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Rodríguez-Montolio J, Navarro-Pérez MP, Almeida-Zurita M, Santos-Lasaosa S. Early Wearing-Off Effect of OnabotulinumtoxinA in Chronic Migraine: A Prospective Real-Life Study. J Clin Med 2023; 12:5360. [PMID: 37629402 PMCID: PMC10455650 DOI: 10.3390/jcm12165360] [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: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE Chronic migraine (CM) is a significant public health problem that affects 2.2% of the global population. Onabotulinumtoxin A (OnabotA) is a safe and effective prophylactic treatment for patients with CM. The standard injection interval for OnabotA is 12 weeks. Nevertheless, some patients experience a wearing-off effect (WOE) in the weeks preceding the next scheduled cycle. The objectives of this study are to determine the prevalence of early WOE, to analyze variables that could be clinical predictors and to specify which interval is the most appropriate to define the existence of this phenomenon. METHODS This is a prospective single-center study of consecutive adult patients with CM who, after failing previous prophylactic therapies, started OnabotA treatment following the PREEMPT protocol between June and December of 2021. RESULTS A total of 59 patients (93.2% female, age 44 ± 12 years) were included. A total of 37 patients (64.9%) fulfilled medication overuse criteria. Of the total patients, 40.6% reported WOE and this was more frequent after the first cycle (35.6%). Depression and anxiety disorder was a statistically significant clinical predictor of WOE (OR 3.4; CI 95% 1.22-10.84; p = 0.028). A better cut-off point to consider WOE seems to be at 10 weeks. CONCLUSIONS Early WOE is common in patients on OnabotA treatment for CM. Individualizing the standard 12-week injection, using total doses of 195 U, and managing psychiatric comorbidities with pharmacological and non-pharmacological strategies may improve treatment outcomes and reduce OnabotA WOE.
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Affiliation(s)
- Joana Rodríguez-Montolio
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain (S.S.-L.)
- Aragon Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
| | - María Pilar Navarro-Pérez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain (S.S.-L.)
- Aragon Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
| | | | - Sonia Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain (S.S.-L.)
- Aragon Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
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Overeem LH, Ornello R, Pocora MM, Reuter U, Sacco S, Tassorelli C, Dueland AN, Raffaelli B, Martinelli D. A Retrospective Real-Life Multicenter Study on Concurrent Oral Preventive Treatments in Patients with Chronic Migraine Treated with OnabotulinumtoxinA. CNS Drugs 2023; 37:453-465. [PMID: 37212943 DOI: 10.1007/s40263-023-01001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND OBJECTIVE OnabotulinumtoxinA (BoNTA) is a relatively safe and effective treatment for chronic migraine. The local mode of action of BoNTA favors the combination of oral treatments with systemic action. However, little is known about the possible interactions with other preventive treatments. The objective of the study was to describe the use of oral preventive treatments in patients with chronic migraine treated with BoNTA in routine clinical care and discuss the tolerability and efficacy according to the presence or absence of concomitant oral treatments. METHODS In this multicenter, observational, retrospective, cohort study, we collected data from patients with chronic migraine receiving prophylactic treatment with BoNTA. Patients were eligible if aged ≥18 years, diagnosed with chronic migraine according to the International Classification of Headache Disorders, Third Edition criteria, and treated with BoNTA according to the PREEMPT paradigm. We documented the proportion of patients with at least one concomitant treatment prescribed specifically for migraine (CT+M) and their side effects during four BoNTA treatment cycles. Additionally, we collected monthly headache days and monthly acute medication days from the patients' headache diaries. Patients with CT+M were compared to those without concomitant treatment (CT-) using a nonparametric approach. RESULTS Our cohort included 181 patients taking BoNTA, of whom 77 (42.5%) received a CT+M. The most frequently prescribed concomitant treatments were antidepressants and antihypertensive drugs. Side effects in the CT+M group occurred in 14 patients (18.2%). Only in three of them (3.9%), the side effects had a significant interference with the patient's functioning (all in topiramate 200-mg/day users). Both CT+M and CT- groups had a significant reduction in monthly headache days of respectively - 6 (95% confidence interval - 9, - 3; p < 0.001; w = 0.200) during cycle 4 compared with baseline versus - 9 (95% confidence interval - 13, -6; p < 0.001; w = 0.469). However, the reduction in monthly headache days was significantly smaller in patients with CT+M after the fourth treatment cycle compared with patients with CT- (p = 0.004). CONCLUSIONS Prescription of oral concomitant preventive treatment is common in patients with chronic migraine receiving BoNTA. We did not identify any unexpected safety or tolerability issues in patients receiving BoNTA and a CT+M. However, patients with a CT+M experienced a smaller reduction in monthly headache days when compared with those with CT-, which might be associated with a higher resistance to treatment in that subgroup of patients.
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Affiliation(s)
- Lucas Hendrik Overeem
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- International Graduate Program Medical Neurosciences, Humboldt Graduate School, Berlin, Germany.
| | - Raffaele Ornello
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Magdalena Pocora
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Rehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Uwe Reuter
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Rehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Aud Nome Dueland
- Sandvika Nevrosenter, Sandvika, Norway
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Bianca Raffaelli
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Daniele Martinelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Rehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
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Corbelli I, Verzina A, Leone De Magistris I, De Vanna G, Eusebi P, Mataluni G, Pisani A, Prudenzano AMP, Trojano M, Delussi M, De Tommaso M, Russo A, Silvestro M, Tedeschi G, Calabresi P, Sarchielli P. Sustained Efficacy, Safety and High Adherence Rate of Onabotulinum Toxin Type A in Chronic Migraine Patients: A Multicentric Prospective Real-Life Study. Toxins (Basel) 2022; 15:toxins15010034. [PMID: 36668854 PMCID: PMC9863104 DOI: 10.3390/toxins15010034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Guidelines regarding long-term use with onabotulinumtoxinA (onaBT-A) in chronic migraine (CM) prophylaxis are lacking. This multicentric prospective real-life study aimed to assess the efficacy and safety of a long-term treatment. A total of 195 chronic migraine patients were treated with onaBT-A, every 3 months for 5 cycles (Phase 1). In the Phase 2 of the study, depending on response rate, patients were divided into "responders" (R), "partially responders" (PR) and "non-responders" (NR). Then, we proposed to R and PR patients to continue with an additional 12 months of treatment (additional 4 sessions). Response to treatment and adverse events were collected for the entire duration of the study. Of the 195 patients included (females 82.1%, mean age 47.4 ± 12.4), at the end of Phase 1 there were 52.3% of R patients, 17.9% of PR patients, 15.4% of NR patients and 14.4% drop-outs. During Phase 2 of treatment, R patients presented a maintenance of the improvement achieved during the first year of treatment, as well as PR patients. Except for three serious adverse events not related to treatment, all other adverse events were mild or moderate in severity and resolved without sequelae. In the literature, adherence to oral migraine-preventive medications among patients with CM was found to be less than 25%. The results of this prospective real-life multicenter study show efficacy, safety and adherence to a long-term treatment with onaBT-A.
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Affiliation(s)
- Ilenia Corbelli
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
- Correspondence: ; Tel.: +39-075-578-4228; Fax: +39-075-578-4229
| | - Angela Verzina
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Ilaria Leone De Magistris
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Gioacchino De Vanna
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Paolo Eusebi
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Giorgia Mataluni
- Neurology Unit, Department of Systems Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Antonio Pisani
- Neurology Unit, Department of Systems Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Addolorata Maria Pia Prudenzano
- Headache Center, Neurological Clinic “L. Amaducci”, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, 70121 Bari, Italy
| | - Maria Trojano
- Headache Center, Neurological Clinic “L. Amaducci”, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, 70121 Bari, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain (ANP) Unit, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Marina De Tommaso
- Applied Neurophysiology and Pain (ANP) Unit, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Paolo Calabresi
- The Institute of Neurology, Agostino Gemelli University Policlinic IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Paola Sarchielli
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
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Onan D, Bentivegna E, Martelletti P. OnabotulinumtoxinA Treatment in Chronic Migraine: Investigation of Its Effects on Disability, Headache and Neck Pain Intensity. Toxins (Basel) 2022; 15:29. [PMID: 36668849 PMCID: PMC9862733 DOI: 10.3390/toxins15010029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Neck disability and pain are frequently encountered problems in patients with chronic migraine (CM). The long-term stimuli of neurons in the trigeminocervical junction may explain this situation. OnabotulinumtoxinA (ONA) treatment is one of the proven treatments for CM; however, there is no study data on the efficacy of ONA treatment on neck disability and pain in CM patients. Therefore, we aimed to investigate the effect of ONA treatment on disability, neck pain and headache intensity in CM patients. One hundred thirty-four patients who met the inclusion criteria were included in the study. ONA treatment was administered at a dose of 195 U to 39 sites in total as per Follow-the-Pain PREEMPT protocol. The disability was evaluated with the Neck Disability Index and the Migraine Disability Assessment; pain intensity was evaluated with the Visual Analogue Scale; the monthly number of headache days were recorded; quality of life was evaluated with the Headache Impact Test. All assessments were recorded at baseline and 3 months after treatment. After the treatment, neck−migraine disabilities decreased from severe to mild for neck and moderate for migraine (p < 0.001). Neck pain and headache intensities decreased by almost half (p < 0.001). The median number of monthly headache days decreased from 20 days to 6 days (p < 0.000). The quality-of-life level decreased significantly from severe to substantial level (p < 0.001). According to our results, ONA treatment was effective in reducing neck-related problems in CM patients. Long-term follow-up results may provide researchers with more comprehensive results in terms of the treatment of chronic migraine−neck-related problems.
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Affiliation(s)
- Dilara Onan
- Spine Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06230, Türkiye
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
| | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
- Regional Referral Headache Centre, Sant’Andrea Hospital, 000189 Rome, Italy
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Ornello R, Ahmed F, Negro A, Miscio AM, Santoro A, Alpuente A, Russo A, Silvestro M, Cevoli S, Brunelli N, Vernieri F, Grazzi L, Baraldi C, Guerzoni S, Andreou AP, Lambru G, Kamm K, Ruscheweyh R, Russo M, Torelli P, Filatova E, Latysheva N, Gryglas-Dworak A, Straburzyński M, Butera C, Colombo B, Filippi M, Pozo-Rosich P, Martelletti P, Sacco S. Is There a Gender Difference in the Response to onabotulinumtoxinA in Chronic Migraine? Insights from a Real-Life European Multicenter Study on 2879 Patients. Pain Ther 2021; 10:1605-1618. [PMID: 34564833 PMCID: PMC8586325 DOI: 10.1007/s40122-021-00328-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/13/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Migraine is mostly a female disorder because of its lower prevalence in men. Less than 20% of patients included in the available studies on migraine treatments are men; hence, the evidence on migraine treatments might not apply to men. The aims of the present study were to provide reliable information on the effectiveness of onabotulinumtoxinA (BT-A) for chronic migraine in men and to compare clinical benefits between men and women. METHODS We performed a pooled patient-level gender-specific analysis of real-life data on BT-A for chronic migraine of patients followed-up to 9 months. We reported the 50% responder rates during each BT-A cycle, defined as percentage of reduction in monthly headache days (MHDs) compared to baseline, along with 75% and 30% responder rates. We also reported the mean decrease in MHDs and in days of acute medication use (DAMs) during each BT-A cycle as compared to baseline. We also evaluated the reasons for stopping the treatment within the third cycle. RESULTS We included an overall cohort of 2879 patients, 522 of whom (18.1%) were men. In men, 50% responder rates were 27.7% during the first BT-A cycle, 29.2% during the second, and 35.6% during the third cycle; in women, the corresponding rates were 26.6%, 33.5%, and 41.0%. In the overall cohort, responder rates did not differ between men and women during the first two cycles; during the third cycle, the distribution was different (P < 0.001) mostly because of higher rates of treatment stopping and non-responders in men. In the propensity score matched cohort, the trend was maintained but lost its statistical significance. Both men and women had a significant decrease in MHDs and in DAMs with BT-A treatment (P < 0.001). There were no gender differences in those changes with the only exception of MHD decrease which, during the third cycle, was lower in men than in women (7.4 vs 8.2 days, P = 0.016 in the overall cohort and 9.1 vs 12.5 days, P = 0.009 in the propensity score matched cohort). At the end of follow-up, 152 men and 485 women stopped BT-A treatment (29.1% vs 20.6%; P < 0.001). The relative proportion of patients stopping treatment because of inadequate response (less than 30% decrease in MHDs from baseline) was higher in men than in women (42.8% vs 39.6%), while the proportion of patients stopping because of adverse events was higher in women than in men (5.6% vs 0%; P = 0.031). CONCLUSIONS Our pooled analysis suggests that the response to BT-A is significant in both men and women with a small gender difference in favor of women. Men tended to stop the treatment more frequently than women. We emphasize the need for more gender-specific data on migraine treatments from randomized controlled trials and observational studies.
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Affiliation(s)
- Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio 1 Coppito, 67100 L’Aquila, Italy
| | - Fayyaz Ahmed
- Department of Neurosciences, Hull University Teaching Hospitals, Hull, UK
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, RM Italy
| | - Anna Maria Miscio
- Unit of Neurology, Headache Center, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, FG Italy
| | - Antonio Santoro
- Unit of Neurology, Headache Center, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, FG Italy
| | - Alicia Alpuente
- Headache Unit, Department of Neurology, Vall d’Hebron University, Barcelona, Spain ,Headache and Neurological Pain Research Group, Department of Medicine, Vall d’Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marcello Silvestro
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle scienze Neurologiche di Bologna, Bologna, Italy
| | - Nicoletta Brunelli
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Licia Grazzi
- Neuroology Department, Headache Center, IRCCS Foundation “Carlo Besta” Neurological Institute, via Celoria,11, 20133 Milan, Italy
| | - Carlo Baraldi
- Department of Biomedical, Metabolic and Neural Sciences, Medical Toxicology-Headache and Drug Abuse Research Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Guerzoni
- Department of Biomedical, Metabolic and Neural Sciences, Medical Toxicology-Headache and Drug Abuse Research Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna P. Andreou
- Headache Service, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Giorgio Lambru
- Headache Service, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Katharina Kamm
- Department of Neurology, Ludwig Maximilians University München, Munich, Germany
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University München, Munich, Germany
| | - Marco Russo
- Neurology Unit, Neuromotor and Rehabilitation Department, Headache Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Elena Filatova
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nina Latysheva
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Marcin Straburzyński
- Headache Clinic, Terapia Neurologiczna Samodzielni, Maurycego Mochnackiego 10, 02-042 Warsaw, Poland
| | - Calogera Butera
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy ,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy ,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patricia Pozo-Rosich
- Headache Unit, Department of Neurology, Vall d’Hebron University, Barcelona, Spain ,Headache and Neurological Pain Research Group, Department of Medicine, Vall d’Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, RM Italy
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy.
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Wilderman I, Tallarigo D, Pugacheva-Zingerman O. A Qualitative Study to Explore Patient Perspectives of Prophylactic Treatment with OnabotulinumtoxinA for Chronic Migraine. Pain Ther 2021; 10:1523-1536. [PMID: 34523107 PMCID: PMC8586057 DOI: 10.1007/s40122-021-00316-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION OnabotulinumtoxinA (OBT-A) is one of the most studied prophylactic treatments for chronic migraine. Large clinical trials, and now real-world studies, continue to provide evidence to support the use of OBT-A as an effective treatment to manage chronic migraine. The objective of this study was to explore patient experience and perception of prophylactic treatment with OBT-A for chronic migraine. METHODS Data were collected using semi-structured interviews using open-ended questions to uncover rich descriptive data on patient experiences. Interviews were transcribed and analysed using NVivo data analysis software to code and identify themes across the dataset. Three patient groups were included in the analysis: (1) patients who were receiving continued OBT-A treatment; (2) patients who discontinued OBT-A treatment; (3) patients who were recommended for OBT-A treatment but did not proceed. RESULTS For patients who received at least one OBT-A treatment, four main themes emerged, which described patients' expectations, experiences, and feelings towards their treatment decisions. Two main themes emerged that were common to patients, who had discontinued their treatment and those, who were recommended for OBT-A treatment but did not proceed, which were identified as potential barriers to initiate or continue prophylactic treatment with OBT-A. CONCLUSION Understanding patients' perspective is an important part of clinical practice and may impact on decision-making. Qualitative data can provide a more holistic view of patient care and treatment insights that may not be evaluated during a clinical trial. This study revealed potential barriers to treatment that can inform future policy and practice.
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OnabotulinumtoxinA Improves Quality of Life in Chronic Migraine: The PREDICT Study. Can J Neurol Sci 2021; 49:540-552. [PMID: 34218836 DOI: 10.1017/cjn.2021.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The PREDICT study assessed real-world, long-term health-related quality of life in adults with chronic migraine (CM) receiving onabotulinumtoxinA. METHODS Canadian, multicenter, prospective, observational study in adults naïve to onabotulinumtoxinA for CM. OnabotulinumtoxinA (155-195 U) was administered every 12 weeks over 2 years (≤7 treatment cycles). Primary endpoint: mean change in Migraine-Specific Quality of Life Questionnaire (MSQ) at treatment 4 (Tx4) versus baseline. Secondary endpoints: mean change in MSQ at final visit versus baseline, and headache days. RESULTS 184 participants (average age 45 years; 84.8% female; 94.6% Caucasian) received ≥1 onabotulinumtoxinA treatment; 150 participants completed 4 treatments (1 year) and 123 completed all 7 treatment cycles (2 years). Mean (SD) onabotulinumtoxinA dose per treatment cycle was 171 (18) U and treatment interval was 13.2 (1.8) weeks. Baseline mean (SD) 20.9 (6.7) headache days/month decreased (Tx1: -3.5 [6.3]; Tx4: -6.5 [6.6]; p < 0.0001 versus baseline). Mean (SD) increased from baseline in MSQ at Tx4 (restrictive: 21.5 [24.3], preventive: 19.5 [24.7], emotional: 22.9 [32.9]) and the final visit (restrictive: 21.3 [23.0], preventive: 19.2 [23.7], emotional: 27.4 [30.7]), exceeding minimal important differences (all p < 0.0001). Seventy-seven (41.8%) participants reported 168 treatment-emergent adverse events (TEAEs); 38 TEAEs (12.0%) were considered treatment-related. Four (2.2%) participants reported six serious TEAEs; none were considered treatment-related. No new safety signals were identified. CONCLUSIONS Real-world evidence from PREDICT demonstrates that onabotulinumtoxinA for CM in Canada improved MSQ scores and reduced headache frequency and severity, adding to the body of evidence on the long-term safety and effectiveness of onabotulinumtoxinA for CM.
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OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy. J Clin Med 2021; 10:jcm10132898. [PMID: 34209849 PMCID: PMC8269087 DOI: 10.3390/jcm10132898] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
The efficacy of onabotulinumtoxinA (OnaB-A) as a preventative treatment for chronic migraine, emerging fortuitously from clinical observation is now supported by class one evidence and over two decades of real-world clinical data. There is still limited ability to predict a clinically meaningful response to OnaB-A for individual patients, however. This review summarises briefly the proposed mechanism of OnaB-A in chronic migraine, the literature of predictors of clinical response, and recent developments in the field.
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Kollewe K, Gaul C, Gendolla A, Sommer K. Real-life use of onabotulinumtoxinA reduces healthcare resource utilization in individuals with chronic migraine: the REPOSE study. J Headache Pain 2021; 22:50. [PMID: 34078259 PMCID: PMC8173963 DOI: 10.1186/s10194-021-01260-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/14/2021] [Indexed: 01/14/2023] Open
Abstract
Background Chronic migraine (CM) is associated with substantial economic burden. Real-world data suggests that onabotulinumtoxinA treatment for CM reduces healthcare resource utilisation (HRU) and related costs. Methods REPOSE was a 2-year prospective, multicentre, non-interventional, observational study to describe the real-world use of onabotulinumtoxinA in adult patients with CM. This analysis examined the impact of onabotulinumtoxinA on HRU. Patients received onabotulinumtoxinA treatment approximately every 12 weeks according to their physicians’ discretion, guided by the summary of product characteristics (SPC) and PREEMPT injection paradigm. HRU outcome measures were collected at baseline and all administration visits and included headache-related hospitalizations and healthcare professional (HCP) visits. Health economic data, including family doctor and specialist visits, inpatient treatment for headache, acupuncture, technical diagnostics, use of nonpharmacologic remedies, and work productivity were also collected for patients enrolled at German study centres. Results Overall, 641 patients were enrolled at 78 study centres across 7 countries (Germany, UK, Italy, Spain, Norway, Sweden, and Russia), 633 received ≥1 onabotulinumtoxinA dose, and 128 completed the 2-year study. Patients were, on average, aged 45 years, 85% were female, and 60% (n = 377) were from Germany. At the end of the 2-year observation period, significantly fewer patients reported headache-related hospitalizations (p < 0.02) and HCP visits (p < 0.001) within the past 3 months than in the 3 months before baseline. In the German population, reductions were observed across all health services at all follow-up visits compared with baseline. The percentage of patients who saw a family doctor decreased from 41.7% at baseline to 13.5% at administration visit 8 and visits to a medical specialist decreased from 61.7% to 5.2% of patients. Inpatient acute treatment and technical diagnostics declined from 6.4% and 19.7% of patients at baseline to 0.0% and 1.0% at administration 8, respectively. The use of nonpharmacologic remedies and medication for the acute treatment of migraine also decreased with continued onabotulinumtoxinA treatment. Work incapacity, disability, absenteeism, and impaired performance at school/work improved with onabotulinumtoxinA treatment for CM over the 2-year observation period. Conclusions Real-world evidence from REPOSE demonstrates that onabotulinumtoxinA treatment is associated with decreased HRU and supports the long-term benefits associated with the use of onabotulinumtoxinA for CM in clinical practice. Trial registration NCT01686581. Name of registry: ClinicalTrials.gov. URL of registry: Date of retrospective registration: September 18, 2012. Date of enrolment of first patient: July 23, 2012. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01260-4.
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Affiliation(s)
- Katja Kollewe
- Medical School Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Charly Gaul
- Migraine and Headache Clinic, Königstein, Germany
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10
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Affatato O, Moulin TC, Pisanu C, Babasieva VS, Russo M, Aydinlar EI, Torelli P, Chubarev VN, Tarasov VV, Schiöth HB, Mwinyi J. High efficacy of onabotulinumtoxinA treatment in patients with comorbid migraine and depression: a meta-analysis. J Transl Med 2021; 19:133. [PMID: 33789668 PMCID: PMC8011097 DOI: 10.1186/s12967-021-02801-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/19/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Migraine and depression are highly prevalent and partly overlapping disorders that cause strong limitations in daily life. Patients tend to respond poorly to the therapies available for these diseases. OnabotulinumtoxinA has been proven to be an effective treatment for both migraine and depression. While many studies have addressed the effect of onabotulinumtoxinA in migraine or depression separately, a growing body of evidence suggests beneficial effects also for patients comorbid with migraine and depression. The current meta-analysis systematically investigates to what extent onabotulinumtoxinA is efficient in migraineurs with depression. METHODS A systematic literature search was performed based on PubMed, Scopus and Web of Science from the earliest date till October [Formula: see text], 2020. Mean, standard deviation (SD) and sample size have been used to evaluate improvement in depressive symptoms and migraine using random-effects empirical Bayes model. RESULTS Our search retrieved 259 studies, eight of which met the inclusion criteria. OnabotulinumtoxinA injections administered to patients with both chronic migraine and major depressive disorder led to mean reduction of [Formula: see text] points (CI [[Formula: see text]], [Formula: see text]) in the BDI scale, of [Formula: see text] points (CI [[Formula: see text]], [Formula: see text]) in the BDI-II scale and of [Formula: see text] points (CI [[Formula: see text]], [Formula: see text]) in the PHQ-9 scale, when evaluating depressive symptoms. In the case of the migraine-related symptoms, we found mean reductions of [Formula: see text] (CI [[Formula: see text]], [Formula: see text]) points in the HIT6 scale, [Formula: see text] (CI [[Formula: see text]], [Formula: see text]) in the MIDAS scale, [Formula: see text] (CI [[Formula: see text]], [Formula: see text]) points in the VAS scale and of [Formula: see text] (CI [[Formula: see text]], [Formula: see text]) migraine episodes per month. Comorbid patients showed slightly better improvements in BDI, HIT6 scores and migraine frequency compared to monomorbid patients. The latter group manifested better results in MIDAS and VAS scores. CONCLUSION Treatment with onabotulinumtoxinA leads to a significant reduction of disease severity of both chronic migraine and major depressive disorder in patients comorbid with both diseases. Comparative analyses suggest an equivalent strong effect in monomorbid and comorbid patients, with beneficial effects specifically seen for certain migraine features.
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Affiliation(s)
- Oreste Affatato
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden.
| | - Thiago C Moulin
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden
| | - Claudia Pisanu
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden.,Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Victoria S Babasieva
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden.,Department of Pharmacology, Institute of Pharmacy, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marco Russo
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Elif I Aydinlar
- Department of Neurology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Paola Torelli
- Headache Centre, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vladimir N Chubarev
- Department of Pharmacology, Institute of Pharmacy, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vadim V Tarasov
- Department of Pharmacology, Institute of Pharmacy, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.,Institute for Translational Medicine and Biothechnology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Helgi B Schiöth
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden.,Institute for Translational Medicine and Biothechnology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jessica Mwinyi
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden
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11
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Ferguson LP, Abdukalikov R, Shbeeb D, Gray TK. Shot in the dark: three patients successfully treated with onabotulinumtoxin A injections for relief of post-traumatic chronic headaches and dystonia induced by gunshot wounds. BMJ Case Rep 2020; 13:13/12/e236433. [PMID: 33370967 PMCID: PMC7757440 DOI: 10.1136/bcr-2020-236433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Three patients ranging from 49 to 61 years-old presented to our pain clinic after failing multiple treatment attempts for debilitating, chronic post-traumatic headaches, neck pain and involuntary muscle spasm following gunshot wounds to the head, neck and face. Concurrent cervical dystonia was noted in each patient on presentation. All patients were treated with onabotulinumtoxin A (ONA) injections in the head and neck. Each patient reported between 70% and 100% improvement of their headache pain, neck pain and spasm with a significant reduction in the frequency, duration and intensity of their headaches. This level of improvement has been successfully maintained in all three patients with regular ONA injections at 90-day intervals. Two patients experienced a single relapse in symptoms when scheduling conflicts caused them to miss their regularly scheduled ONA injections by several weeks. These symptoms resolved when their ONA injections resumed, suggesting that ONA is the causative agent alleviating their symptoms.
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Affiliation(s)
- Lauren Palitz Ferguson
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA,Family Medicine, National Capital Consortium, Fort Belvoir, Virginia, USA
| | | | - David Shbeeb
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA,Anesthesiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Terence K Gray
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA,Interventional Pain Management, Maine Comprehensive Pain Management, PC, Scarborough, Maine, USA
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12
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Sastre Real M, Díaz de Terán J. OnabotulinumtoxinA Is an Effective Treatment for Chronic Migraine in Patients With Comorbid Fibromyalgia. Front Neurol 2020; 11:575130. [PMID: 33178117 PMCID: PMC7593548 DOI: 10.3389/fneur.2020.575130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Fibromyalgia (FM) is a frequent comorbidity in patients with chronic migraine (CM). PREEMPT trials, which demonstrated the efficacy of OnabotulinumtoxinA (OnabotA) on CM, excluded patients with FM. Our aim was to evaluate the effectiveness of OnabotA in a series of patients with CM and FM. Methods: We analyzed patients with a previous diagnosis of CM and FM who had received sessions of OnabotA quarterly between January 2014 and January 2020 in a specialized Headache Clinic. Primary endpoint was the reduction in moderate to severe headache days at 3, 6, 9, and 12 months. Results: Data were collected from 31 patients with CM and FM that received OnabotA (100% females). Mean age at first procedure was 50.2 ± 11.3 years. Depression (93.5%), other central sensitization syndromes (irritable bowel syndrome, interstitial cystitis, multiple chemical sensitivity, endometriosis, and chronic fatigue syndrome) (48.4%), and medication overuse headache (90.3%) were frequent comorbidities. 48.4% of patients had failed ≥3 preventives previously. The percentage of patients who achieved ≥30 and ≥50% moderate-severe headache reduction on the third month was 65.4 and 48.2%, respectively. Twenty-three patients completed four cycles of treatment, with 13.4 fewer headache days per month than at baseline (p < 0.001). By 1 year, 69.5% had ≥50% reduction of headache frequency and 39.1% had a ≥75% reduction. In 4 cases (21%), OnabotA was interrupted due to a lack of response. Only mild adverse effects were recorded. Conclusion: OnabotA is an effective treatment for CM in patients with FM.
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Affiliation(s)
- María Sastre Real
- Department of Neurology, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Javier Díaz de Terán
- Department of Neurology, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,CranioSPain Research Group, La Salle Higher Center for University Studies, Physiotherapy Department, Autonomous University of Madrid, Madrid, Spain
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13
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Sacco S, Russo A, Geppetti P, Grazzi L, Negro A, Tassorelli C, Tedeschi G, Martelletti P. What is changing in chronic migraine treatment? An algorithm for onabotulinumtoxinA treatment by the Italian chronic migraine group. Expert Rev Neurother 2020; 20:1275-1286. [PMID: 32990477 DOI: 10.1080/14737175.2020.1825077] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION OnabotulinumtoxinA (OBT-A) and monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway are two of the few treatments that ameliorate chronic migraine (CM) in randomized controlled trials and real-life studies. Separate clinical practice guidelines have been developed for the management of CM with OBT-A or CGRP-targeting mAbs. AREAS COVERED Considering the concomitant availability of OBT-A and CGRP-targeting mAbs as therapeutic treatment options, Italian migraine experts reviewed the evidence supporting the efficacy of OBT-A and CGRP-targeting mAbs in CM in order to rationalize the management of CM patients treated with OBT-A. Experts addressed everyday practice needs to shape the optimal pharmacological management by balancing adherence to regulatory indications, ethical considerations, and clinical expertise. Considering the remarkable challenge of improving the health and quality of life of patients with CM, even partial improvements may be clinically meaningful, particularly for those who are resistant or intolerant to oral migraine treatments. EXPERT OPINION In this collaborative effort, we propose a treatment algorithm that integrates the relevant aspects of managing patients with CM to provide ready-to-use practical guidance regarding the appropriate use of OBT-A.
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Affiliation(s)
- Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila, Italy
| | - Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Pierangelo Geppetti
- Department of Health Sciences, Section of Clinical Pharmacology, Headache Center Careggi University Hospital, University of Florence , Florence, Italy
| | - Licia Grazzi
- Neuroalgology Unit, Headache Center, Neurological Institute "C. Besta" IRCCS Foundation , Milan, Italy
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University , Rome, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation , Pavia, PV, Italy.,Department of Brain and Behavioral Sciences, University of Pavia , Pavia, PV, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University , Rome, Italy
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14
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Quintas S, García-Azorín D, Heredia P, Talavera B, Gago-Veiga AB, Guerrero ÁL. Wearing Off Response to OnabotulinumtoxinA in Chronic Migraine: Analysis in a Series of 193 Patients. PAIN MEDICINE 2020; 20:1815-1821. [PMID: 30657951 DOI: 10.1093/pm/pny282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Long-term real-life studies have supported a cumulative effect of OnabotulinumtoxinA (OnabotA) for the prophylactic treatment of chronic migraine (CM) during consecutive cycles, and individual adaptations have been described to improve clinical response. METHODS This was a cohort longitudinal retrospective study of consecutive adult patients from the Headache Unit of the Hospital Clínico Universitario de Valladolid and the Hospital Universitario de La Princesa (Madrid) on OnabotA treatment for chronic migraine from May 2012 to December 2017. All patients were followed for 24 weeks. Full-length response to OnabotA was defined as ≥50% reduction in headache days for at least 12 weeks, and wearing off response was defined as a clinical response but with duration shorter than 10 weeks. We have analyzed the incidence and clinical predictors of this wearing off response. RESULTS A total of 193 patients were included, of whom 91 (47.1%) were considered full-length responders and 45 (23.3%) wearing off responders. No statistically significant clinical predictors (including demographic variables and baseline headache characteristics) of full-length response or wearing off response were detected in our study. An increase in dose during the second treatment cycle was attempted in 68.9% of the wearing off patients, achieving a longer duration of response of up to 12 weeks in 74.2%. CONCLUSIONS Wearing off response to OnabotA during the first treatment cycle is not uncommon in patients with CM. Increasing the dose in subsequent cycles could improve clinical response, but further multicenter long-term studies are needed to establish predictors and solutions to this problem.
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Affiliation(s)
- Sonia Quintas
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Patricia Heredia
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Blanca Talavera
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ángel L Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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15
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Iron Deposits in Periaqueductal Gray Matter Are Associated with Poor Response to OnabotulinumtoxinA in Chronic Migraine. Toxins (Basel) 2020; 12:toxins12080479. [PMID: 32731573 PMCID: PMC7472356 DOI: 10.3390/toxins12080479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 01/03/2023] Open
Abstract
Previous studies have reported increased brain deposits of iron in patients with chronic migraine (CM). This study aims to determine the relation between iron deposits and outcome after treatment with OnabotulinumtoxinA (OnabotA). Demographic and clinical data were collected for this study through a prospective cohort study including 62 CM patients treated with OnabotA in the Hospital Clínico Universitario de Santiago de Compostela (Spain). Demographic and clinical variables were registered. Selected biomarkers in plasma during interictal periods (calcitonin gene-related peptide (CGRP) and pentraxin-3 (PTX3)) and neuroimaging changes (iron deposits in the red nucleus (RN), substantia nigra (SN), globus pallidus (GP), and periaqueductal gray matter (PAG), and white matter lesions (WML)) were determined. Subjects were classified in responders (≥50% reduction in headache days) or non-responders (<50%). Responders to treatment were younger (mean age difference = 12.2; 95% confidence interval (CI): 5.4–18.9, p = 0.001), showed higher serum levels of CGRP (≥50 ng/mL) and PTX3 (≥1000 pg/mL) and smaller iron deposits in the GP and PAG (mean difference = 805.0; 95% CI: 37.9–1572.1 μL, p = 0.040 and mean difference = 69.8; 95% CI: 31.0–108.6 μL, p = 0.008; respectively). Differences in PAG iron deposits remained significant after adjusting for age (mean difference = 65.7; 95% CI: 22.8–108.6 μL, p = 0.003) and were associated with poor response to OnabotA after adjustment for clinical and biochemical variables (odds ratio (OR) = 0.963; 95% CI: 0.927–0.997, p = 0.041). We conclude that larger PAG iron deposits are associated with poor response to OnabotA in CM.
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16
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Alpuente A, Gallardo VJ, Torres-Ferrús M, Santos-Lasaosa S, Guerrero AL, Laínez JM, Viguera J, Gago-Veiga A, Irimia P, Sánchez Del Rio M, Pozo-Rosich P. Evaluation of the concomitant use of oral preventive treatments and onabotulinumtoxinA in chronic migraine: the PREVENBOX study. Eur J Neurol 2020; 27:2102-2108. [PMID: 32421912 DOI: 10.1111/ene.14331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/07/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE OnabotulinumtoxinA is an effective preventive treatment for chronic migraine (CM). In CM, in addition to a reduction in headache frequency, a decreased reliance on oral prophylactics is also indicative of treatment effectiveness. This study aimed to quantify the change in the use of oral prophylactics after treatment with onabotulinumtoxinA in patients with CM. METHODS This was a retrospective, multicentric, cross-sectional study. Patients with CM (International Classification of Headache Disorders-3beta) that had been treated with onabotulinumtoxinA were enrolled consecutively. We collected parameters related to each patient's pre-treatment situation, as well as their current situation, focusing on frequency and intensity of migraine, number of oral prophylactics and the respective cycle of onabotulinumtoxinA. Univariate and logistic regression analyses were performed. RESULTS We included 542 patients, 90.0% of whom were taking oral preventive treatments. During treatment with onabotulinumtoxinA, 47.8% withdrew at least one prophylactic and 41.6% stopped using oral prophylactics altogether. Factors associated with a reduction or cessation of oral prophylactics were >50% improvement in frequency and intensity, remission to episodic migraine, use of topiramate as an initial treatment, increased number of infiltrations and shorter chronification period (P < 0.05). The multivariate analysis showed that a chronification period <20 months, more than five cycles of onabotulinumtoxinA, >50% improvement in pain intensity and topiramate as an initial treatment were predictors of a reduction in oral prophylactics (area under the curve, 70.3%; P < 0.001). CONCLUSIONS Our study demonstrated the efficacy and safety of onabotulinumtoxinA. This treatment reduced the use of oral prophylactics. Withdrawal of oral prophylactics was most likely to occur after five cycles of treatment.
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Affiliation(s)
- A Alpuente
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona.,Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona
| | - V J Gallardo
- Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona
| | - M Torres-Ferrús
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona.,Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona
| | - S Santos-Lasaosa
- Headache Unit, Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza
| | - A L Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid
| | - J M Laínez
- Department of Neurology, Hospital Clínico Universitario, Universidad Católica de Valencia, Valencia
| | - J Viguera
- Headache Unit, Neuroscience Department, Hospital Universitario Virgen Macarena, Sevilla
| | - A Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid
| | - P Irimia
- Neurology Department, Clínica Universidad de Navarra, Pamplona
| | | | - P Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona.,Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona
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17
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Ornello R, Guerzoni S, Baraldi C, Evangelista L, Frattale I, Marini C, Tiseo C, Pistoia F, Sacco S. Sustained response to onabotulinumtoxin A in patients with chronic migraine: real-life data. J Headache Pain 2020; 21:40. [PMID: 32334534 PMCID: PMC7183653 DOI: 10.1186/s10194-020-01113-6] [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] [Received: 03/18/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023] Open
Abstract
Background Treatment with onabotulinumtoxin A (BT-A) is safe and effective for chronic migraine (CM). Several studies assessed possible predictors of response to treatment with BT-A, but there is little knowledge on the frequency and predictors of sustained response. The aim of this study was to evaluate sustained response to BT-A in patients with CM. Main body In this prospective open-label study, 115 patients with CM and treated with BT-A were consecutively enrolled in two Italian headache centers and followed up for 15 months. Anytime responders were defined as those patients who achieved a ≥ 50% reduction in headache days during any three-month treatment cycle compared with the 3 months prior to initiation of BT-A treatment. Sustained responders were defined as those who achieved a ≥ 50% reduction in headache days within the third treatment cycle and maintained response until the end of follow-up. Non-responders were defined as those patients who never achieved a ≥ 50% reduction in headache days during the follow-up. Headache characteristics prior to BT-A treatment were assessed in order to evaluate their ability in predicting treatment response. The 115 enrolled patients (84.3% female; median age 50 years) had a median migraine duration of 30 years (interquartile range 22–38). At the end of follow-up, 66 patients (57.4%) were classified as anytime responders. Among the 51 patients who achieved a clinical response within the third month of treatment, 33 (64.7%) were sustained responders. Patients with sustained response had a lower CM duration (median 31 vs 65 months; P = 0.030) and a lower number of headache days (median 25 vs 30; P = 0.013) at baseline compared with non-responders. Conclusions About two thirds of patients who gain ≥50% response to BT-A within the third cycle of treatment maintain this positive response over time. More recent onset of CM and more headache-free days at baseline are associated with sustained response. We suggest not to delay preventive treatment of CM with BT-A, in order to increase the likelihood to achieve sustained clinical response.
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Affiliation(s)
- Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Simona Guerzoni
- Medical Toxicology Unit-Headache and Drug Abuse Research Center, Department of Biomedical, Metabolical and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Baraldi
- Medical Toxicology Unit-Headache and Drug Abuse Research Center, Department of Biomedical, Metabolical and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luana Evangelista
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ilaria Frattale
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Carmine Marini
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Cindy Tiseo
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pistoia
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
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Alpuente A, Gallardo VJ, Torres-Ferrús M, Álvarez-Sabin J, Pozo-Rosich P. Short and Mid-Term Predictors of Response to OnabotulinumtoxinA: Real-Life Experience Observational Study. Headache 2020; 60:677-685. [PMID: 32086801 DOI: 10.1111/head.13765] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify clinical predictors of excellent response to OnabotulinumtoxinA in patients with chronic migraine (CM) at 6 and 12 months of follow-up. BACKGROUND Clinical predictors of response to OnabotulinumtoxinA are scarce and have not been clearly reproduced and analyzed in detail. So far, predictors of response to OnabotulinumtoxinA assess response in general or good response, but not an excellent response. METHODS Cohort study of patients attended in a specialized Headache Clinic in treatment with OnabotulinumtoxinA were classified according to their improvement in frequency: no-response (<25%) and excellent response (≥75%). A comparative analysis was carried out at 6 and 12 months identifying clinical predictors of excellent response to OnabotulinumtoxinA at each timepoint. RESULTS Data were collected from 221 patients. After 6 and also 12 months, we observed a statistically significant mean reduction in frequency and analgesic intake. At month 6, independent variables associated with excellent response (OR[95%CI]) were daily headache frequency (0.32[0.14-0.74]; P = .005), medication overuse (MO) (2.28[1.19-4.37]; P = .013), and a higher ratio of migraine days/month (MDM) (1.20[1.10-1.45]; P = .018) at baseline. At month 12, independent predictors of excellent response were patients with less than 30 years of migraine evolution (0.43[0.23-0.82]; P = .011), presence of anxiety (0.44[0.23-0.85]; P = .018), and aura (0.48[0.25-0.92]; P = .037). Excellent responders showed a higher improvement rate in pain intensity at 6 and 12 months. CONCLUSIONS Patients with daily frequency and MO show a clinical improvement in short-term. Patients with comorbidities who start treatment earlier in the course of the disease need a longer duration of treatment. The profile of response to treatment with OnabotulinumtoxinA determines its minimum treatment duration and the timepoint of a meaningful response.
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Affiliation(s)
- Alicia Alpuente
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor José Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrús
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Álvarez-Sabin
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Yuan H, Silberstein SD. The Use of Botulinum Toxin in the Management of Headache Disorders. Handb Exp Pharmacol 2020; 263:227-249. [PMID: 32562057 DOI: 10.1007/164_2020_365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tremendous progress has been made in the past decades for the treatment of headache disorders. Chronic migraine is the most disabling type of headache and requires the use of acute and preventive medications, many of which are associated with adverse events that limit patient adherence. Botulinum toxin (BoNT) serotype A, a neurotoxin derived from certain strains of Clostridium, disrupts neuropeptide secretion and receptor translocation related to trigeminal nociception, thereby preventing pain sensitization through peripheral and possibly central mechanisms. Ever since the first randomized controlled trial on onabotulinumtoxinA (onabotA) for migraine was published two decades ago, onabotA has been the only BoNT formulation approved for use in the prevention of chronic migraine. Superior tolerability and efficacy have been demonstrated on multiple migraine endpoints in many controlled trials and real-life studies. OnabotA is a safe and efficacious treatment for chronic migraine and possibly high-frequency episodic migraine. Further research is still needed to understand its mechanism of action to fully develop its therapeutic potential.
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Affiliation(s)
- Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
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20
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Ruscheweyh R, Förderreuther S, Gaul C, Gendolla A, Holle-Lee D, Jürgens T, Neeb L, Straube A. [Treatment of chronic migraine with botulinum neurotoxin A : Expert recommendations of the German Migraine and Headache Society]. DER NERVENARZT 2019; 89:1355-1364. [PMID: 29947936 DOI: 10.1007/s00115-018-0534-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Injection of botulinum neurotoxin A (BoNT-A) according to the PREEMPT (Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy) paradigm has been approved for the treatment of refractory chronic migraine in Germany in 2011. OBJECTIVE The practical application raises some questions, such as the choice of dose and injection intervals during the course of the treatment, and the appropriate time point for discontinuation of BoNT-A treatment. MATERIAL AND METHODS Taking into account the existing literature, the German Migraine and Headache Society (Deutsche Migräne- und Kopfschmerzgesellschaft, DMKG) gives recommendations for the treatment of chronic migraine with BoNT-A. RESULTS Treatment is usually started with a dose of 155 U BoNT-A. During the first year of treatment, 3‑month injection intervals are recommended. Goal of the treatment is an improvement of migraine by ≥30%. If needed, dose escalation up to 195 U can be used to reach this goal. If improvement by ≥30% is not reached after the third injection cycle, the treatment is usually considered to be insufficiently efficient and discontinuation is recommended. If a stable success is reached during the first year of treatment, prolongation of injection intervals to 4 months can be considered. If success continues to be stable for at least two 4‑month intervals, discontinuation of BoNT-A treatment can be tried. CONCLUSION The literature on these points is insufficient for recommendations at the guideline level. The present recommendations are based on an expert consensus of the DMKG for the structured approach to the treatment of chronic migraine with BoNT-A.
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Affiliation(s)
- R Ruscheweyh
- Neurologische Klinik und Poliklinik, Klinikum der LMU München, München, Deutschland.
| | - S Förderreuther
- Neurologische Klinik und Poliklinik, Klinikum der LMU München, München, Deutschland
| | - C Gaul
- Migräne- und Kopfschmerzklinik Königstein, Königstein im Taunus, Deutschland
| | | | - D Holle-Lee
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Essen, Deutschland
| | - T Jürgens
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - L Neeb
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - A Straube
- Neurologische Klinik und Poliklinik, Klinikum der LMU München, München, Deutschland
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21
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Dima L, Bălan A, Moga MA, Dinu CG, Dimienescu OG, Varga I, Neculau AE. Botulinum Toxin a Valuable Prophylactic Agent for Migraines and a Possible Future Option for the Prevention of Hormonal Variations-Triggered Migraines. Toxins (Basel) 2019; 11:E465. [PMID: 31398813 PMCID: PMC6722780 DOI: 10.3390/toxins11080465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In 1989, Botulinum toxin (BoNT) was accepted by the FDA for the management of some ophthalmic disorders. Although it was initially considered a lethal toxin, in recent times, Botulinum toxin A (BoNT-A), which is the more used serotype, has expanded to cover different clinical conditions, primarily characterized by neuropathic pain, including migraines and headaches. Evidence suggests that migraines are influenced by hormonal factors, particularly by estrogen levels, but very few studies have investigated the prevalence and management strategies for migraines according to the hormonal status. The effects of several therapeutic regimens on migraines have been investigated, but the medications used varied widely in proven efficacies and mechanisms of action. BoNT-A is increasingly used in the management of migraine and several placebo-controlled trials of episodic and chronic migraine are currently underway. This paper is a review of the recently published data concerning the administration of BoNT-A in the prevention of chronic migraines. Considering the lack of population-based studies about the effectiveness of BoNT-A in the alleviation of premenstrual and perimenopausal migraines, this study proposes a new perspective of the therapeutic approach of migraine syndrome associated with menopausal transition and the premenstrual period. METHODS We selected the reviewed papers from CrossRef, PubMed, Medline, and GoogleScholar, and a total of 21 studies met our inclusion criteria. RESULTS To date, no specific preventive measures have been recommended for menopausal women with migraines. BoNT-A often reduces the frequency and intensity of migraine attacks per month; the treatment is well tolerated and does not exhibit a significantly higher rate of treatment-related side effects. No population-based studies were conducted in order to highlight the role of BoNT-A in menopause-related migraines, neither in menstrual migraines. CONCLUSION There is a need for further research in order to quantify the real burden of menstrual and perimenopausal migraines and to clarify if BoNT-A could be used in the treatment of refractory postmenopausal and premenstrual migraines.
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Affiliation(s)
- Lorena Dima
- Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania
| | - Andreea Bălan
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Marius Alexandru Moga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania
| | - Cătălina Georgeta Dinu
- Department of Law, Faculty of Law, Transilvania University of Brasov, 500019 Brasov, Romania
| | - Oana Gabriela Dimienescu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Ioana Varga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania
| | - Andrea Elena Neculau
- Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania
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Gago-Veiga A, Santos-Lasaosa S, Cuadrado M, Guerrero Á, Irimia P, Láinez J, Leira R, Pascual J, Sanchez del Río M, Viguera J, Pozo-Rosich P. Evidence and experience with onabotulinumtoxinA in chronic migraine: Recommendations for daily clinical practice. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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23
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Barad M, Sturgeon JA, Fish S, Dexter F, Mackey S, Flood PD. Response to BotulinumtoxinA in a migraine cohort with multiple comorbidities and widespread pain. Reg Anesth Pain Med 2019; 44:660-668. [PMID: 31101743 DOI: 10.1136/rapm-2018-100196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/07/2019] [Accepted: 04/03/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The phase III research evaluating migraine prophylaxis therapy (PREEMPT) protocol was developed in low-risk migraine patients. We studied longitudinal response to treatment in a sequential retrospective observational cohort to evaluate predictors of effectiveness in patients with multiple overlapping pain syndromes treated in a quaternary pain management clinic. METHODS We evaluated indicators of individual response in 402 consecutive chronic migraine patients who provided demographic information and used the Collaborative Health Outcomes Information Registry. RESULTS The patients were middle aged 47 (38-56) median (IQR) years old and 83% women. They reported multiple complex pain problems with 11 (6-18) regions represented on a pain body map. Evaluated with National Institutes of Health Patient-Reported Outcomes Measurement Information System measures, they reported higher scores for sleep impairment and disturbance, anxiety, depression, fatigue, pain behavior, pain interference and worse function and satisfaction with social roles compared with the general US population; p<0.001 for all domains. Within 120 days of treatment, 62% of patients reported reduced headache frequency. The best multivariable model developed for prediction of reduced headache frequency in response to treatment included lower treatment number, lower pain interference score, and less depression (p=0.001, 0.002, and 0.009). Depression may have been an obstacle to successful treatment; there was no association between depression score and number of treatments (p=0.54). CONCLUSIONS Our findings point to the importance of identifying and addressing pain interference and depression early in chronic migraine management and, more broadly, highlights the importance of multidisciplinary evaluation and treatment in chronic migraine.
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Affiliation(s)
- Meredith Barad
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - John Andrew Sturgeon
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Shannon Fish
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | | | - Sean Mackey
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Pamela Dru Flood
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
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24
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Ahmed F, Gaul C, García-Moncó JC, Sommer K, Martelletti P. An open-label prospective study of the real-life use of onabotulinumtoxinA for the treatment of chronic migraine: the REPOSE study. J Headache Pain 2019; 20:26. [PMID: 30845917 PMCID: PMC6734221 DOI: 10.1186/s10194-019-0976-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The PREEMPT Studies established onabotulinumtoxinA as preventive treatment for adults with chronic migraine (CM). The purpose of the REal-life use of botulinum toxin for the symptomatic treatment of adults with chronic migraine, measuring healthcare resource utilisation, and Patient-reported OutcomeS observed in practice (REPOSE) Study was to observe real-life, long-term (24-month) use of onabotulinumtoxinA in adults with CM and report on the utilisation, effectiveness, safety, and tolerability. METHODS The REPOSE Study was a European, open-label, multicentre, prospective, noninterventional study. Patients received onabotulinumtoxinA approximately every 12 weeks according to their physician's usual practice, guided by the summary of product characteristics (SPC). Patients were observed for 24 months after initiating onabotulinumtoxinA treatment. Outcome measures were collected at baseline and all administration visits and included onabotulinumtoxinA injection practices, headache-day frequency, Migraine-Specific Quality-of-Life Questionnaire (MSQ), EuroQol 5-Dimension Questionnaire (EQ-5D), and adverse drug reactions (ADRs) to evaluate safety/tolerability. RESULTS Of 641 patients enrolled, 633 received ≥1 dose of onabotulinumtoxinA for a total of 3499 treatment sessions. At baseline, mean (SD) age was 45.4 (11.7) years; patients were predominantly women (85.3%). Injection practices closely followed the SPC in mean dosage (155.1 U) and injection sites per session (31.4), with the exception of a prolongation of the recommended 12-week dosing interval, with 79.1% of patients receiving ≥1 treatment session that was > 13 weeks after the previous treatment session. Headache-day frequency was reduced from a baseline mean (SD) of 20.6 (5.4) to 7.4 (6.6) days at administration visit 8 (P < 0.001). Each MSQ domain (restrictive, preventive, and emotional) was significantly reduced from baseline through each administration visit (P < 0.001). The median EQ-5D total and health state scores were significantly improved from baseline through each administration visit (P < 0.001). Overall, 18.3% of patients reported an ADR; most were mild to moderate intensity, with only 1.3% of patients reporting a serious ADR. Eyelid ptosis (5.4%), neck pain (2.8%), and musculoskeletal stiffness (2.7%) were the most frequently reported. CONCLUSIONS Long-term, real-world preventive treatment of CM with onabotulinumtoxinA showed effectiveness with a sustained reduction in headache-day frequency and significant improvement in quality-of-life measures. ADRs were mild to moderate, with no new safety concerns identified. TRIAL REGISTRATION Trial registration number: NCT01686581. Name of registry: ClinicalTrials.gov. URL of registry: https://clinicaltrials.gov/ct2/show/NCT01686581 . Date of retrospective registration: September 18, 2012. Date of enrolment of first patient: July 23, 2012.
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Affiliation(s)
- Fayyaz Ahmed
- Spire Hesslewood Clinic, Hull York Medical School, 28 Spindlewood, Elloughton, Brough, HU15 1LL, UK.
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein im Taunus, Germany
| | | | | | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Regional Referral Headache Centre, Sant' Andrea Hospital, Rome, Italy
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25
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Wollmer MA, Magid M, Kruger THC, Finzi E. The Use of Botulinum Toxin for Treatment of Depression. Handb Exp Pharmacol 2019; 263:265-278. [PMID: 31691857 DOI: 10.1007/164_2019_272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A series of clinical studies have shown that botulinum toxin can treat major depression. Subjects suffering from unipolar depression may experience a quick, strong, and sustained improvement in the symptoms of depression after a single glabellar treatment with botulinum toxin.Preliminary data suggest that botulinum toxin therapy may also be effective in the treatment of other mental disorders characterized by an excess of negative emotions, such as borderline personality disorder.The mood-lifting effect of botulinum toxin therapy is probably mediated by the interruption of a proprioceptive feedback loop from the facial musculature to the emotional brain.
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Affiliation(s)
- M Axel Wollmer
- Asklepios Clinic North-Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Hamburg, Germany.
| | - Michelle Magid
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany
| | - Eric Finzi
- Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine, Washington, DC, USA
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26
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Frederiksen SD, Warfvinge K, Ohlsson L, Edvinsson L. Expression of Pituitary Adenylate Cyclase-activating Peptide, Calcitonin Gene-related Peptide and Headache Targets in the Trigeminal Ganglia of Rats and Humans. Neuroscience 2018; 393:319-332. [DOI: 10.1016/j.neuroscience.2018.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 11/16/2022]
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27
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Castrillo Sanz A, Morollón Sánchez-Mateos N, Simonet Hernández C, Fernández Rodríguez B, Cerdán Santacruz D, Mendoza Rodríguez A, Rodríguez Sanz M, Tabernero García C, Guerrero Becerra P, Ferrero Ros M, Duate García-Luis J. Experiencia con toxina botulínica en la migraña crónica. Neurologia 2018; 33:499-504. [DOI: 10.1016/j.nrl.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 01/03/2023] Open
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28
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Castrillo Sanz A, Morollón Sánchez-Mateos N, Simonet Hernández C, Fernández Rodríguez B, Cerdán Santacruz D, Mendoza Rodríguez A, Rodríguez Sanz M, Tabernero García C, Guerrero Becerra P, Ferrero Ros M, Duate García-Luis J. Experience with botulinum toxin in chronic migraine. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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29
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Bendtsen L, Sacco S, Ashina M, Mitsikostas D, Ahmed F, Pozo-Rosich P, Martelletti P. Guideline on the use of onabotulinumtoxinA in chronic migraine: a consensus statement from the European Headache Federation. J Headache Pain 2018; 19:91. [PMID: 30259200 PMCID: PMC6755553 DOI: 10.1186/s10194-018-0921-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 09/20/2018] [Indexed: 12/11/2022] Open
Abstract
OnabotulinumtoxinA is being increasingly used in the management of chronic migraine (CM). Treatment with onabotulinumtoxinA poses challenges compared with traditional therapy with orally administered preventatives. The European Headache Federation identified an expert group that was asked to develop the present guideline to provide recommendations for the use of onabotulinumtoxinA in CM. The expert group recommend onabotulinumtoxinA as an effective and well-tolerated treatment of CM. Patients should preferably have tried two to three other migraine prophylactics before start of onabotulinumtoxinA. Patients with medication overuse should be withdrawn from the overused medication before initiation of onabotulinumtoxinA if feasible, if not onabotulinumtoxinA can be initiated from the start or before withdrawal. OnabotulinumtoxinA should be administered according to the PREEMPT injection protocol, i.e. injecting 155 U–195 U to 31–39 sites every 12-weeks. We recommend that patients are defined as non-responders, if they have less than 30% reduction in headache days per month during treatment with onabotulinumtoxinA. However other factors such as headache intensity, disability and patient preferences should also be considered when evaluating response. Treatment should be stopped, if the patient does not respond to the first two to three treatment cycles. Response to continued treatment with onabotulinumtoxinA should be evaluated by comparing the 4 weeks before with the 4 weeks after each treatment cycle. It is recommended that treatment is stopped in patients with a reduction to less than 10 headache days per month for 3 months and that patients are re-evaluated 4–5 months after stopping onabotulinumtoxinA to make sure that the patient has not returned to CM. Questions regarding efficacy and tolerability of onabotulinumtoxinA could be answered on the basis of scientific evidence. The other recommendations were mainly based on expert opinion. Future research on the treatment of CM with onabotulinumtoxinA may further improve the management of this highly disabling disorder.
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Affiliation(s)
- Lars Bendtsen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, 2600, Glostrup, Denmark.
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, 2600, Glostrup, Denmark
| | - Dimos Mitsikostas
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fayyaz Ahmed
- Department of Neurosciences, Hull York Medical School, Hull, UK
| | - Patricia Pozo-Rosich
- Headache & Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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A single-center retrospective study of onabotulinumtoxinA for treatment of 245 chronic migraine patients: survey results of a real-world experience. Acta Neurol Belg 2018; 118:475-484. [PMID: 29992442 DOI: 10.1007/s13760-018-0978-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023]
Abstract
Preventive treatment in migraine is associated with poor adherence and persistence. In this observational study, our first aim was to evaluate the perceived effectiveness of onabotulinumtoxinA based on our chronic migraine (CM) patients' treatment experience. The second purpose of this study was to determine the compliance with onabotulinumtoxinA treatment in our cohort. Third, we assessed the reasons for withdrawal from treatment in our CM patients. A total of 245 consecutive patients with CM (40.43 ± 10.15 years; 214 females, 31 males) were treated with at least one onabotulinumtoxinA. Data were collected by a standardized interview over the telephone. One-hundred and eighty patients were willing to answer questions about: (1) perceived effectiveness of onabotulinumtoxinA based on their treatment experience; (2) the current continuity of the treatment; (3) their current migraine-related disability; and (4) their current medication usage. The mean number of onabotulinumtoxinA cycles of all patients and the participants were 2.58 and 2.90, respectively. Of the 180 participants, 149 patients (82.8%) thought that onabotulinumtoxinA was effective in controlling their headaches. The mean score for perceived effectiveness of onabotulinumtoxinA treatment given by the participants was as 6.94 ± 2.4 (on a scale from 0 to 10). Of the 245 treated subjects, 31 (12.6%) were treated for 12 months. Compliance rates with onabotulinumtoxinA were very low in our population. However, even CM patients who did not complete five cycles of the treatment showed marked improvement of their current migraine-related disability and reduction of their medication intake as compared to baseline.
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31
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Tassorelli C, Tedeschi G, Sarchielli P, Pini LA, Grazzi L, Geppetti P, De Tommaso M, Aguggia M, Cortelli P, Martelletti P. Optimizing the long-term management of chronic migraine with onabotulinumtoxinA in real life. Expert Rev Neurother 2017; 18:167-176. [PMID: 29280408 DOI: 10.1080/14737175.2018.1419867] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Management of chronic migraine is challenging. OnabotulinumtoxinA (OBT-A) is the only medication licensed for prevention of chronic migraine, and has been widely adopted in clinical practice. Limited data is available on its long-term use. Areas covered: Data from controlled trials are combined with available data on the long-term use of OBT-A in real-life studies, with information obtained in a recent survey among Italian headache centers, and the clinical experience of the authors. Six areas were identified as relevant to patients with chronic migraine: 1) definition of responders to OBT-A; 2) management of responders to OBT-A; 3) optimal timing of prophylaxis with OBT-A; 4) position of OBT-A in prevention of chronic migraine; 5) management of medication overuse, and 6) patient education. Expert commentary: This review provides an update on the latest evidence regarding the long-term use of OBT-A in chronic migraine and analyzes the critical issues in the decision-making process that emerge from the analysis of the literature and routine practice. A treatment algorithm is proposed for the adoption in the daily practice.
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Affiliation(s)
- Cristina Tassorelli
- a Headache Science Center , National Neurological Institute C. Mondino , Pavia , Italy.,b Department of Brain and Behavioral Sciences , University of Pavia , Pavia , Italy
| | - Gioacchino Tedeschi
- c Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - P Sarchielli
- d Neurology Clinic , University Hospital of Perugia , Perugia , Italy
| | - Luigi Alberto Pini
- e Center for Neuroscience and Neurotechnology, Polyclinic Hospital , University of Modena and Reggio Emilia , Modena , Italy
| | - Licia Grazzi
- f Headache and Neuroalgology Unit , Neurological Institute "C. Besta" IRCCS Foundation , Milan , Italy
| | - Pierangelo Geppetti
- g Headache Center, Department of Health Sciences , University of Florence , Florence , Italy
| | - Marina De Tommaso
- h Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital , Bari Aldo Moro University , Bari , Italy
| | - Marco Aguggia
- i Headache Center, Neurology Department , Asti Hospital , Asti , Italy
| | - P Cortelli
- j Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy.,k IRCCS Institute of Neurological Sciences of Bologna , Bellaria Hospital , Bologna , Italy
| | - Paolo Martelletti
- l Department of Clinical and Molecular Medicine, Sapienza University of Rome and Regional Referral Headache Center , Sant'Andrea Hospital , Rome , Italy
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Domínguez C, Pozo-Rosich P, Torres-Ferrús M, Hernández-Beltrán N, Jurado-Cobo C, González-Oria C, Santos S, Monzón MJ, Latorre G, Álvaro LC, Gago A, Gallego M, Medrano V, Huerta M, García-Alhama J, Belvís R, Leira Y, Leira R. OnabotulinumtoxinA in chronic migraine: predictors of response. A prospective multicentre descriptive study. Eur J Neurol 2017; 25:411-416. [PMID: 29171146 DOI: 10.1111/ene.13523] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/20/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE OnabotulinumtoxinA is a treatment specifically approved for the prophylaxis of chronic migraine in adults. The aim of this study was to assess the effectiveness of OnabotulinumtoxinA in chronic migraine after 1 year of treatment in a real-life setting and to identify clinical predictors of outcome. METHODS We designed a prospective multicentre study performed in 13 hospitals in Spain. Patients underwent a complete medical history and examination. They were treated with OnabotulinumtoxinA every 12 weeks for 1 year. Data about outcome, adverse events, abortive medication use, emergency room use and disability were collected at 3 and 12 months. RESULTS A total of 725 subjects completed the study. At 12 months, 79.3% showed >50% reduction in number of headaches per month and 94.9% reported no adverse events. Unilaterality of pain, fewer days of disability per month and milder headache at baseline were correlated with good outcome. Duration of disease <12 months increased the chances of response to treatment with OnabotulinumtoxinA (odds ratio, 1.470; 95% confidence interval, 1.123-2.174; P = 0.045). CONCLUSIONS This study confirmed the effectiveness of treatment with OnabotulinumtoxinA after 1 year of treatment. The chances of a good outcome may be increased by starting treatment in the first 12 months after chronic migraine diagnosis.
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Affiliation(s)
- C Domínguez
- Service of Neurology, Headache Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela
| | - P Pozo-Rosich
- Hospital Universitario Vall d'Hebron, Headache Research Group, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M Torres-Ferrús
- Hospital Universitario Vall d'Hebron, Headache Research Group, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - N Hernández-Beltrán
- Hospital Universitario Vall d'Hebron, Headache Research Group, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.,Neuroclinica and Promedan, Medellin, Colombia
| | | | | | - S Santos
- Hospital Clínico Universitario Lozano Blesa, Zaragoza
| | | | - G Latorre
- Hospital Universitario de Fuenlabrada, Madrid
| | | | - A Gago
- Hospital Universitario Basurto, Bilbao
| | - M Gallego
- Hospital Universitario La Princesa, Madrid
| | - V Medrano
- Hospital General Universitario de Elda, Alicante
| | | | | | - R Belvís
- Hospital Universitario Dexeus, Barcelona
| | - Y Leira
- OMEQUI Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - R Leira
- Service of Neurology, Headache Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela
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Aydinlar EI, Dikmen PY, Kosak S, Kocaman AS. OnabotulinumtoxinA effectiveness on chronic migraine, negative emotional states and sleep quality: a single-center prospective cohort study. J Headache Pain 2017; 18:23. [PMID: 28213829 PMCID: PMC5315653 DOI: 10.1186/s10194-017-0723-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND OnabotulinumtoxinA (OnabotA) is considered effective in in patients with chronic migraine (CM) who failed on traditional therapies. This study was designed to evaluate the effect of OnabotA injection series on migraine outcome, negative emotional states and sleep quality in patients with CM. METHODS A total of 190 patients with CM (mean (SD) age: 39.3 (10.2) years; 87.9% were female) were included. Data on Pittsburgh sleep quality index (PSQI), headache frequency and severity, number of analgesics used, Migraine Disability Assessment Scale. (MIDAS) scores and Depression, Anxiety and Stress Scale (DASS-21) were evaluated at baseline (visit 1) and 4 consecutive follow up visits, each conducted after OnabotA injection series; at week 12 (visit 2), week 24 (visit 3), week 36 (visit 4) and week 48 (visit 5) to evaluate change from baseline to follow up. RESULTS From baseline to visit 5, significant decrease was noted in least square (LS) mean headache frequency (from 19.5 to 8.4, p = 0.002), headache severity (from 8.1 to 6.1, p = 0.017), number of analgesics (from 26.9 to 10.4, p = 0.023) and MIDAS scores (from 67.3 to 18.5, p < 0.001). No significant change from baseline was noted in global PSOI and DASS-21 scores throughout the study. CONCLUSIONS Our findings revealed that OnabotA therapy was associated with significant improvement in migraine outcome leading to decrease in headache frequency and severity, number of analgesics used and MIDAS scores. While no significant change was noted in overall sleep quality and prevalence of negative emotional states, patients without negative emotional states at baseline showed improved sleep quality throughout the study.
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Affiliation(s)
- Elif Ilgaz Aydinlar
- Department of Neurology, Acibadem University School of Medicine, Içerenkoy, Kayisdagi Cd, 34752 Atasehir/Istanbul, Turkey
| | - Pinar Yalinay Dikmen
- Department of Neurology, Acibadem University School of Medicine, Içerenkoy, Kayisdagi Cd, 34752 Atasehir/Istanbul, Turkey
| | - Seda Kosak
- Department of Neurology, Acibadem University School of Medicine, Içerenkoy, Kayisdagi Cd, 34752 Atasehir/Istanbul, Turkey
| | - Ayse Sagduyu Kocaman
- Department of Neurology, Acibadem University School of Medicine, Içerenkoy, Kayisdagi Cd, 34752 Atasehir/Istanbul, Turkey
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Tassorelli C, Aguggia M, De Tommaso M, Geppetti P, Grazzi L, Pini LA, Sarchielli P, Tedeschi G, Martelletti P, Cortelli P. Onabotulinumtoxin A for the management of chronic migraine in current clinical practice: results of a survey of sixty-three Italian headache centers. J Headache Pain 2017; 18:66. [PMID: 28667550 PMCID: PMC5493599 DOI: 10.1186/s10194-017-0773-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/17/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Chronic migraine is a complex clinical condition often undertreated. Onabotulinumtoxin A (OBT-A) was approved in Italy in 2013 for symptom relief in patients with chronic migraine who have failed, or do not tolerate, oral prophylactic treatments. However, the impact of OBT-A in clinical practice remains to be defined. METHODS To investigate the current management of chronic migraine with OBT-A in clinical practice, a web-based survey was conducted among clinicians working in third-level headache centers across Italy. A 26-item questionnaire was designed and developed by a group of 10 Italian headache specialists to address the following issues: treatment paradigm and OBT-A injection intervals, frequency of treatment and retreatment, definition of responders/non-responders, satisfaction with treatment potential impact of early treatment with OBT-A. Ninety-six headache centers were selected and contacted via e-mail. The online survey was anonymous and carried out using a secure website. RESULTS Overall, 64 of the 96 centers (66.7%) completed the questionnaire. Most centers (98.4%) had been using OBT-A for >1 year. OBT-A was administered according to the PREEMPT paradigm in most centers (88.9%). While during the first year of prophylaxis with OBT-A most clinicians (93.6%) repeated OBT-A treatment every 3 months, as recommended, in the following years interval duration was variable. Response to OBT-A was defined as a ≥ 50% reduction in the headache days by 58.7% of the clinicians, and as a ≥ 30% reduction by 25.4% of them. Almost 60% of the clinicians considered OBT-A as a long-lasting therapy, while for one-third of them treatment could be discontinued in patients showing a benefit for ≥6 months. According to 80% of the clinicians, early administration of OBT-A after the onset of chronic migraine was associated with better outcomes, and 47.6% felt that OBT-A should be recommended as a first-line option. CONCLUSIONS This survey indicates that in third-level headache centers in Italy OBT-A is used in good compliance with current recommendations. There is agreement about the definition of response as a reduction in headache days by 30% to 50%. Additional effort is required to define response to OBT-A and to establish optimal treatment duration.
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Affiliation(s)
- Cristina Tassorelli
- Headache Science Center, National Neurological Institute C. Mondino, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100 Pavia, Italy
| | - Marco Aguggia
- Headache Center, Neurology Department, Asti Hospital, Asti, Italy
| | - Marina De Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital, Bari Aldo Moro University, Bari, Italy
| | - Pierangelo Geppetti
- Headache Center, Department of Health Sciences, University of Florence, Florence, Italy
| | - Licia Grazzi
- Headache and Neuroalgology Unit, Neurological Institute “C. Besta” IRCCS Foundation, Milan, Italy
| | - Luigi Alberto Pini
- Center for Neuroscience and Neurotechnology, Polyclinic Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Sarchielli
- Neurology Clinic, University Hospital of Perugia, Perugia, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome and Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
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Evidence and experience with onabotulinumtoxinA in chronic migraine: Recommendations for daily clinical practice. Neurologia 2017; 34:408-417. [PMID: 29169810 DOI: 10.1016/j.nrl.2017.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/07/2017] [Indexed: 12/12/2022] Open
Abstract
OnabotulinumtoxinA has been demonstrated to be effective as a preventive treatment in patients with chronic migraine (CM). Five years after the approval of onabotulinumtoxinA in Spain, the Headache Study Group of the Spanish Society of Neurology considered it worthwhile to gather a group of experts in treating patients with CM in order to draw up, based on current evidence and our own experience, a series of guidelines aimed at facilitating the use of the drug in daily clinical practice. For this purpose, we posed 12 questions that we ask ourselves as doctors, and which we are also asked by our patients. Each author responded to one question, and the document was then reviewed by everyone. We hope that this review will constitute a practical tool to help neurologists treating patients with CM.
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Barbanti P, Ferroni P. Onabotulinum toxin A in the treatment of chronic migraine: patient selection and special considerations. J Pain Res 2017; 10:2319-2329. [PMID: 29033605 PMCID: PMC5628659 DOI: 10.2147/jpr.s113614] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Discovered by serendipity, onabotulinum toxin A (BoNT-A) is the only US Food and Drug Administration-approved treatment for the prevention of chronic migraine (CM), one of the most disabling and burdensome human conditions. Its efficacy, safety and tolerability, proved by the largest and longest migraine therapeutic trial (the Phase III Research Evaluating Migraine Prophylaxis Therapy program [PREEMPT]), have been replicated by various real-life studies also in the presence of medication overuse. The benefit of BoNT-A prophylaxis is likely due to its ability to counteract peripheral and central nociceptive sensitization through reversible chemical denervation of pericranial sensitive afferents. Its efficacy increases considerably over time during long-term treatments, significantly varying among patients. The present review focuses on the state-of-the art of current knowledge on putative instrumental, biochemical and clinical predictors of BoNT-A responsiveness, outlining the need for a thorough characterization of the full phenotypic migraine picture when trying to predict good responders. Available evidence suggests that disentangling the BoNT-A responsiveness puzzle requires 1) a reappraisal of easy-obtainable clinical details (eg, site and quality of pain, presence of cranial autonomic symptoms), 2) a proper stratification of patients with CM according to their headache frequency, 3) the evaluation of potential synergistic effects of concomitant prophylaxis/treatment and 4) a detailed assessment of modifiable risk factors evolution during treatment.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences
| | - Patrizia Ferroni
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, IRCCS San Raffaele Pisana, Rome, Italy
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Davies B, Gaul C, Martelletti P, García-Moncó JC, Brown S. Real-life use of onabotulinumtoxinA for symptom relief in patients with chronic migraine: REPOSE study methodology and baseline data. J Headache Pain 2017; 18:93. [PMID: 28879545 PMCID: PMC5587510 DOI: 10.1186/s10194-017-0802-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 08/18/2017] [Indexed: 02/18/2023] Open
Abstract
Background Migraine is a debilitating neurological disorder that affects 14.1% of the US and 14.7% of the European populations. Chronic migraine (CM) is broadly defined as headache occurring on ≥15 days per month for ≥3 months, and has an estimated worldwide prevalence of 1.4% to 2.2%. OnabotulinumtoxinA is currently approved for the treatment of CM in most European countries, and is the only preventative treatment approved for adults with CM, based on results from the PREEMPT clinical trial programme. The ongoing prospective, observational REal-life use of botulinum toxin for the symptomatic treatment of adults with chronic migraine, measuring healthcare resource utilisation, and Patient-reported OutcomeS observed in practice (REPOSE) Study aims to describe real-world healthcare resource utilisation and patient-reported outcomes over a 2-year period in Germany, Italy, Norway, Russia, Spain, Sweden, and the United Kingdom, among patients with CM prescribed onabotulinumtoxinA. Methods Herein, methodology and baseline characteristics of patients who participated for ≥6 months in REPOSE are reported. No outcomes data are presented, although the methods for collecting these data are detailed. In REPOSE, onabotulinumtoxinA is administered at baseline and each follow-up visit (approximately every 3 months) during the 24-month treatment period, according to the treating physician’s best clinical judgment and standard of care, guided by the terms of the marketing authorisation described in the Summary of Product Characteristics. Outcome assessments include Migraine-Specific Quality of Life Questionnaire (MSQ), EuroQol Group Questionnaire (EQ-5D), headache-day frequency, treatment satisfaction, headache-related healthcare resource utilisation (ie, healthcare professional visits, hospital admissions, medication use), onabotulinumtoxinA utilisation (ie, dose, sites), and safety/tolerability. Results As of the interim assessment date for this analysis, the study has enrolled 644 patients from 78 sites throughout Europe, and baseline data are available for 336 patients from 61 sites who participated in the study for ≥6 months. Baseline measures indicate substantial disease burden and healthcare resource utilisation. Conclusions Final results from the REPOSE Study will provide the largest real-world, long-term analysis of the clinical use of onabotulinumtoxinA for the treatment of CM and will add important information to existing real-world findings. Future analyses will assess the long-term safety and efficacy of onabotulinumtoxinA in this population.
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Affiliation(s)
- Brendan Davies
- Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, Staffordshire, ST4 6QG, UK.
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein im Taunus, Germany
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Tassorelli C, Sances G, Avenali M, De Icco R, Martinelli D, Bitetto V, Nappi G, Sandrini G. Botulinum toxin for chronic migraine: Clinical trials and technical aspects. Toxicon 2017; 147:111-115. [PMID: 28877509 DOI: 10.1016/j.toxicon.2017.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 01/03/2023]
Abstract
OnabotulinumtoxinA has been approved for the prophylaxis of chronic migraine following the demonstration of efficacy in two large controlled trials. Data collected from pragmatic studies in the real-life setting have contributed important additional information useful for the management of this group of extremely disabled and challenging patients. The main findings from these studies are presented and discussed.
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Affiliation(s)
- Cristina Tassorelli
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy.
| | - Grazia Sances
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Micol Avenali
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Roberto De Icco
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Daniele Martinelli
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Vito Bitetto
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Giuseppe Nappi
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Giorgio Sandrini
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy
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Ranoux D, Martiné G, Espagne-Dubreuilh G, Amilhaud-Bordier M, Caire F, Magy L. OnabotulinumtoxinA injections in chronic migraine, targeted to sites of pericranial myofascial pain: an observational, open label, real-life cohort study. J Headache Pain 2017; 18:75. [PMID: 28733943 PMCID: PMC5520828 DOI: 10.1186/s10194-017-0781-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/13/2017] [Indexed: 01/03/2023] Open
Abstract
Background OnabotulinumtoxinA has proven its efficacy in reducing the number of headache days in chronic migraine (CM) patients. The usual paradigm includes 31 pericranial injection sites with low dose (5 U) per site. The aim of this study is to present the results obtained using a simpler injection protocol of onabotulinumtoxinA, with injection sites targeted to pericranial myofascial sites of pain. Methods Observational, open label, real-life, cohort study. We enrolled 63 consecutive patients fulfilling the diagnostic criteria of CM, and refractory to conventional treatments. The patients were injected using a “follow-the-pain” pattern into the corrugator and/or temporalis and/or trapezius muscles. The doses per muscle were fixed. According to the number of muscles injected, the total dose could vary from 70 to 150 U per session. Patients were considered responders if they had a ≥ 50% decrease in number of headache days in at least two consecutive injection cycles. Results Forty one patients (65.1% in intention to treat analysis) responded to treatment. In 70.7% of responders, the effect size was even higher, with a reduction ≥70% in the number of headache days. The associated cervical pain and muscle tenderness, present in 33 patients, was reduced by ≥50% in 31 patients (94%). Triptan consumption dramatically decreased (81%) in responders. The trapezius was the most frequently injected muscle. We observed no serious adverse event. The mean patient satisfaction rate was 8.5/10. Conclusions This study provides additional robust evidence supporting the efficacy of onabotulinumtoxinA injections in CM. Furthermore, the paradigm we used, with reduced number of injection sites targeted to pericranial myofascial sites of pain, may provide evidence in favor of the implication of myofascial trigger points in migraine chronicization. Trial Registration ClinicalTrials.gov Protocol Record I17022 ClinicalTrials.gov Identifier: NCT03175263. Date of registration: June 7, 2017. Retrospectively registered.
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Affiliation(s)
- Danièle Ranoux
- Department of Neurosurgery, Centre Hospitalier Universitaire de Limoges, Limoges, France.
| | - Gaelle Martiné
- Pain Center, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | | | - François Caire
- Department of Neurosurgery, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Laurent Magy
- Department of Neurology, Centre Hospitalier Universitaire de Limoges, Limoges, France
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40
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Onabotulinumtoxin A for chronic migraine with medication overuse: clinical results of a long-term treatment. Neurol Sci 2017; 38:141-143. [DOI: 10.1007/s10072-017-2864-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Escher CM, Paracka L, Dressler D, Kollewe K. Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Ther Adv Neurol Disord 2017; 10:127-135. [PMID: 28382110 PMCID: PMC5367647 DOI: 10.1177/1756285616677005] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic migraine (CM) is a severely disabling neurological condition characterized by episodes of pulsating unilateral or bilateral headache. The United States Food and Drug Administration (FDA) approved onabotulinumtoxinA (Botox®) for the prophylactic treatment of CM in 2010. It has been shown that onabotulinumtoxinA is effective in the reduction of headache frequency and severity in patients with CM. Treatment is well tolerated by the patients. This review reports on the history of botulinum neurotoxin (BoNT) in CM and presents the current clinical evidence for the use of onabotulinumtoxinA in the treatment of CM.
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Affiliation(s)
- Claus M Escher
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Lejla Paracka
- Department of Neurology, Movement Disorder Section, Hannover Medical School, Hannover, Germany
| | - Dirk Dressler
- Department of Neurology, Movement Disorder Section, Hannover Medical School, Hannover, Germany
| | - Katja Kollewe
- Department of Neurology, Movement Disorder Section, Hannover Medical School, Carl-Neuberg Str. 1, D-30625 Hannover, Germany
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Aicua-Rapun I, Martínez-Velasco E, Rojo A, Hernando A, Ruiz M, Carreres A, Porqueres E, Herrero S, Iglesias F, Guerrero AL. Real-life data in 115 chronic migraine patients treated with Onabotulinumtoxin A during more than one year. J Headache Pain 2016; 17:112. [PMID: 27957623 PMCID: PMC5153399 DOI: 10.1186/s10194-016-0702-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/28/2016] [Indexed: 12/11/2022] Open
Abstract
Background OnabotulinumtoxinA (OnabotA) is effective in Chronic Migraine (CM) during first year of treatment and longer. In real clinical setting, CM patients with acute Medication Overuse (MO) or concurrently receiving oral preventatives are treated with OnabotA. We aim to assess evolution of CM patients beyond first year on OnabotA. Methods Data were retrospectively collected in three headache units. We analyzed cases who had received at least five sessions of OnabotA according to PREEMPT protocol. We continued OnabotA therapy when a reduction of number of headache days of at least 30% was achieved. Results We included 115 patients (98 females, 17 males) who completed 7.6 ± 2.3 (5–13) OnabotA procedures. Previously they had not responded to topiramate and, at least, one other preventative. Age at inclusion was 45.3 ± 12 (14–74) years, and latency between CM onset and OnabotA therapy was 43.1 ± 38.2 (6–166) months. At first OnabotA session 92 patients (80%) fulfilled MO criteria and 107 (93%) received a concurrent oral preventative. In 42 cases (36.5%) OnabotA dose was increased over 155 units. After first year in 57 out of 92 patients (61.9%) MO was discontinued. Among those receiving preventatives, in 52 out of 107 they were retired (48.6%). In 22 cases (19.1%) OnabotA administration was delayed to the fourth or fifth month and in 12 (10.4%) it was temporally stopped. Finally, in 18 patients (15.7%) OnabotA was discontinued due to lack of efficacy beyond first year of treatment. Conclusion Our results suggest that discontinuation of acute medication overuse and oral preventive therapies are achievable objectives in long-term using of OnabotA in CM patients.
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Affiliation(s)
- I Aicua-Rapun
- Neurology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - E Martínez-Velasco
- Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain
| | - A Rojo
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - A Hernando
- Neurology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - M Ruiz
- Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain
| | - A Carreres
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - E Porqueres
- Neurology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - S Herrero
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - F Iglesias
- Neurology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - A L Guerrero
- Neurology Department, Hospital Clínico Universitario de Valladolid, Avda. Ramón y Cajal 3, 47005, Valladolid, Spain.
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