Effect of calcitonin gene-related peptide (-receptor) antibodies in chronic cluster headache: Results from a retrospective case series support individual treatment attempts.
Cephalalgia 2020;
40:1574-1584. [PMID:
32806953 PMCID:
PMC7691634 DOI:
10.1177/0333102420949866]
[Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective
To assess the efficacy of monoclonal antibodies targeting calcitonin
gene-related peptide (CGRP) or its receptor in chronic cluster headache
(CCH) treatment under real world conditions.
Background
Calcitonin gene-related peptide has an important pathophysiological role in
cluster headache. Although the randomised controlled trial with the
calcitonin gene-related peptide antibody galcanezumab was negative, chronic
cluster headache patients with insufficient response to other preventive
treatments have been receiving individual off-label treatment attempts with
calcitonin gene-related peptide-(receptor) antibodies.
Methods
Data from 22 chronic cluster headache patients who received at least one dose
of a calcitonin gene-related peptide(-receptor) antibody and recorded attack
frequency in a headache diary were retrospectively collected at eight
headache centres.
Results
The number of previous preventive therapies was 6.5 ± 2.4 (mean ± standard
deviation, range: 2–11). The average number of attacks per week was
23.3 ± 16.4 at baseline and significantly decreased by −9.2 ± 9.7 in the
first month of treatment with a calcitonin gene-related peptide(-receptor)
antibody (p < 0.001). Fifty-five percent of the patients
were 50% responders and 36% were 75% responders with respect to attack
frequency. Significant reduction of attack frequency started at week 1
(−6.8 ± 2.8 attacks, p < 0.01). Results were
corroborated by significant decreases in weekly uses of acute headache
medication (−9.8 ± 7.6, p < 0.001) and pain intensity
during attacks (−1.2 ± 2.0, numerical rating scale (NRS) [0–10],
p < 0.01) in the first month. In months 2 (n = 14)
and 3 (n = 10), reduction of attack frequency from baseline was −8.0 ± 8.4
(p = 0.004) and −9.1 ± 10.0
(p = 0.024), respectively.
Conclusion
Under real-world conditions, individual treatment with calcitonin
gene-related peptide(-receptor) antibodies was effective in 55% of our
chronic cluster headache patients. This finding supports individual
off-label treatment attempts with calcitonin gene-related peptide-(receptor)
antibodies in chronic cluster headache patients insufficiently responding to
other therapies.
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