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Muñoz-Vendrell A, Campoy S, Caronna E, Alpuente A, Torres-Ferrus M, Nieves Castellanos C, Olivier M, Campdelacreu J, Prat J, Camiña Muñiz J, Molina Martínez FJ, Mínguez-Olaondo A, Ruibal Salgado M, Santos Lasaosa S, Navarro Pérez MP, Morollón N, López Bravo A, Cano Sánchez LM, García-Sánchez SM, García-Ull J, Rubio-Flores L, Gonzalez-Martinez A, Quintas S, Echavarría Íñiguez A, Gil Luque S, Castro-Sánchez MV, Adell Ortega V, García Alhama J, Berrocal-Izquierdo N, Belvís R, Díaz-Insa S, Pozo-Rosich P, Huerta-Villanueva M. Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients. J Headache Pain 2023; 24:63. [PMID: 37268904 DOI: 10.1186/s10194-023-01585-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/24/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. METHODS In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. RESULTS A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). CONCLUSIONS Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice.
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Affiliation(s)
- Albert Muñoz-Vendrell
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain.
| | - Sergio Campoy
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
- Neurology Department, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marina Olivier
- Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari I Politécnic La Fe, Valencia, Spain
| | - Jaume Campdelacreu
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Joan Prat
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Javier Camiña Muñiz
- Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari Son Espases, Palma, Spain
- Consulta Monográfica de Cefaleas. Clínica Rotger Quirónsalud, Palma, Spain
| | | | - Ane Mínguez-Olaondo
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain
- Department of Medicine, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain
| | - Marta Ruibal Salgado
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain
| | - Sonia Santos Lasaosa
- Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain
| | - María Pilar Navarro Pérez
- Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain
| | - Noemí Morollón
- Unidad de Cefaleas Y Neuralgias. Servicio de Neurología. Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Alba López Bravo
- Unidad de Cefaleas. Sección de Neurología, Hospital Reina Sofía. Instituto de Investigación Sanitaria de Aragón (IIS-A), Tudela, Spain
| | - Luis Miguel Cano Sánchez
- Servicio de Neurología. Hospital Sant Joan Despí. Consorci Sanitari Integral, Sant Joan Despí, Spain
| | | | - Jésica García-Ull
- Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Laura Rubio-Flores
- Servicio de Neurología. Hospital Universitario General de Villalba, Madrid, Spain
| | - Alicia Gonzalez-Martinez
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa E Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Sonia Quintas
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa E Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | | | - Sendoa Gil Luque
- Servicio de Neurología. Hospital Universitario de Burgos, Burgos, Spain
| | | | - Vanesa Adell Ortega
- Servei de Neurologia. Consorci Sanitari de L'Alt Penedès-Garraf, Barcelona, Spain
| | | | | | - Robert Belvís
- Unidad de Cefaleas Y Neuralgias. Servicio de Neurología. Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Samuel Díaz-Insa
- Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari I Politécnic La Fe, Valencia, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mariano Huerta-Villanueva
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
- Neurology Department, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
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Reyes-Bueno JA, Mena-Vázquez N, Ojea-Ortega T, Gonzalez-Sotomayor MM, Cabezudo-Garcia P, Ciano-Petersen NL, Pons-Pons G, Castro-Sánchez MV, Serrano-Castro PJ. [Case fatality of COVID-19 in patients with neurodegenerative dementia]. Neurologia 2020; 35:639-645. [PMID: 38620303 PMCID: PMC7386259 DOI: 10.1016/j.nrl.2020.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/12/2020] [Accepted: 07/19/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction The elderly population is the group most threatened by COVID-19, with the highest mortality rates. This study aims to analyse the case fatality of COVID-19 in a cohort of patients with degenerative dementia. Methods We conducted a descriptive case-control study of a sample of patients diagnosed with primary neurodegenerative dementia. Results Twenty-four of the 88 patients with COVID-19 included in the study died: 10/23 (43.4%) patients diagnosed with dementia and 14/65 (21.5%) controls; this difference was statistically significant. Discussion Our results suggest that case fatality of COVID-19 is significantly higher among patients with primary degenerative dementia than in other patients with similar mean ages and comorbidities.
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Affiliation(s)
- J A Reyes-Bueno
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - N Mena-Vázquez
- Unidad de Gestión Clínica de Reumatología, Hospital Regional Universitario de Málaga, Málaga, España
| | - T Ojea-Ortega
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - M M Gonzalez-Sotomayor
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - P Cabezudo-Garcia
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - N L Ciano-Petersen
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - G Pons-Pons
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - M V Castro-Sánchez
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
| | - P J Serrano-Castro
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España
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Cabezudo-García P, Ciano-Petersen NL, Mena-Vázquez N, Pons-Pons G, Castro-Sánchez MV, Serrano-Castro PJ. Incidence and case fatality rate of COVID-19 in patients with active epilepsy. Neurology 2020; 95:e1417-e1425. [PMID: 32554773 DOI: 10.1212/wnl.0000000000010033] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/01/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This article estimates the incidence and fatality of coronavirus disease 2019 (COVID-19) and identifies potential risk factors for fatality in patients with active epilepsy. METHODS This is a cross-sectional observational study of patients with active epilepsy and COVID-19. A control group was used to compare the cumulative incidence and case-fatality rate (CFR). The main outcomes of the study were cumulative incidence, defined as number of patients with active epilepsy and COVID-19 admitted to an emergency department divided by the total number of patients with epilepsy at risk, and CFR based on the number of deaths during the enrollment period. Multiple logistic regression analysis was performed to investigate risk factors for fatality in patients with active epilepsy. RESULTS Of the 1,537 patients who fulfilled the inclusion criteria, 21 (1.3%) had active epilepsy. The cumulative incidence (95% confidence interval [CI]) of COVID-19 in patients with epilepsy was higher (1.2% [0.6-2.4]) compared to the population without epilepsy (0.5% [0.5-0.5]). In reverse transcription PCR-positive patients, there were no significant differences in CFR in patients with active epilepsy compared to patients without epilepsy (33.3% vs 8.3%; p = 0.266). Of the 21 patients with active epilepsy, 5 (23%) died. In multivariate analysis, the factor associated with fatality in patients with active epilepsy was hypertension (odds ratio [OR] 2.8 [95% CI 1.3-21.6]). In another model, age (OR 1.0 [95% CI 1.0-1.1]) and epilepsy (OR 5.1 [95% CI 1.3-24.0]) were associated with fatality during hospitalization. CONCLUSION COVID-19 cumulative incidence was higher in patients with active epilepsy. Epilepsy was associated with fatality during hospitalization. Hypertension was associated with fatality in patients with epilepsy.
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Affiliation(s)
- Pablo Cabezudo-García
- From Instituto de Investigación Biomédica de Málaga (IBIMA) (P.C.-G., N.L.C.-P., N.M.-V., G.P.-P., M.V.C.-S., P.J.S.-C.); and Servicio de Neurología, Unidad de Gestión Clínica de Neurociencias (P.C.-G., N.L.C.-P., G.P.-P., M.V.C.-S., P.J.S.-C.), and Unidad de Gestión Clínica de Reumatología (N.M.-V.), Hospital Regional Universitario de Málaga, Spain.
| | - Nicolás Lundahl Ciano-Petersen
- From Instituto de Investigación Biomédica de Málaga (IBIMA) (P.C.-G., N.L.C.-P., N.M.-V., G.P.-P., M.V.C.-S., P.J.S.-C.); and Servicio de Neurología, Unidad de Gestión Clínica de Neurociencias (P.C.-G., N.L.C.-P., G.P.-P., M.V.C.-S., P.J.S.-C.), and Unidad de Gestión Clínica de Reumatología (N.M.-V.), Hospital Regional Universitario de Málaga, Spain
| | - Natalia Mena-Vázquez
- From Instituto de Investigación Biomédica de Málaga (IBIMA) (P.C.-G., N.L.C.-P., N.M.-V., G.P.-P., M.V.C.-S., P.J.S.-C.); and Servicio de Neurología, Unidad de Gestión Clínica de Neurociencias (P.C.-G., N.L.C.-P., G.P.-P., M.V.C.-S., P.J.S.-C.), and Unidad de Gestión Clínica de Reumatología (N.M.-V.), Hospital Regional Universitario de Málaga, Spain
| | - Gracia Pons-Pons
- From Instituto de Investigación Biomédica de Málaga (IBIMA) (P.C.-G., N.L.C.-P., N.M.-V., G.P.-P., M.V.C.-S., P.J.S.-C.); and Servicio de Neurología, Unidad de Gestión Clínica de Neurociencias (P.C.-G., N.L.C.-P., G.P.-P., M.V.C.-S., P.J.S.-C.), and Unidad de Gestión Clínica de Reumatología (N.M.-V.), Hospital Regional Universitario de Málaga, Spain
| | - María Victoria Castro-Sánchez
- From Instituto de Investigación Biomédica de Málaga (IBIMA) (P.C.-G., N.L.C.-P., N.M.-V., G.P.-P., M.V.C.-S., P.J.S.-C.); and Servicio de Neurología, Unidad de Gestión Clínica de Neurociencias (P.C.-G., N.L.C.-P., G.P.-P., M.V.C.-S., P.J.S.-C.), and Unidad de Gestión Clínica de Reumatología (N.M.-V.), Hospital Regional Universitario de Málaga, Spain
| | - Pedro J Serrano-Castro
- From Instituto de Investigación Biomédica de Málaga (IBIMA) (P.C.-G., N.L.C.-P., N.M.-V., G.P.-P., M.V.C.-S., P.J.S.-C.); and Servicio de Neurología, Unidad de Gestión Clínica de Neurociencias (P.C.-G., N.L.C.-P., G.P.-P., M.V.C.-S., P.J.S.-C.), and Unidad de Gestión Clínica de Reumatología (N.M.-V.), Hospital Regional Universitario de Málaga, Spain
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