Efficacy and Safety of Erenumab, Galcanezumab, and Fremanezumab in the Treatment of Drug-Resistant Chronic Migraine: Experience in Real Clinical Practice

BACKGROUND

Due to the recent introduction of new biologic drugs for chronic migraine, a global evaluation in real clinical practice is necessary.

OBJECTIVE

The objective was to evaluate the effectiveness and safety in real clinical practice of drugs targeting the calcitonin gene-related peptide receptor (CGRPr) in patients with chronic migraine.

METHODS

Single-center, restrospective study (2019-2022), including patients with chronic migraine treated with erenumab, galcanezumab, or fremanezumab. Effectiveness variables were recorded, namely, number of migraine headache days per month (MHD), Migraine Disability Assessment Scale (MIDAS) score, and Headache Impact Test-6 (HIT-6) score, assessing changes at week 12, 24 from baseline. Toxicity was recorded following the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria.

RESULTS

In all, 104 patients were included (46.2% erenumab, 41.3% galcanezumab, 12.5% fremanezumab). A reduction in MHD, MIDAS, and HIT-6 was achieved at weeks 12 and 24 with erenumab (p75% at week 24 than those intensified; P = 0.041). There was no difference in efficacy (P = 0.154) or improvement in quality of life (P = 0.783, P = 0.150), but there was greater toxicity (P < 0.001) among nonresponders with erenumab 70 mg versus erenumab 140 mg.

CONCLUSIONS

The results confirm the effectiveness and safety of anticalcitonin gene-related peptide (CGRP) drugs in real clinical practice. However, the study shows little benefit from erenumab intensification, with similar effectiveness and worse tolerability than the standard dose.

Cardiovascular and other risk factors among people who live in slums in Buenos Aires, Argentina

OBJECTIVES

Effective planning of health policies requires the availability of accurate data, representing the burden of disease and risks to the diverse components of society. In Argentina, health information comes from the national risk factors survey (NRFS), which characterises the distribution of different risk factors. However, the NRFS has never collected information from residents living in slums, despite slums representing 10% of the population. The objective of this survey was to characterise the prevalence of cardiovascular and other risk factors among the inhabitants of one of the largest slums in Buenos Aires (Villa 31) and compare it to data from the NRFS.

STUDY DESIGN

This was a cross-sectional study.

METHODS

A cross-sectional study was carried out in 400 slum households, using the same data structure as the NRFS. The survey obtained information about economic aspects, reproductive health, addictions and risk factors. All participants had their blood pressure, weight and height measured. A total of 406 people were interviewed and their data were compared with data from 32,365 people in the NRFS. All comparisons were made on the basis of age group.

RESULTS

A fair/poor self-perceived level of health (odds ratio [OR] 3.19, 95% confidence interval [CI]: 2.60-3.91), anxiety and moderate to severe depression (OR 5.44, 95% CI: 4.43-6.69), problem drinking (OR 10.01, 95% CI 8.08-12.40), self-reported hypertension (OR 1.26, 95% CI: 1.01-1.57), overweight (OR 1.26, 95% CI: 1.03-1.55) and obesity (OR 1.72, 95% CI: 1.38-2.15) were significantly higher in the slum population. In people aged 18-24 years, the prevalence of diabetes was triple the national average (OR 3.17, 95% CI: 1.26-7.98). For all evaluated conditions in this study, the inhabitants of the slum received significantly less treatment compared with participants from the NRFS.

CONCLUSIONS

The prevalence of cardiovascular and other risk factors in the slum population has a different distribution to that reported in the NRFS. These data suggest the need to establish specific policies for slum populations.