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Merola JF, Parish LC, Guenther L, Lynde C, Lacour JP, Staubach P, Cheng S, Paris M, Picard H, Deignan C, Jardon S, Chen M, Papp KA. Efficacy and safety of apremilast in patients with moderate-to-severe genital psoriasis: Results from DISCREET, a phase 3 randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol 2024; 90:485-493. [PMID: 37852306 DOI: 10.1016/j.jaad.2023.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Genital psoriasis can be stigmatizing, is highly prevalent among patients with psoriasis, and has limited treatment options. Apremilast is a unique oral immunomodulating phosphodiesterase 4 inhibitor approved for psoriasis treatment. OBJECTIVE To assess the efficacy and safety of apremilast 30 mg twice daily in patients with genital psoriasis. METHODS DISCREET, a phase 3, placebo-controlled trial (NCT03777436), randomized patients with moderate-to-severe genital psoriasis (stratified by affected body surface area <10% or ≥10%) to apremilast or placebo for a 16-week period, followed by an apremilast extension period. Week 16 results are presented. RESULTS Patients were randomized to apremilast (n = 143) or placebo (n = 146). At Week 16, 39.6% and 19.5% of apremilast and placebo patients, respectively, achieved a modified static Physician Global Assessment of Genitalia response (primary endpoint; score of 0/1, ≥2-point reduction); treatment difference was significant (20.1%, P = .0003). Improvements in genital signs and symptoms, skin involvement, and quality of life were observed. Common treatment-emergent adverse events were diarrhea, headache, nausea, and nasopharyngitis. LIMITATIONS Lack of active-comparator. CONCLUSIONS Apremilast demonstrated statistically and clinically meaningful genital Physician Global Assessment responses and improvement of signs, symptoms, severity, and quality of life in this first randomized, controlled study of an oral systemic treatment in patients with genital psoriasis.
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Affiliation(s)
- Joseph F Merola
- Division of Rheumatology, Department of Dermatology and Department of Medicine and Associate Program Director, Combined Medicine-Dermatology Residency Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | | | | | - Charles Lynde
- Chief Medical Director, Lynde Institute for Dermatology, Markham, Ontario, Canada; Probity Medical Research, Markham, Ontario, Canada
| | | | - Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Sue Cheng
- Global Development, Amgen Inc, Thousand Oaks, California
| | - Maria Paris
- Global Patient Safety, Amgen Inc, Thousand Oaks, California
| | - Hernan Picard
- Global Development, Amgen Inc, Thousand Oaks, California
| | | | - Shauna Jardon
- Medical Affairs, Amgen Inc, Thousand Oaks, California
| | - Mindy Chen
- Global Development, Amgen Inc, Thousand Oaks, California
| | - Kim A Papp
- Alliance Clinical Trials and Probity Medical Research, Waterloo, Ontario, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Mease PJ, Hatemi G, Paris M, Cheng S, Maes P, Zhang W, Shi R, Flower A, Picard H, Stein Gold L. Apremilast Long-Term Safety Up to 5 Years from 15 Pooled Randomized, Placebo-Controlled Studies of Psoriasis, Psoriatic Arthritis, and Behçet's Syndrome. Am J Clin Dermatol 2023; 24:809-820. [PMID: 37316690 PMCID: PMC10266699 DOI: 10.1007/s40257-023-00783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Since US FDA approval in 2014, apremilast has consistently demonstrated a favorable benefit-risk profile in 706,585 patients (557,379 patient-years of exposure) worldwide across approved indications of plaque psoriasis, psoriatic arthritis, and Behçet's syndrome; however, long-term exposure across these indications has not been reported. OBJECTIVE The aim of this study was to conduct a pooled analysis of apremilast data from 15 clinical studies with open-label extension phases, focusing on long-term safety. METHODS We analyzed longer-term safety and tolerability of apremilast 30 mg twice daily across three indications for up to 5 years, focusing on adverse events of special interest, including thrombotic events, malignancies, major adverse cardiac events (MACE), serious infections, and depression. Data were pooled across 15 randomized, placebo-controlled studies and divided into placebo-controlled or all-apremilast-exposure groups. Treatment-emergent adverse events (TEAEs) were assessed. RESULTS Overall, 4183 patients were exposed to apremilast (6788 patient-years). Most TEAEs were mild to moderate in the placebo-controlled period (96.6%) and throughout all apremilast exposure (91.6%). TEAE rates of special interest were similar between treatment groups in the placebo-controlled period and remained low throughout all apremilast exposure. Exposure-adjusted incidence rates per 100 patient-years during all apremilast exposure were MACE, 0.30; thrombotic events, 0.10; malignancies, 1.0; serious infections, 1.10; serious opportunistic infections, 0.21; and depression, 1.78. Safety findings were consistent across indications and regions. No new safety signals were identified. CONCLUSIONS The incidence of serious TEAEs and TEAEs of special interest was low despite long-term exposure, further establishing apremilast as a safe oral option for long-term use across indications with a favorable benefit-risk profile. CLINICAL TRIAL REGISTRATION NCT00773734, NCT01194219, NCT01232283, NCT01690299, NCT01988103, NCT02425826, NCT03123471, NCT03721172, NCT01172938, NCT01212757, NCT01212770, NCT01307423, NCT01925768, NCT00866359, NCT02307513.
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Affiliation(s)
- Philip J. Mease
- Swedish Medical Center/Providence St, Joseph Health and University of Washington School of Medicine, Seattle, WA USA
| | - Gülen Hatemi
- School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Mrowietz U, Barker J, Conrad C, Jullien D, Gisondi P, Flower A, Reddy J, Paris M, Picard H, Jardon S, Augustin M. Efficacy and safety of apremilast in patients with limited skin involvement, plaque psoriasis in special areas and impaired quality of life: Results from the EMBRACE randomized trial. J Eur Acad Dermatol Venereol 2023; 37:348-355. [PMID: 36300769 DOI: 10.1111/jdv.18689] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/14/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION/BACKGROUND Manifestations of psoriasis in special areas are difficult to treat and are associated with a high disease burden and significant quality of life (QoL) impairment. Topical therapies may be inadequate for these patients, necessitating systemic treatment. OBJECTIVE The objective of EMBRACE was to evaluate the impact on QoL, efficacy and safety of apremilast 30 mg BID in patients with limited skin involvement with plaque psoriasis manifestations in special areas and impaired QoL. METHODS EMBRACE (NCT03774875) was a phase 4, randomized, placebo-controlled, multinational study. Patients had plaque psoriasis not controlled by topical therapy; lack of response, contraindication or intolerance to conventional first-line systemic therapy; psoriasis in ≥1 special area (including visible locations, scalp, nails, genital areas or palmoplantar areas); Psoriasis Area and Severity Index (PASI) ≥3 to ≤10; and Dermatology Life Quality Index (DLQI) >10. The primary endpoint was DLQI response (≥4-point reduction) at Week 16. RESULTS Of 277 randomized patients (apremilast: n = 185; placebo: n = 92), 221 completed Week 16 (apremilast: n = 152; placebo: n = 69). The primary endpoint (≥4-point reduction in DLQI at Week 16) was met by significantly more patients receiving apremilast (73.3%) versus placebo (41.3%; p < 0.0001). Significantly greater improvement in affected body surface area (BSA) and PASI was observed with apremilast versus placebo at Week 16. There were also significantly greater improvements with apremilast versus placebo in itch numeric rating scale (-2.5 vs. -0.9, p < 0.0001) and skin discomfort/pain visual analog scale (-21.5 vs. -5.4, p = 0.0003) and greater achievement of Patient Benefit Index ≥1 (77% vs. 40%, p < 0.0001) at Week 16. No new safety signals were observed. CONCLUSIONS Apremilast significantly improved skin-related QoL in patients with limited skin involvement with plaque psoriasis in special areas and highly impaired QoL. The safety profile was consistent with prior apremilast studies.
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Affiliation(s)
- Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jonathan Barker
- St John's Institute of Dermatology of King's College, London, UK
| | - Curdin Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Denis Jullien
- Department of Dermatology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | | | | | | | | | | | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Tepper SJ, Ashina M, Reuter U, Hallström Y, Broessner G, Bonner JH, Picard H, Cheng S, Chou DE, Zhang F, Klatt J, Mikol DD. Reduction in acute migraine-specific and non-specific medication use in patients treated with erenumab: post-hoc analyses of episodic and chronic migraine clinical trials. J Headache Pain 2021; 22:81. [PMID: 34301173 PMCID: PMC8299690 DOI: 10.1186/s10194-021-01292-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/10/2021] [Indexed: 01/13/2023] Open
Abstract
Background In patients with migraine, overuse of acute medication, including migraine-specific medication (MSM) such as triptans and ergots, can lead to adverse health outcomes, including development of medication overuse headache. Here, we examined the effect of erenumab on reducing acute medication use, in particular MSM, in patients with episodic migraine (EM) and chronic migraine (CM). Methods The current post-hoc analyses were based on data from the double-blind treatment phase (DBTP) of two erenumab studies, a pivotal EM (N = 955) and a pivotal CM (N = 667) trial, and their respective extensions. Patients were administered subcutaneous placebo or erenumab (70 or 140 mg) once monthly. Daily acute headache medication use (including MSM and non-MSM) was recorded using an electronic diary during a 4-week pretreatment baseline period until the end of the treatment period. Outcome measures included change in monthly acute headache medication days (HMD) in acute headache medication users at baseline, and changes in monthly MSM days (MSMD) in MSM users at baseline and non-MSMD in non-MSM users at baseline. Results In total, 60 and 78 % of patients (all acute headache medication users) with EM and CM used MSM at baseline, respectively. For acute headache medication users, the change in mean monthly acute HMD over Months 4, 5 and 6 compared with the pre-DBTP was 1.5, 2.5, and 3.0 for placebo, erenumab 70 mg and 140 mg, respectively for the EM study. The respective change in monthly MSMD in MSM users was 0.5, 2.1 and 2.8, and in monthly non-MSMD in non-MSM users was 2.3, 2.6, and 2.7. In the acute headache medication users at baseline, the change in monthly acute HMD at Month 3 compared with pre-DBTP was 3.4, 5.5, and 6.5 for placebo, erenumab 70 mg and 140 mg, respectively for the CM study. The respective change in monthly MSMD in MSM users was 2.1, 4.5, and 5.4, and in monthly non-MSMD in non-MSM users was 5.9, 6.4, and 6.6. Reductions in MSMD versus placebo were sustained in the extension periods of both studies. Erenumab was also associated with a higher proportion of MSM users achieving ≥ 50 %, ≥ 75 and 100 % reduction from baseline in monthly MSMD versus placebo in both EM and CM. Conclusions In both EM and CM, treatment with erenumab is associated with a significant and sustained reduction in the use of acute headache medication, in particular MSM. Trial registrations NCT02456740; NCT02066415; NCT02174861.
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Affiliation(s)
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Jo H Bonner
- Mercy Clinic Neurology and Headache Centre, Saint Louis, MO, USA
| | | | | | | | | | - Jan Klatt
- Novartis Pharma AG, CH-4002, Basel, Switzerland
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Ashina M, Doležil D, Bonner JH, Zhou L, Klatt J, Picard H, Mikol DD. A phase 2, randomized, double-blind, placebo-controlled trial of AMG 301, a pituitary adenylate cyclase-activating polypeptide PAC1 receptor monoclonal antibody for migraine prevention. Cephalalgia 2020; 41:33-44. [PMID: 33231489 PMCID: PMC7786389 DOI: 10.1177/0333102420970889] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective To assess the safety and efficacy of AMG 301, an inhibitor of the pituitary adenylate cyclase-activating polypeptide (PACAP)-1 (PAC1) receptor, for prevention of migraine. Methods In a double-blind trial, patients were randomized 4:3:3 to placebo, AMG 301 210 mg every 4 weeks, or AMG 301 420 mg every 2 weeks for 12 weeks. Effect on monthly migraine days and other secondary measures were assessed over weeks 9–12. Safety and tolerability were assessed. Results Of 343 randomized patients (mean age, 41.8–42.5 years), the majority were women (85.4–90.4%), white (94.1–96.2%), and had episodic migraine (62.5–67.9%). A total of 305 patients completed treatment (placebo, n = 124; AMG 301 210 mg, n = 94; AMG 301 420 mg, n = 87). Least squares mean reduction at week 12 in monthly migraine days from baseline was −2.5 (0.4) days for placebo and −2.2 (0.5) days for both AMG 301 treatment groups. No difference between AMG 301 and placebo on any measure of efficacy was observed; mean (95% confidence interval) treatment difference versus placebo for monthly migraine days for AMG 301 210 mg, 0.3 (−0.9 to 1.4); AMG 301 420 mg, 0.3 (−0.9 to 1.4). The incidence of adverse events was similar across groups. Conclusion AMG 301 offered no benefit over placebo for migraine prevention; further studies may be necessary to fully understand the role of PACAP isoforms and its receptors in migraine pathophysiology. Study Registration ClinicalTrials.gov: NCT03238781
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Doležil
- Prague Headache Center, DADO MEDICAL sro, Prague, Czech Republic
| | | | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Broessner G, Reuter U, Bonner JH, Dodick DW, Hallström Y, Picard H, Zhang F, Lenz RA, Klatt J, Mikol DD. The Spectrum of Response to Erenumab in Patients With Episodic Migraine and Subgroup Analysis of Patients Achieving ≥50%, ≥75%, and 100% Response. Headache 2020; 60:2026-2040. [PMID: 32851644 PMCID: PMC7590156 DOI: 10.1111/head.13929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 01/03/2023]
Abstract
Objective To assess the efficacy of erenumab at the ≥50%, ≥75%, and 100% reduction in monthly migraine days (MMD) response thresholds, using data from the 6‐month double‐blind treatment phase (DBTP) of the Study to Evaluate the Efficacy and Safety of Erenumab in Migraine Prevention (STRIVE) pivotal clinical trial. Methods Enrolled patients with episodic migraine (EM; ≥4 MMD and <15 monthly headache days) were randomized (1:1:1) to erenumab 70 mg (n = 312), erenumab 140 mg (n = 318), or placebo (n = 316) once monthly. We determined the proportions of patients with ≥50%, ≥75% and 100% reduction in MMD over the last 3 months of the STRIVE DBTP (months 4 through 6) and conducted post hoc analyses to contextualize the treatment benefit in patient subgroups achieving, and not achieving, these response thresholds. Outcome measures included changes in MMD, acute migraine‐specific medication days (MSMD), and patient‐reported outcomes. Results The proportions of patients with a reduction in MMD from baseline were greater for erenumab than for placebo at all response thresholds. As previously reported for the ≥50% response threshold, 135/312 (43.3%) of patients on erenumab 70 mg and 159/318 (50.0%) on erenumab 140 mg responded, vs 84/316 (26.6%) for placebo. At months 4 through 6, 65/312 (20.8%) and 70/318 (22.0%) of those on erenumab 70 mg and erenumab 140 mg, respectively, achieved ≥75% reductions vs 25/316 (7.9%) on placebo. A reduction of 100% response, which required no migraine days over 3 consecutive months based on observed data, was achieved by 10/312 (3.2%) of patients treated with erenumab 70 mg and 16/318 (5.0%) for erenumab 140 mg, vs 9/316 (2.8%) for placebo. At all response thresholds, responders achieved numerically greater reductions in mean MMD and MSMD, and greater improvements in disability than did the overall population; importantly, these remarkable responses were noted early. Meanwhile, 60/312 (19.2%) and 53/318 (16.7%) patients on erenumab 70 and 140 mg, respectively, had no reduction in MMD from baseline in months 4 through 6, compared with 104/316 (32.9%) patients on placebo. Conclusions The responses at the ≥50%, ≥75%, and 100% thresholds provide context for establishing realistic patient and physician expectations regarding the magnitude of treatment benefit that may be achieved by patients with EM responding to erenumab (STRIVE, NCT02456740).
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Affiliation(s)
- Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jo H Bonner
- Mercy Clinic Neurology and Headache Centre, Saint Louis, MO, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Pavlovic JM, Paemeleire K, Göbel H, Bonner J, Rapoport A, Kagan R, Zhang F, Picard H, Mikol DD. Efficacy and safety of erenumab in women with a history of menstrual migraine. J Headache Pain 2020; 21:95. [PMID: 32746775 PMCID: PMC7398400 DOI: 10.1186/s10194-020-01167-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We performed a post hoc, subgroup analysis of a phase 3, randomized, double-blind, placebo-controlled study of erenumab for prevention of episodic migraine (STRIVE) to determine the efficacy and safety of erenumab in women with self-reported menstrual migraine. METHODS Patients received placebo, erenumab 70 mg, or erenumab 140 mg subcutaneously once monthly during the 6-month double-blind treatment phase of STRIVE. Women who reported history of menstrual migraine and who were ≤ 50 years old were included in the analysis. Endpoints were change from baseline in monthly migraine days (MMD) and monthly acute migraine-specific medication days (MSMD; among patients who took acute migraine-specific medications at baseline), proportion of patients achieving ≥ 50% reduction from baseline in MMD, and incidence of adverse events. RESULTS Among 814 women enrolled in STRIVE, 232 (28.5%) reported a history of menstrual migraine and were ≤ 50 years old. Of the 232 patients, 214 (92%) had a baseline MMD > 5, suggesting a high proportion of women with attacks outside of the 5-day perimenstrual window (2 days before and 3 days after the start of menstruation). Information on "migraine days" includes (and does not discriminate between) perimenstrual and intermenstrual migraine attacks. Between-group differences from placebo over months 4-6 for erenumab 70 mg and 140 mg were - 1.8 (P = 0.001) and - 2.1 (P < 0.001) days for MMD and - 1.6 (P = 0.002) and - 2.4 (P < 0.001) days for acute MSMD, respectively. The odds of having a ≥ 50% reduction from baseline in MMD over months 4-6 were 2.2 (P = 0.024) and 2.8 (P = 0.002) times greater for erenumab 70 mg and 140 mg, respectively, than for placebo. Erenumab had an overall safety profile comparable to placebo. CONCLUSION Data from this subgroup analysis of women with menstrual migraine are consistent with data from the overall STRIVE episodic migraine population, supporting the efficacy and safety of erenumab in women who experience menstrual migraine. TRIAL REGISTRATION ClinicalTrials.gov, NCT02456740. Registered 28 May 2015.
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Affiliation(s)
- Jelena M Pavlovic
- Department of Neurology, Montefiore Headache Center, 1300 Morris Park Avenue, Van Etten 3C9, Bronx, NY, 10461, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | | | - Jo Bonner
- Mercy Clinic Neurology, St Louis, MO, USA
| | - Alan Rapoport
- The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Risa Kagan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,Sutter East Bay Medical Foundation, Berkeley, CA, USA
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Goadsby PJ, Reuter U, Hallström Y, Broessner G, Bonner JH, Zhang F, Wright IK, Chou DE, Klatt J, Picard H, Lenz RA, Mikol DD. One-year sustained efficacy of erenumab in episodic migraine: Results of the STRIVE study. Neurology 2020; 95:e469-e479. [PMID: 32636324 PMCID: PMC7455346 DOI: 10.1212/wnl.0000000000010019] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 06/01/2020] [Indexed: 01/03/2023] Open
Abstract
Objective To assess efficacy and tolerability of 1-year erenumab treatment in patients with episodic migraine. Methods Patients were randomized (n = 955; 1:1:1) during the 24-week double-blind treatment phase (DBTP) to monthly subcutaneous placebo or erenumab 70 or 140 mg. At week 24, 845 patients were rerandomized (1:1) to erenumab 70 or 140 mg during the 28-week dose-blinded active-treatment phase (ATP). Monthly migraine days (MMD), achieving ≥50%, ≥75%, and 100% reduction in MMD, and safety/tolerability were assessed. Results Mean MMD at DBTP baseline was 8.3. At week 52, mean changes (SE) from pre-DBTP baseline/week 24 (pre-ATP baseline) in MMD were −4.2 (0.2)/−1.1 (0.2) (70 mg) and −4.6 (0.2)/−1.8 (0.2) (140 mg) irrespective of treatment during the DBTP. For patients reducing dose from 140 (DBTP) to 70 mg (ATP), change in MMD from week 24 to 52 was −0.1 (0.3), and for those increasing from 70 (DBTP) to 140 mg (ATP), −1.8 (0.3). At week 52, 61.0%, 38.5%, and 19.8% of patients on erenumab 70 mg, and 64.9%, 40.8%, and 21.2% on erenumab 140 mg, achieved ≥50%, ≥75%, and 100% reduction in MMD from DBTP baseline, respectively. Among erenumab-treated patients in DBTP who showed ≥50% reduction in MMD during the last 3 months of DBTP and completed ATP, 86% showed sustained responses at ≥50% during the last 3 months of ATP. Safety of erenumab in ATP was similar to DBTP; exposure-adjusted incidence rates of adverse events were similar for either dose. Conclusion Over 52 weeks, erenumab provided sustained efficacy in episodic migraine; the safety profiles were similar between erenumab dose groups in the presence of dose blinding. Clinicaltrials.gov identifier NCT02456740. Classification of evidence Class II evidence that 52 weeks of treatment with erenumab 70 and 140 mg subcutaneously monthly results in sustained reductions in monthly migraine days and similar dose tolerability for patients with episodic migraine.
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Affiliation(s)
- Peter J Goadsby
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland.
| | - Uwe Reuter
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Yngve Hallström
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Gregor Broessner
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Jo H Bonner
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Feng Zhang
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Ian K Wright
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Denise E Chou
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Jan Klatt
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Hernan Picard
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Robert A Lenz
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Daniel D Mikol
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
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Kudrow D, Pascual J, Winner PK, Dodick DW, Tepper SJ, Reuter U, Hong F, Klatt J, Zhang F, Cheng S, Picard H, Eisele O, Wang J, Latham JN, Mikol DD. Vascular safety of erenumab for migraine prevention. Neurology 2019; 94:e497-e510. [PMID: 31852816 PMCID: PMC7080286 DOI: 10.1212/wnl.0000000000008743] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/06/2019] [Indexed: 01/13/2023] Open
Abstract
Objective To examine the cardiovascular, cerebrovascular, and peripheral vascular safety of erenumab across migraine prevention studies. Methods Vascular adverse events (AEs) and blood pressure data were integrated across 4 double-blind, placebo-controlled studies of erenumab and their open-label extensions in patients with chronic or episodic migraine. Subgroup analyses were conducted by acute migraine-specific medication use and number of vascular risk factors at baseline. Standardized search terms were used to identify vascular AEs (cardiovascular, cerebrovascular, or peripheral). An independent committee adjudicated whether targeted events were vascular in origin. Results In placebo-controlled studies, 2,443 patients received placebo (n = 1,043), erenumab 70 mg (n = 893), or erenumab 140 mg (n = 507) subcutaneously once monthly. Regardless of acute migraine-specific medication use or vascular risk factors at baseline, AE incidence was similar across the placebo and erenumab treatment groups. Hypertension AEs were reported for 0.9% (placebo), 0.8% (erenumab 70 mg), and 0.2% (erenumab 140 mg) of patients. Vascular AEs, which were similar across double-blind and open-label treatment, generally were confounded, with plausible alternative etiologies. In 18 patients with events reviewed by the independent committee, 4 events were positively adjudicated as cardiovascular in origin: 2 deaths and 2 vascular events. All 4 positively adjudicated cardiovascular events occurred during open-label erenumab treatment. Conclusion Selective blockade of the canonical calcitonin gene-related peptide receptor with erenumab for migraine prevention had a vascular safety profile comparable to that of placebo over 12 weeks, with no increased emergence of events over time. Further study of long-term safety of erenumab in patients with migraine is needed. Clinicaltrials.gov identifiers NCT02066415, NCT02456740, NCT01952574, NCT02483585, NCT02174861, and NCT01723514. Classification of evidence This analysis provides Class II evidence that for patients with migraine, erenumab does not increase the risk of vascular AEs.
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Affiliation(s)
- David Kudrow
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA.
| | - Julio Pascual
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Paul K Winner
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - David W Dodick
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Stewart J Tepper
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Uwe Reuter
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Frank Hong
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Jan Klatt
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Feng Zhang
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Sunfa Cheng
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Hernan Picard
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Osa Eisele
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Julie Wang
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Jonathan N Latham
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Daniel D Mikol
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
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Ashina M, Kudrow D, Reuter U, Dolezil D, Silberstein S, Tepper SJ, Xue F, Picard H, Zhang F, Wang A, Zhou Y, Hong F, Klatt J, Mikol DD. Long-term tolerability and nonvascular safety of erenumab, a novel calcitonin gene-related peptide receptor antagonist for prevention of migraine: A pooled analysis of four placebo-controlled trials with long-term extensions. Cephalalgia 2019; 39:1798-1808. [PMID: 31707815 DOI: 10.1177/0333102419888222] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Efficacy and safety of erenumab have been evaluated in a comprehensive clinical development program resulting in approval for migraine prevention in over 40 countries to date. METHODS This integrated safety analysis included four double-blind randomized trials and their extensions (up to three-plus years). Safety endpoints included exposure-adjusted patient incidences of adverse events, serious adverse events, and anti-erenumab antibodies. RESULTS In all, 2375 of the patients randomized across the four studies received at least one dose of erenumab (70 mg or 140 mg), with cumulative exposure of 2641.2 patient-years. Exposure-adjusted adverse event rates during the double-blind treatment phase were similar to placebo, with the exception of injection-site reactions (17.1 vs. 10.8 per 100 patient-years), constipation (7.0 vs. 3.8 per 100 patient-years), and muscle spasm (2.3 vs. 1.2 per 100 patient-years). During the long-term extensions, adverse events reported were similar to those observed during the double-blind treatment phase, and rates of injection site reactions, constipation, and muscle spasm were reported at lower rates than in the double-blind treatment phase. There were two deaths reported, both confounded by pre-existing conditions. CONCLUSIONS This pooled safety analysis revealed a favorable and stable adverse event profile over time for erenumab with more than three years of exposure. TRIAL REGISTRATION ClinicalTrials.gov NCT01952574, NCT02483585, NCT02456740, NCT02066415, and NCT02174861.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David Dolezil
- Dado Medical sro, Prague Headache Center, Prague, Czech Republic
| | - Stephen Silberstein
- Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Fei Xue
- Amgen Inc, Thousand Oaks, CA, USA
| | | | | | | | | | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Goadsby PJ, Paemeleire K, Broessner G, Brandes J, Klatt J, Zhang F, Picard H, Lenz R, Mikol DD. Efficacy and safety of erenumab (AMG334) in episodic migraine patients with prior preventive treatment failure: A subgroup analysis of a randomized, double-blind, placebo-controlled study. Cephalalgia 2019; 39:817-826. [PMID: 30982348 DOI: 10.1177/0333102419835459] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Erenumab was effective and well tolerated in a pivotal clinical trial of episodic migraine that included subjects both naïve to, and those who had failed, previous preventives. Here we evaluated the efficacy and safety of erenumab (70 mg or 140 mg) versus placebo in the subgroup of patients who had previously failed preventive treatment(s): ≥1 or ≥2 prior failed migraine preventive categories, and in patients who had never failed. METHODS Prespecified subgroup analyses evaluated change from baseline to months 4-6 (the primary endpoint of the blinded study phase) in monthly migraine days, achievement of ≥50% and ≥75% reduction in monthly migraine days, and change from baseline in acute migraine-specific medication days. Adverse events were also evaluated. RESULTS Treatment with both doses of erenumab resulted in greater reductions in monthly migraine days at months 4-6 (treatment difference versus placebo [95% CI], never failed subgroup: -0.9 [-1.5, -0.3] for 70 mg and -1.3 [-1.9, -0.7] for 140 mg; ≥1 prior failed medication categories subgroup: -2.0 [-2.8, -1.2] for 70 mg and -2.5 [-3.4, -1.7] for 140 mg; ≥2 prior failed medication categories subgroup: -1.3 [-2.6, 0.0] for 70 mg and -2.7 [-4.0, -1.4] for 140 mg). Similar results were observed in the monthly acute migraine-specific medication days endpoint, and in the achievement of ≥50% and ≥75% reduction in monthly migraine days. For the ≥50% reduction in monthly migraine day endpoint, placebo response in the no prior treatment failed group was 32.6%, in the ≥1 failed treatment 17.5%, and in the ≥2 failed treatments 11.1%. CONCLUSION Erenumab showed consistent efficacy in episodic migraine patients who had failed prior preventive treatments and was well tolerated across subgroups. The data suggest prior patients with prior treatment failures have lower placebo response rates.
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Affiliation(s)
- Peter J Goadsby
- 1 NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, UK.,2 SLaM Biomedical Research Centre, King's College London, UK
| | - Koen Paemeleire
- 3 Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Gregor Broessner
- 4 Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan Brandes
- 5 Nashville Neuroscience Group and Vanderbilt University School of Neurology, Nashville, TN, USA
| | - Jan Klatt
- 6 Novartis Pharma AG, Basel, Switzerland
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Schwedt T, Reuter U, Tepper S, Ashina M, Kudrow D, Broessner G, Boudreau GP, McAllister P, Vu T, Zhang F, Cheng S, Picard H, Wen S, Kahn J, Klatt J, Mikol D. Early onset of efficacy with erenumab in patients with episodic and chronic migraine. J Headache Pain 2018; 19:92. [PMID: 30276500 PMCID: PMC6755616 DOI: 10.1186/s10194-018-0923-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/24/2018] [Indexed: 11/12/2022] Open
Abstract
Background Subcutaneous erenumab reduced monthly migraine days and increased the likelihood of achieving a ≥ 50% reduction at all monthly assessment points tested in 2 pivotal trials in episodic migraine (EM) and chronic migraine (CM). Early efficacy of migraine preventive medications is an important treatment characteristic to patients. Delays in achievement of efficacy can result in failed adherence. The objective of these post-hoc analyses were to evaluate efficacy in the first 4 weeks after initial subcutaneous administration of erenumab 70 mg, erenumab 140 mg, or placebo. Methods There is no generally accepted methodology to measure onset of action for migraine preventive medications. We used a comprehensive approach with data from both studies to evaluate change from baseline in weekly migraine days (WMD), achievement of ≥ 50% reduction in WMD, and proportion of patients experiencing migraine measured on a daily basis. The 7-day moving averages were overlaid with observed data. Results In both studies (EM: N = 955; CM: N = 667), there was evidence of onset of efficacy of erenumab vs. placebo during the first week of treatment, which in some cases reached nominal significance. For EM the changes in WMD were (least squares mean [LSM] [95% CI]): placebo, − 0.1 (− 0.3, 0.0); erenumab 70 mg, − 0.3 (− 0.5, − 0.2) p = 0.130; erenumab 140 mg, − 0.6 (− 0.7, − 0.4) p < 0.001. For CM the changes were: placebo, − 0.5 (− 0.8, − 0.3); erenumab 70 mg, − 0.9 (− 1.2, − 0.7) p = 0.047; erenumab 140 mg, − 0.8 (− 1.1, − 0.5) p = 0.18. Achievement of ≥ 50% reduction in WMD was observed as early as Week 1 (adjusted OR [95% CI] erenumab vs placebo) in EM: erenumab 70 mg, 1.3 (1.0, 1.9) p = 0.097; erenumab 140 mg, 2.0 (1.4, 2.7) p < 0.001. A similar outcome was observed for CM: erenumab 70 mg, 1.8 (1.1, 2.8) p = 0.011; erenumab 140 mg, 1.9 (1.2, 2.9) p = 0.009. Seven-day moving averages of observed data showed each treatment arm differed from placebo by Week 1 (OR [95% CI]): in EM Day 3 for erenumab 140 mg, 0.7 (0.5, 1.0) p = 0.031 and at Day 7 for 70 mg, 0.6 (0.4, 0.8) p = 0.002; in CM: Day 6 for erenumab 70 mg, 0.6 (0.4, 0.9) p = 0.022 and at Day 7 for 140 mg, 0.7 (0.4, 1.0); p = 0.038. Conclusion Erenumab showed early onset of efficacy with separation from placebo within the first week of treatment in both chronic and episodic migraine patients.
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Affiliation(s)
- Todd Schwedt
- Department of Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stewart Tepper
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Guy P Boudreau
- Clinique de la Migraine et Céphalées, Département de Neurologie, Centre Hospitalier de L'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada
| | - Peter McAllister
- New England Institute for Neurology & Headache, Stamford, CT, USA
| | - Thuy Vu
- Amgen Inc., Thousand Oaks, CA, USA
| | | | | | | | - Shihua Wen
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Joseph Kahn
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Buse DC, Lipton RB, Hallström Y, Reuter U, Tepper SJ, Zhang F, Sapra S, Picard H, Mikol DD, Lenz RA. Migraine-related disability, impact, and health-related quality of life among patients with episodic migraine receiving preventive treatment with erenumab. Cephalalgia 2018; 38:1622-1631. [DOI: 10.1177/0333102418789072] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background We evaluated the effect of erenumab, a fully human monoclonal antibody that inhibits the canonical calcitonin gene-related peptide receptor, on migraine-related disability, impact, and health-related quality of life among patients with episodic migraine. Methods Patients enrolled in a phase 3, 6-month, double-blind, placebo-controlled study of once-monthly erenumab 70 and 140 mg for migraine prevention (STRIVE) used an eDiary during the baseline and double-blind treatment phases to complete validated, specific questionnaires, including the modified (monthly) Migraine Disability Assessment Questionnaire; Headache Impact Test; and Migraine-Specific Quality of Life Questionnaire-role function-restrictive (MSQ-RFR), -role function-preventive (MSQ-RFP), and -emotional function (MSQ-EF). Results A total of 955 patients were randomized to receive erenumab 70 mg (n = 317), erenumab 140 mg (n = 319), or placebo (n = 319). Erenumab versus placebo resulted in significantly greater improvements in all patient-reported outcomes; changes from baseline were numerically higher with 140 mg erenumab. Improvements occurred rapidly and were maintained over 6 months of treatment. Between-group differences from placebo over months 4–6 for the 70- and 140-mg dose groups were, respectively, −2.1 and −2.8 for modified (monthly) Migraine Disability Assessment Questionnaire, −2.1 and −2.3 for Headache Impact Test, 5.1 and 6.5 for MSQ-RFR, 4.2 and 5.4 for MSQ-RFP, and 5.2 and 6.7 for MSQ-EF ( p < 0.001 for all). Erenumab also significantly reduced the proportion of patients with severe and very severe migraine-related disability and increased the proportion of patients with clinically meaningful improvements in migraine-related impact and health-related quality of life. Conclusion Erenumab reduced migraine disability and impact and improved patients’ health-related quality of life, reinforcing its role as a promising new therapy for migraine prevention.
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Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, New York, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, New York, NY, USA
| | | | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stewart J Tepper
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Feng Zhang
- Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA, USA
| | - Sandhya Sapra
- Global Health Economics, Amgen Inc., Thousand Oaks, CA, USA
| | - Hernan Picard
- Global Development, Amgen Inc., Thousand Oaks, CA, USA
| | | | - Robert A Lenz
- Global Development, Amgen Inc., Thousand Oaks, CA, USA
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Dodick DW, Ashina M, Brandes JL, Kudrow D, Lanteri-Minet M, Osipova V, Palmer K, Picard H, Mikol DD, Lenz RA. ARISE: A Phase 3 randomized trial of erenumab for episodic migraine. Cephalalgia 2018; 38:1026-1037. [DOI: 10.1177/0333102418759786] [Citation(s) in RCA: 312] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Calcitonin gene-related peptide plays an important role in migraine pathophysiology. Erenumab, a human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor, is being evaluated for migraine prevention. Methods In this randomized, double-blind, placebo-controlled, phase 3 study, 577 adults with episodic migraine were randomized to placebo or 70 mg erenumab; 570 patients were included in efficacy analyses. Primary endpoint was change in monthly migraine days. Secondary endpoints were ≥50% reduction in monthly migraine days, change in acute migraine-specific medication treatment days, and ≥5-point reduction in Physical Impairment and Impact on Everyday Activities domain scores measured by the Migraine Physical Function Impact Diary. All endpoints assessed change from baseline at month 3. Results Patients receiving erenumab experienced −2.9 days change in monthly migraine days, compared with −1.8 days for placebo, least-squares mean (95% CI) treatment difference of −1.0 (−1.6, −0.5) ( p < 0.001). A ≥ 50% reduction in monthly migraine days was achieved by 39.7% (erenumab) and 29.5% (placebo) of patients (OR:1.59 (95% CI: 1.12, 2.27) ( p = 0.010). Migraine-specific medication treatment days were reduced by −1.2 (erenumab) and −0.6 (placebo) days, a treatment difference of −0.6 (−1.0, −0.2) ( p = 0.002). The ≥5-point reduction rates in Migraine Physical Function Impact Diary – Physical Impairment were 33.0% and 27.1% (OR:1.33 (0.92, 1.90) ( p = 0.13) and in Migraine Physical Function Impact Diary – Everyday Activities were 40.4% and 35.8% (OR:1.22 (0.87, 1.71) ( p = 0.26). Safety and adverse event profiles of erenumab were similar to placebo. Most frequent adverse events were upper respiratory tract infection, injection site pain, and nasopharyngitis. Conclusions As a preventive treatment of episodic migraine, erenumab at a dosage of 70 mg monthly significantly reduced migraine frequency and acute migraine-specific medication use. (Funded by Amgen). Trial registration ClinicalTrials.gov, NCT02483585.
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Affiliation(s)
| | - Messoud Ashina
- Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Lewis Brandes
- Department of Neurology, Vanderbilt University School of Medicine and Nashville Neuroscience Group, Nashville, TN, USA
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | | | - Vera Osipova
- Neurological Research Department, First Sechenov Moscow State Medical University and Research Center for Neuropsychiatry, Moscow, Russia
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Goadsby PJ, Reuter U, Hallström Y, Broessner G, Bonner JH, Zhang F, Sapra S, Picard H, Mikol DD, Lenz RA. A Controlled Trial of Erenumab for Episodic Migraine. N Engl J Med 2017; 377:2123-2132. [PMID: 29171821 DOI: 10.1056/nejmoa1705848] [Citation(s) in RCA: 523] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We tested erenumab, a fully human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor, for the prevention of episodic migraine. METHODS We randomly assigned patients to receive a subcutaneous injection of either erenumab, at a dose of 70 mg or 140 mg, or placebo monthly for 6 months. The primary end point was the change from baseline to months 4 through 6 in the mean number of migraine days per month. Secondary end points were a 50% or greater reduction in mean migraine days per month, change in the number of days of use of acute migraine-specific medication, and change in scores on the physical-impairment and everyday-activities domains of the Migraine Physical Function Impact Diary (scale transformed to 0 to 100, with higher scores representing greater migraine burden on functioning). RESULTS A total of 955 patients underwent randomization: 317 were assigned to the 70-mg erenumab group, 319 to the 140-mg erenumab group, and 319 to the placebo group. The mean number of migraine days per month at baseline was 8.3 in the overall population; by months 4 through 6, the number of days was reduced by 3.2 in the 70-mg erenumab group and by 3.7 in the 140-mg erenumab group, as compared with 1.8 days in the placebo group (P<0.001 for each dose vs. placebo). A 50% or greater reduction in the mean number of migraine days per month was achieved for 43.3% of patients in the 70-mg erenumab group and 50.0% of patients in the 140-mg erenumab group, as compared with 26.6% in the placebo group (P<0.001 for each dose vs. placebo), and the number of days of use of acute migraine-specific medication was reduced by 1.1 days in the 70-mg erenumab group and by 1.6 days in the 140-mg erenumab group, as compared with 0.2 days in the placebo group (P<0.001 for each dose vs. placebo). Physical-impairment scores improved by 4.2 and 4.8 points in the 70-mg and 140-mg erenumab groups, respectively, as compared with 2.4 points in the placebo group (P<0.001 for each dose vs. placebo), and everyday-activities scores improved by 5.5 and 5.9 points in the 70-mg and 140-mg erenumab groups, respectively, as compared with 3.3 points in the placebo group (P<0.001 for each dose vs. placebo). The rates of adverse events were similar between erenumab and placebo. CONCLUSIONS Erenumab administered subcutaneously at a monthly dose of 70 mg or 140 mg significantly reduced migraine frequency, the effects of migraines on daily activities, and the use of acute migraine-specific medication over a period of 6 months. The long-term safety and durability of the effect of erenumab require further study. (Funded by Amgen and Novartis; STRIVE ClinicalTrials.gov number, NCT02456740 .).
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Affiliation(s)
- Peter J Goadsby
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
| | - Uwe Reuter
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
| | - Yngve Hallström
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
| | - Gregor Broessner
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
| | - Jo H Bonner
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
| | - Feng Zhang
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
| | - Sandhya Sapra
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
| | - Hernan Picard
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
| | - Daniel D Mikol
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
| | - Robert A Lenz
- From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA
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Lecler A, Obadia M, Savatovsky J, Picard H, Charbonneau F, Menjot de Champfleur N, Naggara O, Carsin B, Amor-Sahli M, Cottier JP, Bensoussan J, Auffray-Calvier E, Varoquaux A, De Gaalon S, Calazel C, Nasr N, Volle G, Jianu DC, Gout O, Bonneville F, Sadik JC. TIPIC Syndrome: Beyond the Myth of Carotidynia, a New Distinct Unclassified Entity. AJNR Am J Neuroradiol 2017; 38:1391-1398. [PMID: 28495942 DOI: 10.3174/ajnr.a5214] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/05/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The differential diagnosis of acute cervical pain includes nonvascular and vascular causes such as carotid dissection, carotid occlusion, or vasculitis. However, some patients present with unclassified vascular and perivascular changes on imaging previously reported as carotidynia. The aim of our study was to improve the description of this as yet unclassified clinico-radiologic entity. MATERIALS AND METHODS From January 2009 through April 2016, 47 patients from 10 centers presenting with acute neck pain or tenderness and at least 1 cervical image showing unclassified carotid abnormalities were included. We conducted a systematic, retrospective study of their medical charts and diagnostic and follow-up imaging. Two neuroradiologists independently analyzed the blinded image datasets. RESULTS The median patient age was 48 years. All patients presented with acute neck pain, and 8 presented with transient neurologic symptoms. Imaging showed an eccentric pericarotidian infiltration in all patients. An intimal soft plaque was noted in 16 patients, and a mild luminal narrowing was noted in 16 patients. Interreader reproducibility was excellent. All patients had complete pain resolution within a median of 13 days. At 3-month follow-up, imaging showed complete disappearance of vascular abnormalities in 8 patients, and a marked decrease in all others. CONCLUSIONS Our study improved the description of an unclassified, clinico-radiologic entity, which could be described by the proposed acronym: TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome.
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Affiliation(s)
- A Lecler
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | | | - J Savatovsky
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | - H Picard
- Clinical Research Unit (H.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Charbonneau
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | - N Menjot de Champfleur
- Department of Neuroradiology (N.M.d.C.), Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - O Naggara
- Department of Neuroradiology (O.N.), Centre Hospitalier Sainte-Anne, Paris, France
| | - B Carsin
- Department of Radiology (B.C.), Centre Hospitalier Régional Universitaire de Rennes, Rennes, France
| | - M Amor-Sahli
- Department of Neuroradiology (M.A.-S.), Pitié-Salpêtrière Hospital, Paris, France.,Centre D'imagerie Médicale Tourville (M.A.-S.), Paris, France
| | - J P Cottier
- Department of Radiology (J.P.C.), Centre Hospitalier Régional Universitaire de Tours, Tours, France.,Brain and Imaging Laboratory Unite Mixte de Recherche U930 (J.P.C.), Institut National de la Santé et de la Recherche Médicale, François-Rabelais University, Tours, France
| | - J Bensoussan
- Department of Radiology (J.B.), Hotel-Dieu Hospital, Paris, France
| | | | - A Varoquaux
- Department of Radiology (A.V.), Conception Hospital, Aix-Marseille University, Marseille, France
| | - S De Gaalon
- Neurology Department (S.D.G.), Hôpital René et Guillaume-Laënnec, Centre Hospitalier Universitaire de Nantes, Saint-Herblain, France
| | - C Calazel
- Departments of Neuroradiology (C.C., F.B.)
| | - N Nasr
- Neurology (N.N.), Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - G Volle
- Neurology (M.O., G.V., O.G.)
| | - D C Jianu
- Department of Neurology (D.C.J.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - O Gout
- Neurology (M.O., G.V., O.G.)
| | | | - J C Sadik
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
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Goadsby PJ, Reuter U, Bonner J, Broessner G, Hallstrom Y, Zhang F, Sapra S, Picard H, Mikol D, Lenz R. Phase 3, randomised, double-blind, placebo-controlled study to evaluate the efficacy and safety of erenumab (amg 334) in migraine prevention: primary results of the strive trial. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-316074.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dodick D, Ashina M, Kudrow D, Lanteri-Minet M, Osipova V, Palmer K, Picard H, Mikol DD, Lenz RA. A phase 3, randomised, double-blind, placebo-controlled study to evaluate the efficacy and safety of erenumab in migraine prevention: primary results of the arise trial. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-316074.63] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lecler A, Boucenna M, Lafitte F, Koskas P, Nau E, Jacomet PV, Galatoire O, Morax S, Putterman M, Mann F, Héran F, Sadik JC, Picard H, Bergès O. Usefulness of colour Doppler flow imaging in the management of lacrimal gland lesions. Eur Radiol 2016; 27:779-789. [PMID: 27271920 DOI: 10.1007/s00330-016-4438-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 03/03/2016] [Accepted: 05/23/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the role of colour Doppler flow imaging (CDFI) in the diagnosis and management of lacrimal fossa lesions. METHODS Institutional ethical committee approval was obtained. Fifty-one patients with 62 lacrimal fossa lesions were retrospectively included from 2003-2015. All patients underwent conventional ultrasonography and CDFI, with a qualitative and quantitative analysis of the vascularization. All patients had lacrimal gland surgery. Definitive diagnosis was based on pathological examination. RESULTS The study included 47 non-epithelial lesions (NEL) and 15 epithelial lesions (EL), with 24 (39 %) malignant lesions and 38 (61 %) benign lesions. NEL were significantly more likely to present with septa (p < 0.001), hypoechogenicity (p < 0.001), high vascular intensity (p < 0.001), both central and peripheral vascularization (p < 0.001), tree-shape vascularization (p < 0.05) and a low resistance index (RI) (p < 0.0001). EL were significantly more likely to present with the presence of cysts (p < 0.001), and a higher RI. Receiver operating characteristic curves identified a RI value of 0.72 as the best cut-off to differentiate NEL from EL, with a sensitivity and specificity of 100 %. CONCLUSION CDFI is a valuable tool in the differential diagnosis of lacrimal fossa lesions. Resistance index measurement enables substantial distinction between EL and NEL, thus providing crucial data for surgical management. KEY POINTS • CDFI is a valuable tool in lacrimal fossa lesions. • Resistance Index measurement enables substantial distinction between epithelial and non-epithelial lesions. • Management of patients becomes more appropriate.
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Affiliation(s)
- A Lecler
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France.
| | - M Boucenna
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - F Lafitte
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - P Koskas
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - E Nau
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - P V Jacomet
- Department of Orbito Palpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - O Galatoire
- Department of Orbito Palpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Morax
- Department of Orbito Palpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Putterman
- Department of Pathology (M.P.), Necker-Enfants Malades Hospital APHP, Paris, France
| | - F Mann
- Department of Orbito Palpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Héran
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - J C Sadik
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
| | - H Picard
- Clinical Research Unit, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - O Bergès
- Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France
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Schacht A, Gorwood P, Boyce P, Schaffer A, Picard H. Depression symptom clusters and their predictive value for treatment outcomes: results from an individual patient data meta-analysis of duloxetine trials. J Psychiatr Res 2014; 53:54-61. [PMID: 24572681 DOI: 10.1016/j.jpsychires.2014.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 01/30/2014] [Accepted: 02/03/2014] [Indexed: 12/28/2022]
Abstract
We evaluated individual patient data from phase II to IV clinical trials of duloxetine in major depressive disorder (MDD) (34 studies, 13,887 patients). Our goal was to identify clusters of patients with similar depressive symptom patterns at baseline, as measured by the 17-item Hamilton Depression Rating Scale (HAMD-17), and to investigate their respective predictive value of outcomes as measured by the HAMD-17 total score. Five clusters were identified at baseline: 1) "Lack of insight"; 2) "Sleep/sexual/somatic"; 3) "Typical MDD"; 4) "Gastrointestinal/weight loss"; and 5) "Mild MDD". However, it should be noted that cluster descriptors are not mutually exclusive. Analyses of the HAMD-17 total score results over time were performed using the 18 randomized placebo and/or actively controlled studies representing 6723 patients. At the end of acute treatment (ranging from 4 to 36 weeks), different levels of effect sizes for active therapy (64.5% duloxetine) vs. placebo were detected by cluster. In 3 out of 5 clusters (representing about 80% of the patients), the effect size was significantly different from 0, in favor of active therapy. The effect size was largest in those clusters with severe somatic symptoms ("Sleep/sexual/somatic" cluster [-0.4170], and "Gastrointestinal/weight loss" cluster [-0.338]). In conclusion, our cluster analysis identified 5 clinically relevant MDD patient clusters with specific mean treatment outcomes. Identification of MDD clusters may help to improve outcomes by adapting MDD treatment to particular clinical profiles.
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Affiliation(s)
- Alexander Schacht
- Lilly Deutschland GmbH, Global Statistical Sciences, Bad Homburg, Germany.
| | - Philip Gorwood
- Sainte-Anne Hospital (CMME), Paris Descartes University, INSERM UMR894, Paris, France
| | - Philip Boyce
- University of Sydney, Sydney Medical School, Discipline of Psychiatry, Sydney, NSW, Australia; Westmead Hospital, Department of Psychiatry, Wentorthville, NSW, Australia
| | - Ayal Schaffer
- University of Toronto, Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, ON, Canada
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Vinckier F, Cohen L, Oppenheim C, Salvador A, Picard H, Amado I, Krebs MO, Gaillard R. Reading impairment in schizophrenia: Dysconnectivity within the visual system. Neuropsychologia 2014; 53:187-96. [DOI: 10.1016/j.neuropsychologia.2013.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/28/2013] [Accepted: 10/13/2013] [Indexed: 12/31/2022]
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Romera I, Pérez V, Menchón JM, Schacht A, Papen R, Neuhauser D, Abbar M, Picard H, Gilaberte I. Early vs. conventional switching of antidepressants in patients with MDD and moderate to severe pain: a double-blind randomized study. J Affect Disord 2012; 143:47-55. [PMID: 22858211 DOI: 10.1016/j.jad.2012.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/17/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Concomitant painful physical symptoms in depressive patients frequently impair functioning and failure to treat these symptoms may adversely impact treatment outcomes of depression. Early vs. conventional switch of antidepressants were compared in patients with major depressive disorder (MDD) and moderate to severe pain. METHOD Pre-specified subgroup analysis of a 16-week, randomized, double-blind clinical study on MDD patients with >30 mm overall pain visual analog scale (VAS). Patients not achieving 30% reduction Hamilton Depression Rating Scale (HAM-D) after 4 weeks escitalopram (10 mg/day) were randomized to duloxetine 60-120 mg/day (early switch) or continued on escitalopram (conventional switch) with non-responders at week 8 switching to duloxetine. Endpoints were time to confirmed response and remission, VAS pain severity, and Sheehan disability scale (SDS). Switch strategies were compared using Kaplan-Meier, logistic regression, and repeated measures analyses. RESULTS No differences between early and conventional switching were found in time to confirmed response after randomization (3.9 vs. 4.1 weeks, p=0.511) or remission (6.0 vs. 8.0 weeks, p=0.238). Significantly lower VAS mean pain levels at for overall pain, headache, back pain, shoulder pain, interference with daily activities, and time being awake in pain were found for patients in the early switching group. Time to achieving normal functioning (SDS total score <6) was shorter in the early switching group (p=0.042). Safety results were comparable between switch strategies. CONCLUSIONS In MDD patients with moderate to severe painful physical symptoms not improving after 4 weeks of treatment with escitalopram, an earlier switch to duloxetine may lead to better pain and functional outcomes.
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Affiliation(s)
- Irene Romera
- Medical Department, Eli Lilly and Company, Madrid 28108, Spain.
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Dantchev N, Tcherny-Lessenot S, Picard H, Baraille L, Quail D. [Results of the French cohort of the European observational study FINDER: quality of life of patients treated with antidepressants]. Encephale 2012; 39:101-8. [PMID: 23095580 DOI: 10.1016/j.encep.2012.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 03/07/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe health-related quality of life (HRQoL), pain, clinical outcomes and treatment patterns in French patients with depression treated by general practitioners and psychiatrists. METHODS Factors Influencing Depression Endpoints Research (FINDER) is a European longitudinal observational, naturalistic, multicentre study to determine the HRQoL (SF-36 and EQ-5D) and to assess outcomes of depression and anxiety (Hospital Anxiety and Depression Scale [HADS]), and pain (VAS) in a population of depressed patients initiating antidepressant treatment. Clinical diagnosis of depression was based on physician's clinical judgment. Physicians decided at their own discretion and clinical practice to initiate pharmacological treatment for depression. Adult patients with a first or new episode of depression were enrolled between May 2004 and September 2005, and followed up for 6 months. Across Europe, 437 physicians observed 3468 patients. RESULTS In France, 606 patients (approximately 17% of the whole sample) were enrolled by 57 psychiatrists and 46 general practitioners. These patients were (mean ± SD) 45.6 ± 13.0 years old, 69% female and 39% having had a previous depressive episode in the last 2 years. According to the patient-rated HADS score greater or equal to 11, most patients (75%) were classified as cases of depression as well as cases of anxiety (84%); 51% of patients rated their overall pain severity (based on VAS cut-off of 30 mm) as moderate/severe, with 65% of these patients reporting no medical explanation for their pain. The majority (81%) of the patients were prescribed selective serotonin reuptake inhibitors (SSRI). During the 6-month follow-up, the majority of the patients (73%) remained on the same antidepressant at the same dose during the course of treatment. Between baseline and 6-month endpoint, French patients improved their mean scores (SD) on the SF-36 physical score by+3.5 (9.0) (P<0.001) and mental score by+20.6 (14.2) (P<0.001); on the EQ-5D Health State Index by+0.37 (0.32) (P<0.001) and the EQ-5D VAS by+32.3 (25.0) (P<0.001); on the HADS depression score by-8.1 (6.0) (P<0.001) and HADS anxiety score by-6.9 (5.0) (P<0.001). Patients with moderate/severe pain at baseline improved their overall pain on a mean VAS score by-34.1 (28.7) (P<0.001). CONCLUSIONS More than half of the French patients enrolled in the study experienced pain associated with depression. During follow-up, patients improved all of their outcome measurements (physical and mental SF-36 scores, depression and anxiety HADS scores, pain VAS, EQ-5D Health State Index and VAS) and most patients remained on the same antidepressant at the same dose.
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Affiliation(s)
- N Dantchev
- Unité de psychiatrie, Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75181 Paris cedex 4, France.
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Gourion D, Galinowski A, Baraille L, Picard H. Changer d’antidépresseur : quand, comment, pourquoi ? Encephale 2011; 37 Suppl 1:S50-7. [DOI: 10.1016/j.encep.2010.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 04/15/2010] [Indexed: 10/16/2022]
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Picard H. Dr. Max Meyerhof, F.I.C.S.: a tribute. Korot 2001; 11:8-11. [PMID: 11618566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Guiard-Schmid JB, Picard H, Slama L, Maslo C, Amiel C, Pialoux G, Lebrette MG, Rozenbaum W. [Piercing and its infectious complications. A public health issue in France]. Presse Med 2000; 29:1948-56. [PMID: 11244629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
CHARACTERISTIC FEATURES: Piercing, an act that modifies the body, has progressed considerably in France over the last few years. The population involved has grown and become more diversified. Performed with a solid needle or a catheter, a wide variety of anatomic localizations are concerned, particularly the nose, ears, and navel. The shape of the "rings", generally made of surgical steel, niobium or titanium, varies greatly. Wound healing by epithelialisation can take up to several months. INFECTIOUS RISK: Between 10% and 20% of all piercings lead to a local infection. The most commonly found causal agests are Staphylococcus aureus, group A Streptococcus and Pseudomonas sp. These germs can cause severe life-threatening complications even in common localizations (earlobe). Viral transmission is another risk (hepatitis B, hepatitis C, hepatitis delta, HIV). A few cases of fatal fulminant hepatitis have been described immediately after piercing. SAFETY MEASURES: Generally performed under less than desirable sanitary conditions, safety measures are needed for piercing. Among professional "piercers", a certain number have emphasized the need for providing their clients with safer services. The prevention of infection risk should be a priority for all. Work along this line has been done in the United States and Canada. In light of the impact on public health, it is important to rapidly develop guidelines and regulations for piercing in France. Both professional piercers and health care workers should participate in developing these safety measures in order to assure their implementation.
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Affiliation(s)
- J B Guiard-Schmid
- Service des Maladies infectieuses et tropicales, Hôpital Rothschild, 33, boulevard de Picpus, F75571 Paris
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Affiliation(s)
- H Picard
- Canadian Association of Occupational Therapists, Université de Montréal, C.P. 6128 Succursale centre-ville, Montréal, Québec H3C 3J7.
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Moncorgé C, Picard H. [Evaluation of the population received and cared for in France in the "Doctors of the World" Health Centers]. Bull Acad Natl Med 1997; 181:1701-12; discussion 1712-3. [PMID: 9554128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For 11 years now, Médecins du Monde's Mission to France has tried to respond to the needs of a part of marginalized population, which has no access to health care. In 1996, 72,000 consultations have been given throughout the 31 free Health centers based in 31 cities in France. Who is this population? Basically young people (more than half are under the age of 30 and 10% are underaged), men in 213 of the cases, living alone, in 80% of the cases. How do they live? Almost 65% live with less than 20 francs per day (given by social care); 54% are officially jobless. As far as housing is concerned, only 1/4 have a home (women in particular). The others live in hostels, self-made shelters, hotels, or with relatives; 13% admit living on the street. Why do they come to health centers? Almost all diseases observed are identical to the ones detected in regular Health care centers, i.e., Ear--Nose and Throat, respiratory and gynecological infections. What makes them particular is the fact they are diagnosed later than usual, which makes them more serious than usual. The living conditions of this marginalized population explain the high frequency of skin problems (12%) and neuropsychologic disorders. Why do they come to Médecins du Monde? 1/4 of the patients do benefit from social welfare, but are unable to advance the payment of medical costs, or support the difference between the actual cost and the reimbursement by the Social security. 40% have no social coverage whatsoever. However, other motives (1 to 7%) such as administrative problems, rights outside their district, refusal to start the administrative procedures, ignorance of their rights ... are rarely put forward. The population with no access to health care is still unknown. This is why the information gathered is so important. It allows a better qualification of the patients' requests and, consequently, a better comprehension of the social exclusion phenomenon, particularly in the area of health.
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Braden B, Picard H, Caspary WF, Posselt HG, Lembcke B. Monitoring pancreatin supplementation in cystic fibrosis patients with the 13C-Hiolein breath test: evidence for normalized fat assimilation with high dose pancreatin therapy. Z Gastroenterol 1997; 35:123-9. [PMID: 9066102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND 13C-Hiolein is a randomly 13C-labeled mixture of long chain triglycerides synthesized by algae. METHODS Because the 13C-Hiolein breath test is a suitable noninvasive tool to detect and monitor pancreatic steatorrhea, we used this new breath test for monitoring the effect of enzyme replacement therapy with an acid resistant enteric coated polydisperse pancreatin preparation (1.500 U/kg d) in children with cystic fibrosis. RESULTS Administration of 1.5 mg/kg 13-C-Hiolein together with a physiological mixed meal (1.5 g/kg rice cookies, containing 25% fat and 37% starch) resulted in significantly higher breath 13CO2/12CO2 ratios in controls than in cystic fibrosis children (maximal delta over baseline responses (DOBmax) 39.2 +/- 18.1% vs. 13.1 +/-13.9%; p < 0.001). With pancreatin, DOBmax in the cystic fibrosis patients responses returned completely to normal (39.2 +/- 29.2% DOBmax). A breath hydrogen increase indicating the malassimilation of starch was noticed in one patient with severe pancreatic insufficiency only. CONCLUSION In contrast to fecal fat analysis, the 13C-Hiolein breath test reflects postprandial fat assimilation immediately after a given, labeled meal. Monitoring the oxidative fate of physiological test meal with a stable isotope breath test, this study shows that fat assimilation in cystic fibrosis patients can be normalized with high dose pancreatin.
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Affiliation(s)
- B Braden
- Medical Department II, University of Frankfurt/Main, Germany
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Picard H. Un cas de zona à troubles nerveux uniquement vasomoteurs. Dermatology 1948. [DOI: 10.1159/000257352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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