Publicaciones científicas
Redefining migraine prevention: early treatment with anti-CGRP monoclonal antibodies enhances response in the real world
Edoardo Caronna 1 2 , Victor José Gallardo 2 , Gabriella Egeo 3 , Manuel Millán Vázquez 4 , Candela Nieves Castellanos 5 , Javier A Membrilla 6 7 , Gloria Vaghi 8 9 , Joana Rodríguez-Montolio 10 11 , Neus Fabregat Fabra 12 , Francisco Sánchez-Caballero 13 , Alex Jaimes Sánchez 14 , Albert Muñoz-Vendrell 15 , Renato Oliveira 16 , Gabriel Gárate 17 , Yésica González-Osorio 18 , Daniel Guisado-Alonso 19 , Raffaele Ornello 20 , Cem Thunstedt 21 , Iris Fernández-Lázaro 22 , Marta Torres-Ferrús 1 2 , Alicia Alpuente 1 2 , Paola Torelli 23 , Cinzia Aurilia 3 , Raquel Lamas Pére 4 , Maria José Ruiz Castrillo 6 , Roberto De Icco 8 9 , Grazia Sances 9 , Sarah Broadhurst 24 , Hui Ching Ong 24 , Andrea Gómez García 14 , Sergio Campoy 15 25 , Jordi Sanahuja 26 , Gonçalo Cabral 27 , Isabel Beltrán Blasco 28 , Marta Waliszewska-Prosół 29 , Liliana Pereira 30 , Almudena Layos-Romero 31 , Isabel Luzeiro 32 33 , Laura Dorado 34 , María Rocio Álvarez Escudero 35 , Arne May 36 , Alba López-Bravo 11 37 , Isabel Pavão Martins 38 , Christina Sundal 39 40 41 42 , Pablo Irimia 43 , Alberto Lozano Ros 44 , Ana Beatriz Gago-Veiga 22 , Fernando Velasco Juanes 45 , Ruth Ruscheweyh 21 , Simona Sacco 20 , Elisa Cuadrado-Godia 19 46 , David García-Azorín 18 , Julio Pascual 17 , Raquel Gil-Gouveia 16 47 , Mariano Huerta-Villanueva 15 25 , Jaime Rodriguez-Vico 14 , Javier Viguera Romero 13 , Victor Obach 12 , Sonia Santos-Lasaosa 10 11 , Mona Ghadiri-Sani 24 , Cristina Tassorelli 8 9 , Javier Díaz-de-Terán 6 7 , Samuel Díaz Insa 5 , Carmen González Oria 4 , Piero Barbanti 3 48 , Patricia Pozo-Rosich 49 2 ; EUREkA study group
Background: Anti-CGRP monoclonal antibodies (anti-CGRP MAbs) are approved and available treatments for migraine prevention. Patients do not respond alike and many countries have reimbursement policies, which hinder treatments to those who might respond. This study aimed to investigate clinical factors associated with good and excellent response to anti-CGRP MAbs at 6 months.
Methods: European multicentre, prospective, real-world study, including high-frequency episodic or chronic migraine (CM) patients treated since March 2018 with anti-CGRP MAbs. We defined good and excellent responses as ≥50% and ≥75% reduction in monthly headache days (MHD) at 6 months, respectively. Generalised mixed-effect regression models (GLMMs) were used to identify variables independently associated with treatment response.
Results: Of the 5818 included patients, 82.3% were females and the median age was 48.0 (40.0-55.0) years. At baseline, the median of MHD was 20.0 (14.0-28.0) days/months and 72.2% had a diagnosis of CM. At 6 months (n=4963), 56.5% (2804/4963) were good responders and 26.7% (1324/4963) were excellent responders. In the GLMM model, older age (1.08 (95% CI 1.02 to 1.15), p=0.016), the presence of unilateral pain (1.39 (95% CI 1.21 to 1.60), p<0.001), the absence of depression (0.840 (95% CI 0.731 to 0.966), p=0.014), less monthly migraine days (0.923 (95% CI 0.862 to 0.989), p=0.023) and lower Migraine Disability Assessment at baseline (0.874 (95% CI 0.819 to 0.932), p<0.001) were predictors of good response (AUC of 0.648 (95% CI 0.616 to 0.680)). These variables were also significant predictors of excellent response (AUC of 0.691 (95% CI 0.651 to 0.731)). Sex was not significant in the GLMM models.
Conclusions: This is the largest real-world study of migraine patients treated with anti-CGRP MAbs. It provides evidence that higher migraine frequency and greater disability at baseline reduce the likelihood of responding to anti-CGRP MAbs, informing physicians and policy-makers on the need for an earlier treatment in order to offer the best chance of treatment success.
CITA DEL ARTÍCULO J Neurol Neurosurg Psychiatry. 2024 May 22:jnnp-2023-333295.doi: 10.1136/jnnp-2023-333295
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