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Romero Del Rincón C, Gonzalez-Martinez A, Quintas S, García-Azorín D, Fernández Lázaro I, Guerrero-Peral AL, Gonzalez Osorio Y, Santos-Lasaosa S, González Oria C, Sánchez Rodríguez N, Iglesias Díez F, Echavarría Íñiguez A, Gil Luque S, Huerta-Villanueva M, Campoy Díaz S, Muñoz-Vendrell A, Lozano Ros A, Sánchez-Soblechero A, Velasco Juanes F, Kortazar-Zubizarreta I, Echeverría A, Rodríguez-Vico J, Jaimes Sánchez A, Gómez García A, Morollón Sánchez-Mateos N, Belvis R, Navarro Pérez MP, García-Moncó JC, Álvarez Escudero MR, Montes N, Gago-Veiga AB. RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine. Eur J Neurol 2024; 31:e16203. [PMID: 38270379 DOI: 10.1111/ene.16203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND PURPOSE According to the latest European guidelines, discontinuation of monoclonal antibodies against calcitonin gene-related peptide (anti-CGRP MAb) may be considered after 12-18 months of treatment. However, some patients may worsen after discontinuation. In this study, we assessed the response following treatment resumption. METHODS This was a prospective study conducted in 14 Headache Units in Spain. We included patients with response to anti-CGRP MAb with clinical worsening after withdrawal and resumption of treatment. Numbers of monthly migraine days (MMD) and monthly headache days (MHD) were obtained at four time points: before starting anti-CGRP MAb (T-baseline); last month of first treatment period (T-suspension); month of restart due to worsening (T-worsening); and 3 months after resumption (T-reintroduction). The response rate to resumption was calculated. Possible differences among periods were analysed according to MMD and MHD. RESULTS A total of 360 patients, 82% women, with a median (interquartile range [IQR]) age at migraine onset of 18 (12) years. The median (IQR) MHD at T-baseline was 20 (13) and MMD was 5 (6); at T-suspension, the median (IQR) MHD was 5 (6) and MMD was 4 (5); at T-worsening, the median (IQR) MHD was 16 (13) and MMD was 12 (6); and at T-reintroduction, the median (IQR) MHD was 8 (8) and MHD was 5 (5). In the second period of treatment, a 50% response rate was achieved by 57.4% of patients in MHD and 65.8% in MMD. Multivariate models showed significant differences in MHD between the third month after reintroduction and last month before suspension of first treatment period (p < 0.001). CONCLUSION The results suggest that anti-CGRP MAb therapy is effective after reintroduction. However, 3 months after resumption, one third of the sample reached the same improvement as after the first treatment period.
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Affiliation(s)
- Celia Romero Del Rincón
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Alicia Gonzalez-Martinez
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Sonia Quintas
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - David García-Azorín
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Iris Fernández Lázaro
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Angel Luis Guerrero-Peral
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | | | | | | | | | | | | | - Sendoa Gil Luque
- Headache Unit, Hospital Clínico Universitario de Burgos, Burgos, Spain
| | - Mariano Huerta-Villanueva
- Neurology Department of Neurology, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
- Servicio de Neurología, Unidad de Cefaleas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Campoy Díaz
- Neurology Department of Neurology, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
- Servicio de Neurología, Unidad de Cefaleas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Muñoz-Vendrell
- Servicio de Neurología, Unidad de Cefaleas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Izaro Kortazar-Zubizarreta
- Department of Neurology, Hospital de Álava, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Spain
| | - Amaya Echeverría
- Department of Neurology, Hospital de Álava, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Spain
| | | | | | | | | | - Robert Belvis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Nuria Montes
- Unidad de Metodología, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Servicio de Reumatología, Hospital Universitario La Princesa, Madrid, Spain
- Plant Physiology, Pharmaceutical and Health Sciences Department, Faculty of Pharmacy, Universidad San Pablo-CEU, CEU-Universities, Boadilla del Monte, Spain
| | - Ana Beatriz Gago-Veiga
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Gonzalez-Martinez A, Sanz-García A, García-Azorín D, Rodríguez-Vico J, Jaimes A, Gómez García A, Casas-Limón J, Díaz de Terán J, Sastre-Real M, Membrilla J, Latorre G, Calle de Miguel C, Gil Luque S, Trevino-Peinado C, Quintas S, Heredia P, Echavarría-Íñiguez A, Guerrero-Peral Á, Sierra Á, González-García N, Porta-Etessam J, Gago-Veiga AB. Effectiveness, tolerability, and response predictors of preventive anti-CGRP mAbs for migraine in patients over 65 years old: a multicenter real-world case-control study. Pain Med 2024; 25:194-202. [PMID: 37847661 DOI: 10.1093/pm/pnad141] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/19/2023] [Accepted: 10/08/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To evaluate clinical characteristics, effectiveness, and tolerability of preventive anti- calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) in the elderly. Anti-CGRP mAbs have demonstrated efficacy and safety in patients with migraine although there is limited information regarding the elderly. DESIGN We performed a multicenter case-control study of cases (patients over 65 years old) and controls (sex-matched patients under 55 years old) with migraine receiving anti-CGRP mAbs. METHODS We included the demographic characteristics, effectiveness-reduction in the number of monthly headache days (MHD) and monthly migraine days (MMD), 30%, 50%, and 75% responder rates-and treatment emergent adverse events (TEAEs). The primary endpoint was the 50% response rate regarding MHD at weeks 20-24; exploratory 50% response predictors in the elderly were evaluated. RESULTS In total, 228 patients were included: 114 cases , 114 controls-. Among cases 84.2% (96/114) were women, 79.8% (91/114) CM; mean age of cases 70.1 years old (range: 66-86); mean age of controls was 42.9 years old(range: 38-49). Cases had a higher percentage of vascular risk factors (P < .05),older age of onset (P < .001) and more reported prior preventive treatments (P < .001). Regarding effectiveness in cases, 50% response rate was achieved by 57.5% (42/73) at 20-24 weeks, with lower reduction in the MHD at 8-12 weeks (5 [7.2], 8 [9.1]; P = .001) and a higher reduction in MMD at 20-24 weeks (10.7 [9.1], 9.2 [7.7]; P = .04) compared to the control group. The percentage of TEAEs was similar in the 2 groups. Diagnosis of episodic migraine (EM) (P = .03) and lower number of MHD at baseline (P = .001) were associated with a 50% response in the elderly in univariate analysis. CONCLUSIONS Our study provides real world evidence of effectiveness and safety of anti-CGRP mAbs for migraine in patients without upper age-limit and possible predictors of anti-CGRP response in the elderly.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Madrid 28006, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Madrid 28049, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Hospital Universitario de la Princesa, Madrid, Madrid 28006, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León 47003, Spain
- Department of Medicine, University of Valladolid, Valladolid, Castilla y León 47003, Spain
| | - Jaime Rodríguez-Vico
- Headache Unit, Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid 28040, Spain
| | - Alex Jaimes
- Headache Unit, Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid 28040, Spain
| | - Andrea Gómez García
- Headache Unit, Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid 28040, Spain
| | - Javier Casas-Limón
- Headache Unit, Neurology Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid 28922, Spain
| | - Javier Díaz de Terán
- Headache Unit, Neurology Department, Hospital Universitario La Paz, Madrid, Madrid 28046, Spain
| | - María Sastre-Real
- Headache Unit, Neurology Department, Hospital Universitario La Paz, Madrid, Madrid 28046, Spain
| | - Javier Membrilla
- Headache Unit, Neurology Department, Hospital Universitario La Paz, Madrid, Madrid 28046, Spain
| | - Germán Latorre
- Headache Unit, Neurology Department, Hospital Universitario de Fuenlabrada, Madrid, Madrid 28942, Spain
| | - Carlos Calle de Miguel
- Headache Unit, Neurology Department, Hospital Universitario de Fuenlabrada, Madrid, Madrid 28942, Spain
| | - Sendoa Gil Luque
- Headache Unit, Neurology Department, Hospital Universitario de Burgos, Burgos, Castilla y León 09006, Spain
| | - Cristina Trevino-Peinado
- Headache Unit, Neurology Department, Hospital Universitario Severo Ochoa, Leganés, Madrid 28914, Spain
| | - Sonia Quintas
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Madrid 28006, Spain
| | - Patricia Heredia
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Madrid 28006, Spain
| | - Ana Echavarría-Íñiguez
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León 47003, Spain
| | - Ángel Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León 47003, Spain
- Department of Medicine, University of Valladolid, Valladolid, Castilla y León 47003, Spain
| | - Álvaro Sierra
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León 47003, Spain
| | - Nuria González-García
- Headache Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Madrid 28040, Spain
| | - Jesús Porta-Etessam
- Headache Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Madrid 28040, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Madrid 28006, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Madrid 28049, Spain
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Muñoz-Vendrell A, Campoy S, Caronna E, Alpuente A, Torres-Ferrus M, Nieves Castellanos C, Olivier M, Campdelacreu J, Prat J, Camiña Muñiz J, Molina Martínez FJ, Mínguez-Olaondo A, Ruibal Salgado M, Santos Lasaosa S, Navarro Pérez MP, Morollón N, López Bravo A, Cano Sánchez LM, García-Sánchez SM, García-Ull J, Rubio-Flores L, Gonzalez-Martinez A, Quintas S, Echavarría Íñiguez A, Gil Luque S, Castro-Sánchez MV, Adell Ortega V, García Alhama J, Berrocal-Izquierdo N, Belvís R, Díaz-Insa S, Pozo-Rosich P, Huerta-Villanueva M. Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients. J Headache Pain 2023; 24:63. [PMID: 37268904 DOI: 10.1186/s10194-023-01585-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/24/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. METHODS In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. RESULTS A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). CONCLUSIONS Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice.
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Affiliation(s)
- Albert Muñoz-Vendrell
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain.
| | - Sergio Campoy
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
- Neurology Department, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marina Olivier
- Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari I Politécnic La Fe, Valencia, Spain
| | - Jaume Campdelacreu
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Joan Prat
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Javier Camiña Muñiz
- Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari Son Espases, Palma, Spain
- Consulta Monográfica de Cefaleas. Clínica Rotger Quirónsalud, Palma, Spain
| | | | - Ane Mínguez-Olaondo
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain
- Department of Medicine, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain
| | - Marta Ruibal Salgado
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain
| | - Sonia Santos Lasaosa
- Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain
| | - María Pilar Navarro Pérez
- Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain
| | - Noemí Morollón
- Unidad de Cefaleas Y Neuralgias. Servicio de Neurología. Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Alba López Bravo
- Unidad de Cefaleas. Sección de Neurología, Hospital Reina Sofía. Instituto de Investigación Sanitaria de Aragón (IIS-A), Tudela, Spain
| | - Luis Miguel Cano Sánchez
- Servicio de Neurología. Hospital Sant Joan Despí. Consorci Sanitari Integral, Sant Joan Despí, Spain
| | | | - Jésica García-Ull
- Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Laura Rubio-Flores
- Servicio de Neurología. Hospital Universitario General de Villalba, Madrid, Spain
| | - Alicia Gonzalez-Martinez
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa E Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Sonia Quintas
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa E Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | | | - Sendoa Gil Luque
- Servicio de Neurología. Hospital Universitario de Burgos, Burgos, Spain
| | | | - Vanesa Adell Ortega
- Servei de Neurologia. Consorci Sanitari de L'Alt Penedès-Garraf, Barcelona, Spain
| | | | | | - Robert Belvís
- Unidad de Cefaleas Y Neuralgias. Servicio de Neurología. Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Samuel Díaz-Insa
- Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari I Politécnic La Fe, Valencia, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mariano Huerta-Villanueva
- Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
- Neurology Department, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
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