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Zhao C, Li C, Yu X, Dai X, Zou W. Effectiveness and safety of pharmacological prophylaxis for chronic migraine: a systematic review and network meta-analysis. J Neurol 2024:10.1007/s00415-024-12512-z. [PMID: 38910144 DOI: 10.1007/s00415-024-12512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Chronic migraine (CM) significantly impacts both the physical and mental health of patients. Current studies on the safety and effectiveness of different pharmacological prophylaxis interventions for CM are limited. To address this gap, we conducted a network meta-analysis (NMA) to compare and rank the efficacy and safety of various drugs in preventing CM. METHODS Two independent researchers systematically searched four databases from their inception to August 1, 2023, to identify eligible randomized controlled trials (RCTs). Subsequently, they performed data extraction and assessed the risk of bias. A NMA was then performed. Continuous outcomes and binary outcomes were displayed as weighted mean difference (WMD) and risk ratio (RR), respectively, and corresponding 95% confidence intervals (CI) were reported. The surface under the cumulative ranking curve (SUCRA) was used to rank each intervention separately. RESULTS 24 RCTs involving 8789 patients were included. Compared to placebo, Botulinum toxin A demonstrated the most significant effect in reducing the monthly migraine days for CM patients (MD = 3.88, 95% CI 0.48, 7.28); in terms of improving the response rate by a 50% reduction in monthly migraine days, Topiramate (RR = 50.06, 95% CI 3.18, 787.30) was the most effective; there was no statistically significant difference between all preventive drugs and placebo in improving the migraine disability assessment (MIDAS) score; in terms of the incidence of adverse events, Eptinezumab (RR = 1.09, 95% CI 0.8, 1.54) exhibited the highest safety profile. CONCLUSION Among all the drugs for the preventive drugs for CM, Botulinum toxin A has the best efficacy and safety profile, closely followed by calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs).
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Affiliation(s)
- Chengqi Zhao
- First School of Clinical Medicine, Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
| | - Changxin Li
- The Second Department of Rehabilitation, Heilongjiang Provincial Hospital of Traditional Chinese Medicine, Harbin, 150030, Heilongjiang, China
| | - Xueping Yu
- The Third Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China
| | - Xiaohong Dai
- The Third Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China
| | - Wei Zou
- The Third Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China.
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Varnado OJ, Vu M, Buysman EK, Kim G, Allenback G, Hoyt M, Trenz H, Cao F, Viktrup L. Treatment patterns of galcanezumab versus standard of care preventive migraine medications over 24 months: a US retrospective claims study. Curr Med Res Opin 2024; 40:635-646. [PMID: 38334320 DOI: 10.1080/03007995.2024.2316864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To describe long-term (24-month) treatment patterns of patients initiating galcanezumab versus standard of care (SOC) preventive migraine treatments including anticonvulsants, beta-blockers, antidepressants, and onabotulinumtoxinA using administrative claims data. METHODS This retrospective cohort study, which used Optum de-identified Market Clarity data, included adults with migraine with ≥1 claim for galcanezumab or SOC preventive migraine therapy (September 1, 2018 - March 31, 2020) and continuous database enrollment for 12 months before (baseline) and 24 months after (follow-up) the index date (date of first claim). Baseline patient demographics, clinical characteristics, and treatment patterns were analyzed after 24-month follow-up, including adherence (measured as the proportion of days covered [PDC]), persistence, discontinuation (≥60-day gap), restart, and treatment switch. Propensity score matching (1:1) was used to balance the galcanezumab and SOC cohorts. RESULTS The study included 2307 matched patient pairs with 24-month follow-up. The mean age across cohorts was 44.5 years (females: ∼87%). Patients in the galcanezumab versus SOC cohort demonstrated greater treatment adherence (PDC: 48% vs. 38%), with more patients considered adherent (PDC ≥80%: 26.6% vs. 20.7%) and persistent (322.1 vs. 236.4 d) (all p < .001). After 24-month follow-up, fewer galcanezumab-treated patients had discontinued compared with SOC-treated patients (80.1% vs. 84.7%; p < .001), of which 41.3% and 39.6% switched to a non-index medication, respectively. The most prevalent medication patients switched to in both cohorts was erenumab. Significantly greater proportions of patients who initiated galcanezumab versus SOC medications switched to fremanezumab (p < .001) and onabotulinumtoxinA (p = .016). CONCLUSION Patients who initiated galcanezumab for migraine prevention had higher treatment adherence and persistence compared with those who initiated SOC medications after 24-month follow-up.
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Affiliation(s)
| | - Michelle Vu
- Optum Life Sciences, HEOR, Eden Prairie, MN, USA
| | | | - Gilwan Kim
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Helen Trenz
- Optum Life Sciences, HEOR, Eden Prairie, MN, USA
| | - Feng Cao
- Optum Life Sciences, HEOR, Eden Prairie, MN, USA
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Pallapothu MR, Quintana Mariñez MG, Chakkera M, Ravi N, Ramaraju R, Vats A, Nair AR, Bandhu AK, Koirala D, Mohammed L. Long-Term Management of Migraine With OnabotulinumtoxinA (Botox) vs Calcitonin Gene-Related Peptide Antibodies (Anti-CGRP). Cureus 2023; 15:e46696. [PMID: 38021691 PMCID: PMC10630153 DOI: 10.7759/cureus.46696] [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: 09/06/2022] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
In this literature review, we will evaluate the effectiveness of OnabotulinumtoxinA (Botox) and anti-calcitonin gene-related peptide (anti-CGRP) in the treatment of migraine headaches. Both therapies are frequently prescribed for managing and preventing migraines and have received Food and Drug Administration (FDA) approval. The mechanism of action, side effects, compliance, cost-effectiveness, and migraine treatment provided by these two medicines were compared in the analysis of several studies. Many studies found that as Botox was administered by a doctor every three months and had fewer side effects than anti-CGRP, which is self-administered every month, it was more compliant than anti-CGRP. After examining the data, Botox is believed to be the most effective therapy. Although both therapies are efficient, this article compares them to determine which is the best management strategy.
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Affiliation(s)
- Manoj R Pallapothu
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Neurology, Pontiac General Hospital, Pontiac, USA
| | | | - Mohana Chakkera
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Niriksha Ravi
- Internal Medicine and Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rajita Ramaraju
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aastha Vats
- General Practice, Lady Hardinge Medical College, New Delhi, IND
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Athira R Nair
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Pontiac General Hospital, Pontiac, USA
| | - Atithi K Bandhu
- Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Divya Koirala
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Smith TR, Spierings ELH, Cady R, Hirman J, Schaeffler B, Shen V, Sperling B, Brevig T, Josiassen MK, Brunner E, Honeywell L, Mehta L. Safety and tolerability of eptinezumab in patients with migraine: a pooled analysis of 5 clinical trials. J Headache Pain 2021; 22:16. [PMID: 33781209 PMCID: PMC8008612 DOI: 10.1186/s10194-021-01227-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/12/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The humanized anti-CGRP monoclonal antibody eptinezumab has been evaluated in five large-scale clinical trials conducted in patients with migraine. This integrated analysis was conducted to evaluate the comprehensive safety and tolerability of eptinezumab in patients with migraine across these studies. METHODS Data were pooled from four randomized, double-blind, placebo-controlled studies and the first year of one open-label study. RESULTS The pooled population comprised 2867 adults with migraine: eptinezumab, n = 2076 (4797 infusions); placebo, n = 791 (1675 infusions). A total of 1137/2076 (54.8%) patients who received eptinezumab and 414/791 (52.3%) patients who received placebo experienced ≥1 treatment-emergent adverse event (TEAE); rates were similar across eptinezumab dose groups (10-1000 mg). For most patients with TEAEs, the events were mild or moderate in severity and considered unrelated to study drug by the investigators. Thirty infusion-site AEs occurred in 27/2076 (1.3%) patients who received eptinezumab and 7 in 7/791 (0.9%) patients who received placebo. Infusion-site AEs led to infusion interruption in 19/2076 (0.9%) and 5/791 (0.6%) patients in the eptinezumab and placebo groups, respectively. Nasopharyngitis occurred in ≥2% of patients in the eptinezumab 300-mg group and with an incidence of at least 2 percentage points greater than in the placebo group; however, in most patients (eptinezumab, 139/140; placebo 40/41), its occurrence was considered not related to study treatment. Adverse events coded to hypersensitivity occurred for 23/2076 (1.1%) patients treated with eptinezumab and no patients in the placebo group. If additional TEAE terms that could indicate hypersensitivity are considered (e.g., urticaria, flushing/hot flush, rash, and pruritus), hypersensitivity reactions in the two pivotal placebo-controlled phase 3 studies occurred in ≥2% of patients in the eptinezumab 100-mg and 300-mg groups, and the incidence was at least 2 percentage points greater in either of these groups than in the placebo group. Most hypersensitivity reactions were not serious and resolved with standard medical treatment or observation without treatment, usually within 1 day. CONCLUSIONS In adults with migraine, the intravenous administration of eptinezumab every 12 weeks demonstrated a favorable safety and tolerability profile. TRIAL REGISTRATION ClinicalTrials.gov (Identifiers: NCT01772524 , NCT02275117 , NCT02559895 , NCT02974153 , NCT02985398 ).
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Affiliation(s)
- Timothy R. Smith
- StudyMetrix Research, LLC, 3862 Mexico Road, St. Peters, MO 63303 USA
| | | | - Roger Cady
- Lundbeck La Jolla Research Center, San Diego, CA USA
| | - Joe Hirman
- Pacific Northwest Statistical Consulting, Inc., Woodinville, WA USA
| | | | | | - Bjørn Sperling
- grid.424580.f0000 0004 0476 7612H. Lundbeck A/S, Copenhagen, Denmark
| | - Thomas Brevig
- grid.424580.f0000 0004 0476 7612H. Lundbeck A/S, Copenhagen, Denmark
| | | | | | - Loan Honeywell
- grid.424580.f0000 0004 0476 7612H. Lundbeck A/S, Copenhagen, Denmark
| | - Lahar Mehta
- Lundbeck Seattle BioPharmaceuticals, Inc., Seattle, WA USA
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