology, Keio University School of Medicine, Japan
| | - Seiya Ohtani
- Department of Neurology, Keio University School of Medicine, Japan; Division of Drug Informatics, Keio University Faculty of Pharmacy, Japan
| | - Narumi Watanabe
- Department of Neurology, Keio University School of Medicine, Japan
| | | | - Naoki Miyazaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Japan
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Japan
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Japan.
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Hong JB, Lange KS, Overeem LH, Triller P, Raffaelli B, Reuter U. A Scoping Review and Meta-Analysis of Anti-CGRP Monoclonal Antibodies: Predicting Response. Pharmaceuticals (Basel) 2023; 16:934. [PMID: 37513846 PMCID: PMC10385131 DOI: 10.3390/ph16070934] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Calcitonin gene-related peptide-targeted monoclonal antibodies (CGRP mAbs) are increasingly being used as preventive treatments for migraine. Their effectiveness and safety were established through numerous randomized placebo-controlled trials and real-world studies, yet a significant proportion of patients do not respond to this treatment, and currently, there is a lack of accepted predictors of response to guide expectations, as data from studies so far are lacking and inconsistent. We searched Embase and MEDLINE databases for studies reporting on predictors of response to CGRP and/or CGRP-receptor (CGRP-R) mAbs, defined as a 30% or 50% reduction in monthly headache or migraine days at varying durations of follow-up. Quantitative synthesis was performed where applicable. We found 38 real-world studies that investigated the association between various predictors and response rates. Based on these studies, good response to triptans and unilateral pain with or without unilateral autonomic symptoms are predictors of a good response to CGRP(-R) mAbs. Conversely, obesity, interictal allodynia, the presence of daily headaches, a higher number of non-successful previous prophylactic medications, and psychiatric comorbidities including depression are predictive of a poor response to CGRP(-R) mAbs. Future studies should confirm these results and help to generate more tailored treatment strategies in patients with migraine.
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Affiliation(s)
- Ja Bin Hong
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Humboldt University and Free University Berlin, 10117 Berlin, Germany
| | - Kristin Sophie Lange
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Humboldt University and Free University Berlin, 10117 Berlin, Germany
| | - Lucas Hendrik Overeem
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Humboldt University and Free University Berlin, 10117 Berlin, Germany
- Doctoral Program, International Graduate Program Medical Neurosciences, Humboldt Graduate School, 10117 Berlin, Germany
| | - Paul Triller
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Humboldt University and Free University Berlin, 10117 Berlin, Germany
| | - Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Humboldt University and Free University Berlin, 10117 Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), 10117 Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Humboldt University and Free University Berlin, 10117 Berlin, Germany
- Universitätsmedizin Greifswald, 17475 Greifswald, Germany
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