1
|
Pehlivanlar E, Carradori S, Simsek R. Migraine and Its Treatment from the Medicinal Chemistry Perspective. ACS Pharmacol Transl Sci 2024; 7:951-966. [PMID: 38633587 PMCID: PMC11020076 DOI: 10.1021/acsptsci.3c00370] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024]
Abstract
Migraine is a disease of neurovascular origin that affects the quality of life of more than one billion people and ranks sixth among the most common diseases in the world. Migraine is characterized by a moderate or severe recurrent and throbbing headache, accompanied by nausea, vomiting, and photo-phonophobia. It usually starts in adolescence and is twice as common in women as in men. It is classified as with or without aura and has chronic or acute treatment types according to the frequency of occurrence. In acute treatment, analgesics that relieve pain in the fastest way are preferred, while there are different options in chronic treatment. While non-specific methods were used in the treatment of migraine until the 1950s, triptans, ditans, and CGRP-receptor-dependent therapies (monoclonal antibodies and gepants) started to be used in the clinic more recently. In this Review, we focus on the synthesis, side effects, and pharmacological and pharmacokinetic properties of FDA-approved drugs used in acute and preventive-specific treatment of migraine.
Collapse
Affiliation(s)
- Ezgi Pehlivanlar
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Hacettepe University, 06100 Ankara, Turkey
| | - Simone Carradori
- Department
of Pharmacy, University “G. d’Annunzio”
of Chieti-Pescara, 66100 Chieti, Italy
| | - Rahime Simsek
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Hacettepe University, 06100 Ankara, Turkey
| |
Collapse
|
2
|
Conijn M, Maas V, van Tuyl M, Ceulemans M, Hendriks J, van Hunsel F, van der Mijle A. Breastfeeding-Related Adverse Drug Reactions of Triptans: A Descriptive Analysis Using Four Pharmacovigilance Databases. Breastfeed Med 2024. [PMID: 38563407 DOI: 10.1089/bfm.2024.0022] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective: Migraine attacks are common in women of reproductive age. Although attacks are often less severe and less frequent during pregnancy, they regularly reoccur shortly after delivery. When first-line analgesic treatment is insufficient, triptans may be used for acute treatment of migraine attacks. Milk levels of occasional triptan use have shown to be low, and no adverse effects in breastfed infants have been reported. However, the available knowledge on the safety of triptans during breastfeeding is still limited. Methods: Four (inter)national pharmacovigilance databases were searched for breastfeeding related adverse drug reactions of triptans. These included the Dutch Pregnancy Drug Register and three databases of spontaneous reports (Netherlands Pharmacovigilance Centre Lareb, the European Medicines Agency [EudraVigilance], and the World Health Organization [VigiBase]). Results: A total of 26 reports on 27 breastfeeding related adverse drug reactions were identified (one report involved two separate adverse drug reactions). These involve three main complaints: painful breasts and/or nipples, painful milk ejection reflex, and a decrease in milk production. Discussion and Conclusion: The hypothesized pharmacological mechanism relates to the serotonin-receptor agonistic properties of triptans. These may lead to vasoconstriction in the breasts and nipples, including the vasculature surrounding the milk ducts and alveoli, and may also influence the hormonal function and levels of prolactin. The reported adverse drug reactions do not negatively impact the overall compatibility of triptans with breastfeeding. However, breastfeeding women may experience them as unsettling. Awareness of these potential adverse drug reactions is essential and should be weighed against the potential adverse effects of (untreated) symptoms of migraine attacks.
Collapse
Affiliation(s)
- Maartje Conijn
- Netherlands Pharmacovigilance Centre Lareb, Den Bosch, The Netherlands
| | - Veronique Maas
- Netherlands Pharmacovigilance Centre Lareb, Den Bosch, The Netherlands
| | - Miranda van Tuyl
- Netherlands Pharmacovigilance Centre Lareb, Den Bosch, The Netherlands
| | - Michael Ceulemans
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- L-C&Y, KU Leuven Child and Youth Institute, Leuven, Belgium
| | - Judith Hendriks
- Netherlands Pharmacovigilance Centre Lareb, Den Bosch, The Netherlands
| | | | | |
Collapse
|
3
|
Katsuki M, Matsumori Y, Ichihara T, Yamada Y, Kawamura S, Kashiwagi K, Koh A, Goto T, Kaneko K, Wada N, Yamagishi F. Treatment Patterns for and Characteristics of Headache in Children and Adolescents Aged 6-17 Years in Japan: A Retrospective Cross-Sectional and Longitudinal Analysis of Health Insurance Claims Data. Life (Basel) 2024; 14:96. [PMID: 38255711 PMCID: PMC10820976 DOI: 10.3390/life14010096] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/21/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To investigate the prescription patterns for patients aged 6-17 years with headaches in the REZULT database. METHODS We cross-sectionally investigated (Study 1) the pattern of prescription and the proportion of triptan overprescription (≥30 tablets/90 d of triptans) among patients diagnosed with headaches in 2020. Next, we longitudinally studied patients (Study 2) for more than two years from the initial headache diagnosis (July 2010 to April 2022). The number of prescribed tablets was counted every 90 days. RESULTS In Study 1, headache diagnoses were assigned to 62,568 of 543,628 (11.51%) patients, and 1524 of 62,568 (2.44%) patients received acute medication. Single nonsteroidal anti-inflammatory drugs and triptans were prescribed to 620/624 (99.36%) and 5/624 (0.80%) of patients aged 6-11 years, respectively, and 827/900 (91.89%) and 91/900 (10.11%) of patients aged 12-17 years, respectively. Triptan overprescription was observed in 11/96 (11.46%) patients, and 5/11 (45.45%) of those patients received prophylactic medication. In Study 2, 80,756/845,470 (9.55%) patients aged 6-17 years were diagnosed with headaches that persisted for at least two years. Over two years, 44/80,756 (0.05%) patients were overprescribed triptans, and 3408/80,756 (4.22%) patients were prescribed prophylaxis on at least one occasion. CONCLUSIONS Based on real-world data, the appropriate use of prophylactic treatment is still problematic. Overprescription of triptans was observed, although the number of patients was small.
Collapse
Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa 392-0027, Japan
- Headache Outpatient, Suwa Red Cross Hospital, Suwa 392-0027, Japan
| | | | - Taisuke Ichihara
- Japan System Techniques Co., Ltd. (JAST), Minato-ku 108-8288, Japan
| | - Yuya Yamada
- Japan System Techniques Co., Ltd. (JAST), Minato-ku 108-8288, Japan
| | - Shin Kawamura
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa 941-0006, Japan
| | - Kenta Kashiwagi
- Department of Neurology, Itoigawa General Hospital, Itoigawa 941-0006, Japan
| | - Akihito Koh
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa 941-0006, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa 392-0027, Japan
| | - Kazuma Kaneko
- Headache Outpatient, Suwa Red Cross Hospital, Suwa 392-0027, Japan
- Department of Neurology, Suwa Red Cross Hospital, Suwa 392-0027, Japan
| | - Naomichi Wada
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa 392-0027, Japan
- Headache Outpatient, Suwa Red Cross Hospital, Suwa 392-0027, Japan
| | - Fuminori Yamagishi
- Department of Surgery, Itoigawa General Hospital, Itoigawa 941-0006, Japan
| |
Collapse
|
4
|
Domitrz I. Clinical guidance for choosing the right pharmacotherapy for migraine attacks. Expert Opin Pharmacother 2024; 25:37-44. [PMID: 38189111 DOI: 10.1080/14656566.2024.2303425] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Migraine as headache attacks with autonomic symptoms is a serious condition and it is important to treat a single attack effectively in order to improve not only the patient's quality of life at a given moment but also to prevent the migraine from becoming a chronic one. AREA COVERED The article briefly presents the guidance in selecting the most appropriate pharmacological treatment of migraine attack, indicating a personalized approach to migraine patient. EXPERT OPINION In this short paper, we show the implementation of new drugs into everyday clinical practice. Good cooperation between the physician and the patient and having the patient's trust is one of the elements of a personalized therapeutic approach and the key to achieving satisfaction of both the patient and the doctor.
Collapse
Affiliation(s)
- Izabela Domitrz
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Bielanski Hospital, Warsaw, Poland
| |
Collapse
|
5
|
Wang L, Dai C, Gao M, Geng Z, Hu P, Wu X, Wang K. Patients with episodic migraine without aura have an increased rate of delayed discounting. Brain Behav 2024; 14:e3367. [PMID: 38376010 PMCID: PMC10761331 DOI: 10.1002/brb3.3367] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE This study aimed to explore decision-making impulsivity and its neural mechanisms in patients with episodic migraine without aura (EMoA). BACKGROUND Previous evidence indicates increased impulsivity and altered reward processing in patients with chronic migraine and medication overuse; however, whether the same holds true for those with EMoA is unclear. METHODS Patients newly diagnosed with EMoA (n = 51) and healthy controls (HC, n = 45) were recruited. All participants completed delay discounting task, cognitive assessments, a questionnaire for headache profile, and resting-state function magnetic resonance imaging scans. Resting-state functional connectivity (RSFC) between the regions of interest and the entire brain was explored. RESULTS Patients with EMoA showed a steeper subjective discount rate than HCs (F = 4.74, p = .032), which was positively related to a history of migraines (r = .742, p < .001). RSFC among the ventral striatum (vSTR), ventromedial prefrontal cortex, and occipital cortex was lower in patients with EMoA than in control groups, which was correlated with history (r' = .294, p = .036) and subjective discount rate (r' = .380, p = .006). Additionally, discounting rates and RSFC between the vSTR and occipital regions were significantly abnormal in the triptan group than the non-triptan group. Mediating effect analysis indicated a significant mediating effect in the change in RSFC between the vSTR and occipital status, history of triptan use, and subjective discount rate. CONCLUSION This study further elucidated that an increase in delayed discounting rate exists in patients with EMoA and is related to the abnormality of the value processing network.
Collapse
Affiliation(s)
- Lu Wang
- Department of NeurologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefeiChina
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental HealthHefeiChina
| | - Chenyang Dai
- Department of NeurologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefeiChina
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental HealthHefeiChina
| | - Manman Gao
- Department of NeurologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefeiChina
| | - Zhi Geng
- Department of NeurologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefeiChina
| | - Panpan Hu
- Department of NeurologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefeiChina
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental HealthHefeiChina
| | - Xingqi Wu
- Department of NeurologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefeiChina
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental HealthHefeiChina
| | - Kai Wang
- Department of NeurologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- School of Mental Health and Psychological SciencesAnhui Medical UniversityHefeiChina
- Institute of Artificial IntelligenceHefei Comprehensive National Science CenterHefeiChina
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefeiChina
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental HealthHefeiChina
- Anhui Provincial Institute of Translational MedicineAnhui Medical UniversityHefeiChina
| |
Collapse
|
6
|
Katsuki M, Matsumori Y, Ichihara T, Yamada Y, Kawamura S, Kashiwagi K, Koh A, Goto T, Kaneko K, Wada N, Yamagishi F. Treatment patterns and characteristics of headache in patients in Japan: A retrospective cross-sectional and longitudinal analysis of health insurance claims data. Cephalalgia 2024; 44:3331024231226177. [PMID: 38194504 DOI: 10.1177/03331024231226177] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The present study aimed to investigate prescription patterns for patients aged over 17 years with headaches in the REZULT database. METHODS We conducted a cross-sectional study (Study 1) of the proportion of over-prescription of acute medications (≥30 tablets/90 days for triptans, combination non-steroidal anti-inflammatory drugs (NSAIDs) and multiple types; ≥45 tablets/90 days for single NSAIDs) among patients with headache diagnosed in 2020. We longitudinally studied (Study 2) patients for >2 years from initial headache diagnosis (July 2010 to April 2022). The number of prescribed tablets was counted every 90 days. RESULTS In Study 1, headache was diagnosed in 200,055 of 3,638,125 (5.5%) patients: 13,651/200,055 (6.8%) received acute medication. Single NSAIDs were prescribed to 12,297/13,651 (90.1%) patients and triptans to 1710/13,651 (12.5%). Over-prescription was found in 2262/13,651 (16.6%) patients and 1200/13,651 (8.8%) patients received prophylactic medication. In Study 2, 408,183/6,840,618 (6.0%) patients were first diagnosed with headaches, which persisted for ≥2 years. Over time, the proportion of patients over-prescribed acute medications increased. Over 2 years, 37,617/408,183 (9.2%) patients were over-prescribed acute medications and 29,313/408,183 (7.2%) patients were prescribed prophylaxis at least once. CONCLUSIONS According to real-world data, prophylaxis remains poorly prescribed, and both acute and prophylactic treatment rates for headaches have increased over time.
Collapse
Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
- Headache Outpatient, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | | | - Taisuke Ichihara
- Japan System Techniques Co., Ltd (JAST), Minato-ku, Tokyo, Japan
| | - Yuya Yamada
- Japan System Techniques Co., Ltd (JAST), Minato-ku, Tokyo, Japan
| | - Shin Kawamura
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Kenta Kashiwagi
- Department of Neurology, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Akihito Koh
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Kazuma Kaneko
- Headache Outpatient, Suwa Red Cross Hospital, Suwa, Nagano, Japan
- Department of Neurology, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Naomichi Wada
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
- Headache Outpatient, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Fuminori Yamagishi
- Department of Surgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| |
Collapse
|
7
|
Wells-Gatnik WD, Martelletti P. Gepants in the acute management of migraine. Pain Manag 2023; 13:627-630. [PMID: 37942638 DOI: 10.2217/pmt-2023-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
|
8
|
Valentine MJ, Kramer HD, Kim J, Pettinelli N, Hu T. Heart Break or Headache: A Case Report of Sumatriptan-Induced Takotsubo Syndrome. Cureus 2023; 15:e45990. [PMID: 37900384 PMCID: PMC10601754 DOI: 10.7759/cureus.45990] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Takotsubo syndrome (TS) describes a transient type of dilated cardiomyopathy that mimics acute coronary syndrome (ACS) on initial presentation. Classic TS presents with marked dilation and ballooning of the left ventricular apex with hyperdynamic basal segments. The most frequent etiology is from emotional and stressful triggers; recently, evidence suggests neurologic and psychiatric involvement. There are increasing reports of TS occurring secondary to migraine abortives. We describe a unique case of TS in a woman after taking sumatriptan to abort her headache.
Collapse
Affiliation(s)
| | - Hunter D Kramer
- Interventional Cardiology, Kansas City University, Kansas City, USA
| | - James Kim
- Interventional Cardiology, Kansas City University, Kansas City, USA
| | | | - Tom Hu
- Interventional Cardiology, Oklahoma State University, Tulsa, USA
| |
Collapse
|
9
|
Ruscheweyh R, Dresler T, Förderreuther S, Gaul C, Gossrau G, Jürgens TP, Ruschil V, Straube A, Scheidt J. What do patients' efficacy and tolerability ratings of acute migraine medication tell us? Cross-sectional data from the DMKG Headache Registry. Cephalalgia 2023; 43:3331024231174855. [PMID: 37177799 DOI: 10.1177/03331024231174855] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Most migraine patients need an effective acute medication. Real-world data can provide important information on the performance of acute migraine medication in clinical practice. METHODS We used data from the German Migraine and Headache Society Headache Registry, where patients rate efficacy and tolerability of and satisfaction with each of their acute headache medications. RESULTS A total of 1756 adult migraine patients (females: 85%, age: 39.5 ± 12.8 years, headache days per month: 13.5 ± 8.1) were included. Of these, 93% used acute medication, most frequently triptans (59.3%) and/or non-opioid analgesics (56.4%), and 58.5% rated efficacy as good or very good. This was more frequent for triptans (75.4%) than for non-opioid analgesics (43.6%, p < 0.001). Among non-opioid analgesics, naproxen was rated most effective (61.9% very good or good, p < 0.001 compared to ibuprofen, acetylsalicylic acid and paracetamol). Patient-rated efficacy significantly declined with higher headache frequencies (p < 0.001), and this effect remained significant after omitting patients overusing acute medication. CONCLUSION In the present population recruited at specialized headache centers, patients rated triptans as more effective than non-opioid analgesics, naproxen as more effective than ibuprofen, and acute medication efficacy decreased with increasing headache frequency.Trial registration: The German Migraine and Headache Society Headache Registry is registered with the German Clinical Trials Register (DRKS 00021081).
Collapse
Affiliation(s)
- Ruth Ruscheweyh
- Department of Neurology with Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany
- German Migraine and Headache Society, Frankfurt, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Thomas Dresler
- LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - Stefanie Förderreuther
- Department of Neurology with Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany
| | - Charly Gaul
- Headache Center Frankfurt, Frankfurt, Germany
| | - Gudrun Gossrau
- Headache Outpatient Clinic, Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| | - Tim Patrick Jürgens
- Department of Neurology, Headache Center North-East, University Medical Center Rostock, Rostock, Germany
- Department of Neurology, KMG Klinikum Güstrow, Güstrow, Germany
| | - Victoria Ruschil
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Andreas Straube
- Department of Neurology with Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jörg Scheidt
- Institute for Information Systems, University of Applied Sciences Hof, Hof, Germany
| |
Collapse
|
10
|
Hyeraci G, Gini R, Bezin J, Iannone LF, Benemei S, Lupi C, De Cesaris F, Geppetti P, Roberto G. Utilization patterns, cardiovascular risk, and concomitant serotoninergic medications among triptan users between 2008 and 2018: A gender analysis in one Italian region, Tuscany. Headache 2023; 63:222-232. [PMID: 36705316 DOI: 10.1111/head.14463] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe the pattern of triptan use by gender in Tuscany, Italy, focusing on special user populations in which evidence on triptan safety is still not conclusive. BACKGROUND Growing evidence supports the role of gender differences in migraine pathophysiology and treatment. However, gender impact on triptan real-word utilization has been poorly investigated. METHODS A retrospective, descriptive, cohort study was performed using the population-based Administrative Healthcare Database of Tuscany region (Italy). Subjects registered in the database on the January 1 of each year between 2008 and 2018 were identified. New users (NU) of triptans (ATC:N02CC*) were patients with one or more triptan dispensation during the year of interest and none in the past. Age, cardiovascular comorbidities representing an absolute or a possible contraindication to triptan utilization, concomitant serotonergic medications, and pattern of triptan use during 1-year follow-up were described by gender. RESULTS A total of 86,109 patients who received one or more triptan dispensing were identified. Of 64,672 NU (men = 17,039; women = 47,633), 10.2% (6823/64,672) were aged >65 years, who were mostly women (n = 4613). Among NU, men and women with absolute cardiovascular contraindications were 4.3% (740/17,039) and 2.1% (1022/47,633), respectively, while those concomitantly taking serotonergic medications were 17.2% (267/1549) and 21.9% (949/4330), respectively (949/4330). Regular users (two or more dispensing with ≥3 months between first and last observed dispensing) accounted for 26.4% of women (12,597/47,633) and 19.11% of men (3250/17,039); frequent users (≥15 dosage units/month during ≥3 consecutive months) were overall 0.1% (94/64,672) and 62.0% (58/94) of them concomitantly received serotonergic medications. CONCLUSION Considering gender differences in triptan use highlighted here, large scale observational studies are warranted to better define what populations are safe to use triptans and whether it is appropriate to tighten or relax certain recommendations on triptan use. In the meantime, any suspected adverse drug reaction observed in the special user populations highlighted in this study should be promptly reported.
Collapse
Affiliation(s)
- Giulia Hyeraci
- Agenzia regionale di sanità della Toscana (ARS), Florence, Italy
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana (ARS), Florence, Italy
| | - Julien Bezin
- Clinical Pharmacology Unit, Univ. Bordeaux, INSERM, BPH, Team Pharmacoepidemiology, U1219, CHU de Bordeaux, Bordeaux, France
| | - Luigi Francesco Iannone
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Silvia Benemei
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Chiara Lupi
- Area Vasta Centro Ethics Committee Secretariat - Clinical Trial Unit for Phase 1 Trials, Careggi University Hospital, Florence, Italy
| | - Francesco De Cesaris
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Pierangelo Geppetti
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana (ARS), Florence, Italy
| |
Collapse
|
11
|
Khokhlov AL, Leykin ZN. [Comparative clinical study of pharmacokinetics and bioequivalence of Relonova and Maxalt]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:68-74. [PMID: 37655413 DOI: 10.17116/jnevro202312308168] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Evaluation of the bioequivalence of the tested Relonova, tablets, 10 mg and Maxalt, tablets, 10 mg drugs on an empty stomach in healthy volunteers. MATERIAL AND METHODS The pharmacokinetic analysis population included 40 volunteers, the safety analysis population included 40 volunteers. The average age of randomized volunteers (men - 20, women - 20) was 29.3±8.9 years, height 1.71±0.09 m, body weight 70.86±11.66 kg, mean BMI 24.18±2.81 kg/m2. The method used high performance liquid chromatography with tandem mass spectrometric detection. Statistical analysis of the obtained data was performed based on the assumption of a log-normal distribution of the parameters AUC0-72 and Cmax. RESULTS The ratio of geometric means for the key pharmacokinetic parameters (AUC0-t, AUC0-inf and Cmax) of rizatriptan is close to 90%, CI is within the acceptable range for bioequivalent drugs (80-125%). The intrasubject variability (CVintra) for rizatriptan was 23.74% (Cmax), 10.94% (AUC0-t). The average profiles of the pharmacokinetic curves of rizatriptan when taking the test and reference drugs have similar shapes. Relonova and reference Maxalt are bioequivalent. CONCLUSION The results of the study make it possible to recommend Relonova for further clinical study and wide practical application.
Collapse
Affiliation(s)
- A L Khokhlov
- Yaroslavl State Medical University, Yaroslavl, Russia
| | | |
Collapse
|
12
|
Chwolka M, Goadsby PJ, Gantenbein AR. Comorbidity or combination - more evidence for cluster-migraine? Cephalalgia 2023; 43:3331024221133383. [PMID: 36694429 DOI: 10.1177/03331024221133383] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND While migraine and cluster headache share some clinical features and therapies, they differ considerably in the frequency and duration of the headache, as well as the inter-attack, or inter-bout, pathophysiology. Neither is fully understood, with their shared pathways being of interest. FINDINGS Five patients for whom it was difficult to distinguish migraine from cluster headache are presented. They had aspects of their phenotypes, which could be attributed to both disorders. Each patient was thoroughly examined, excluding secondary causes of headache, and had been treated with a number of medicines. CONCLUSION A correct diagnosis is key to the appropriate treatment approach. Especially, if treatment is not successful for the suspected headache type, and enlargement of the diagnostic and therapeutic range, respectively, should be evaluated. Whether in such settings there is shared or different pathophysiology can only be speculated upon.
Collapse
Affiliation(s)
- Mateusz Chwolka
- Department of Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Peter J Goadsby
- NIHR King's Clinical Research Facility, King's College London, London, United Kingdom.,Department of Neurology, University of California, Los Angeles, CA, USA
| | - Andreas R Gantenbein
- Neurorehabilitation and Pain, Zurzach Care, Bad Zurzach, Switzerland.,Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| |
Collapse
|
13
|
Rubino E, Marcinnò A, Grassini A, Piella EM, Ferrandes F, Roveta F, Boschi S, Cermelli A, Gallone S, Savi L, Rainero I. Polymorphisms of the Proinflammatory Cytokine Genes Modulate the Response to NSAIDs but Not to Triptans in Migraine Attacks. Int J Mol Sci 2022; 24:ijms24010657. [PMID: 36614097 PMCID: PMC9820603 DOI: 10.3390/ijms24010657] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
Migraine is a common neurovascular disorder characterized by recurrent episodes of headache and associated neurological symptoms. At present, a significant portion of patients do not obtain a satisfactory response to acute pain-relieving therapies, including NSAIDs and triptans. In this context, pharmacogenetics plays a key role in the understanding of such a diverse response. In order to investigate whether functional polymorphisms in proinflammatory cytokine genes (IL-1α, IL-1β, IL-1RN; IL-6 and TNF-α) may influence the response to acute treatment, 313 consecutive patients with episodic migraine without aura were enrolled. Pain relief by administration of NSAIDs or triptans for three consecutive migraine attacks was evaluated. We found a significant association between A allele of the TNF-α promoter (−308 A/G) and a lack of efficacy after NSAID administration (p < 0.01, OR 2.51, 95% CI: 1.33 < OR < 4.75 compared to the G allele). Remaining polymorphisms had no significant effect on pain relief. Our study showed that a functional polymorphism in the TNF-α gene significantly modulates the clinical response to NSAID administration in acute attacks. Patients with higher production of the active cytokine during stress showed a significantly lower anti-migraine effect. Our results further support a role for TNF-α in the pathophysiological mechanisms of migraine attack.
Collapse
Affiliation(s)
- Elisa Rubino
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
- Correspondence:
| | - Andrea Marcinnò
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Alberto Grassini
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Elisa Maria Piella
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Fabio Ferrandes
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Fausto Roveta
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Silvia Boschi
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Aurora Cermelli
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Salvatore Gallone
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Lidia Savi
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Innocenzo Rainero
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| |
Collapse
|
14
|
Grazzi L, Raggi A, Guastafierro E, Passavanti M, Marcassoli A, Montisano DA, D’Amico D. A Preliminary Analysis on the Feasibility and Short-Term Efficacy of a Phase-III RCT on Mindfulness Added to Treatment as Usual for Patients with Chronic Migraine and Medication Overuse Headache. Int J Environ Res Public Health 2022; 19:ijerph192114116. [PMID: 36360996 PMCID: PMC9653620 DOI: 10.3390/ijerph192114116] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 06/06/2023]
Abstract
This preliminary analysis of a single-blind phase-III RCT aims to compare the feasibility and short-term efficacy of mindfulness as an add-on to treatment as usual (TaU) in the management of patients with chronic migraine (CM) and medication overuse headache (MOH). Patients were randomized to either TaU (structured withdrawal of overused drugs, patient education and pharmacological prophylaxis) or TaU + MIND, wherein patients additionally received six 90 min weekly group sessions of mindfulness-based therapy. Repeated measures analyses were used to test whether patients in the two arms showed different course with regard to headache frequency and medication intake over a three-month period. Drop-out rates were not different between the two groups: 6/89 (6.7%) and 9/88 (10.2%) among those in TaU and TaU + MIND, respectively. A significant effect of time for all variables was shown, together with a significant effect of time by group, favoring TaU + MIND condition for headache frequency (p = 0.025) and NSAID intake (p = 0.007), controlling for age and CM duration. In total, 45/83 (54.2%) and 69/79 (75.9%) of the patients allocated to TaU and TaU + MIND, respectively, achieved 50% or more headache-day reduction (chi-squared 8.38, p = 0.004). Our preliminary analysis indicates that adding six mindfulness-based sessions to TaU was feasible and showed short-term efficacy in the treatment of patients with CM and MOH.
Collapse
Affiliation(s)
- Licia Grazzi
- Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Alberto Raggi
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Erika Guastafierro
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Marco Passavanti
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Alessia Marcassoli
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | | | - Domenico D’Amico
- Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| |
Collapse
|
15
|
Abstract
The standard of care paradigm for migraine treatment has been based almost exclusively on approaches that grew out of the happenstance use of market pharmaceuticals. Only methysergide, which has long since been removed from use for safety concerns, the ergotamine family of drugs, and the triptans were explicitly developed with migraine and other vascular headaches in mind. While the forward and innovative thinking to utilize the broad array of agents to treat migraine served millions well, their therapeutic efficacy was often low, and adverse event profiles were troublesome in the least. Advances in biochemical and molecular biology and the application of advanced "designing drugs" methods have brought about a potentially significant shift in treatment. The gepants have efficacies similar to the triptans but without vascular safety or medication overuse concerns. Preventative gepants offer innovative approaches to prevention and efficacy that exceed even the CGRP monoclonal antibodies. Those monoclonal antibodies brought rapid and highly effective outcomes across the spectrum of migraine. They outpaced older oral medication efficacy and eliminated most adverse events while potentially improving compliance with monthly or quarterly dosing. Other serotonin receptors beyond the 5HT1B and1D receptors have been targeted for decades. They now lead us to better formulations of dihydroergotamine for efficacy, convenience, and tolerability, and a 5HT1F-specific acute treatment like the gepants opens new options for acute management. Neuromodulation goes back to the mid-1800's. Our improved understanding of applied biomedical engineering has brought forward several tantalizing devices, including the application of currents distant from the target and patient regulated. Whether these advances change the paradigm of migraine treatment and standards of care remains to be seen, and issues such as cost and patient acceptance will help mold it.
Collapse
Affiliation(s)
| | - Frederick G. Freitag
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| |
Collapse
|
16
|
Yamaguchi Y, Yamada T, Goto M, Kawasaki H, Wada T, Ikeda-Sakai Y, Saito Y, Hayashi M, Tanaka S, Takahashi R, Nakayama T, Murashima A, Kosugi S. Analysis of triptan use during pregnancy in Japan: A case series. Congenit Anom (Kyoto) 2022; 62:78-81. [PMID: 34981573 DOI: 10.1111/cga.12456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/27/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
To evaluate the safety of triptan use during pregnancy in a Japanese population, we descriptively analyzed the data on pregnancy and fetal outcomes from 128 pregnant women using triptans for migraine treatment at two Japanese facilities that provided counseling on drug exposure in pregnancy between 2001 and 2017. The risks of miscarriage, low birth weight, and preterm birth were similar to those reported in the demographic statistics in Japan. The incidence proportion of malformation was also within the baseline risk range. Accumulated data suggest that exposure to triptans during pregnancy does not clearly increase the risk of negative pregnancy and fetal outcomes. This finding can help reduce anxiety in pregnant women with migraines who are taking triptans.
Collapse
Affiliation(s)
- Yuko Yamaguchi
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan.,Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Yamada
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
| | - Mikako Goto
- National Center for Child Health and Development, The Japan Drug Information Institute in Pregnancy, Tokyo, Japan
| | - Hidenori Kawasaki
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takahito Wada
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
| | - Yasuko Ikeda-Sakai
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Health Informatics, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Yoshiyuki Saito
- Department of Health Informatics, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | | | - Shiro Tanaka
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Atsuko Murashima
- National Center for Child Health and Development, The Japan Drug Information Institute in Pregnancy, Tokyo, Japan
| | - Shinji Kosugi
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
| |
Collapse
|
17
|
Albanese M, Mercuri NB. Could the New Anti-CGRP Monoclonal Antibodies Be Effective in Migraine Aura? Case Reports and Literature Review. J Clin Med 2022; 11:1228. [PMID: 35268319 DOI: 10.3390/jcm11051228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Recently, monoclonal antibodies (mAbs) directed against calcitonin gene-related peptide (CGRP) (Eptinezumab, Fremanezumab, and Galcanezumab) or its receptor (Erenumab) have been approved for clinical use as prophylactic drugs for high-frequency episodic and chronic migraine. While their therapeutic effects on headache pain is well documented, there is scarce information on the usefulness of these medications in preventing migraine aura, which is believed to be associated with cortical spreading depression (CSD). Because of their large size, mAbs cannot easily cross the blood-brain barrier in high quantities, rendering the peripheral trigeminovascular system to likely be a major site of their action. In this paper, we report two cases of patients suffering from migraine with and without aura, who reported a complete disappearance of aura or reduced aura duration and intensity while taking Galcanezumab or Erenumab, respectively. Then, we present a brief overview of the literature about the controversial relationship between CSD and CGRP and about the potential "additional central" role of these mAbs in the pathophysiology of migraine aura.
Collapse
|
18
|
Morishita N, Yamanaka G, Go S, Takeshita M, Tsutsumi N. Pediatric retinal migraine: A case report and literature review. Pediatr Int 2022; 64:e14922. [PMID: 34897886 DOI: 10.1111/ped.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Natsumi Morishita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan.,Department of Pediatrics, Kohsei Chuo General Hospital, Tokyo, Japan
| | - Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Soken Go
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Mika Takeshita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Norito Tsutsumi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan.,Department of Pediatrics, Kohsei Chuo General Hospital, Tokyo, Japan
| |
Collapse
|
19
|
Meng Y, Yuen J. Onset of Transient Sadness Following the Concomitant Use of a Triptan and Selective Serotonin Reuptake Inhibitor/Serotonin Norepinephrine Reuptake Inhibitors Therapy: A Case Report. J Pharm Pract 2021; 36:705-710. [PMID: 34962845 DOI: 10.1177/08971900211064444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
Background: Migraine and depression have a bi-directional, positive association. The likelihood of these conditions being comorbidities is high, thus, the possibility of concomitant use of an antidepressant and a triptan is also increased. Case Presentation: We present a case of a 39-year-old female with a history of migraine with aura and depression who had brief episodes of exacerbated depressive symptoms following oral administration of sumatriptan 100 mg daily as needed while taking various selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) medications on different occasions. The patient experienced 30-minute episodes of sweating and subjective increase in temperature approximately 2-3 hours after administration of sumatriptan 100 mg. This was followed by a transient exacerbation of sadness described by the patient as unhappiness, hopelessness, and tearfulness, which lasted 1 to 2 hours. To date, there are no other published case reports that have described this particular presentation. Several studies have reported possible serotonin syndrome as a result of the combination. Current evidence and known pharmacological actions of SSRIs/SNRIs and triptans are not well-defined enough to explain how one can experience episodic worsening depression. Conclusion: This case illustrates that clinicians should consider other potential adverse effects of the combined use of triptans and SSRIs/SNRIs beyond serotonin syndrome.
Collapse
Affiliation(s)
- Yuki Meng
- Faculty of Pharmaceutical Sciences, 63650The University of British Columbia, Vancouver, BC, Canada
| | - Jamie Yuen
- Faculty of Pharmaceutical Sciences, 63650The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
20
|
Giniatullin R. 5-hydroxytryptamine in migraine: The puzzling role of ionotropic 5-HT 3 receptor in the context of established therapeutic effect of metabotropic 5-HT 1 subtypes. Br J Pharmacol 2021; 179:400-415. [PMID: 34643938 DOI: 10.1111/bph.15710] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/23/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022] Open
Abstract
5-hydroxytryptamine (5-HT; serotonin) is traditionally considered as a key mediator implicated in migraine. Multiple 5-HT receptor subtypes contribute to a variety of region-specific functional effects. The raphé nuclei control nociceptive inputs by releasing 5-HT in the brainstem, whereas dural mast cells provide the humoral source of 5-HT in the meninges. Triptans (5-HT1B/D agonists) and ditans (5-HT1F agonists) are the best established 5-HT anti-migraine agents. However, activation of meningeal afferents via ionotropic 5-HT3 receptors results in long-lasting excitatory drive suggesting a pro-nociceptive role for these receptors in migraine. Nevertheless, clinical data do not clearly support the applicability of currently available 5-HT3 antagonists to migraine treatment. The reasons for this might be the presence of 5-HT3 receptors on inhibitory interneurons dampening the excitatory drive, a lack of 5-HT3 A-E subunit-selective antagonists and gender/age-dependent effects. This review is focusing on the controversial role of 5-HT3 receptors in migraine pathology and related pharmacological perspectives of 5-HT ligands.
Collapse
Affiliation(s)
- Rashid Giniatullin
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Laboratory of Neurobiology, Kazan Federal University, Kazan, Russia
| |
Collapse
|
21
|
Scuteri D, Bagetta G. Progress in the Treatment of Migraine Attacks: From Traditional Approaches to Eptinezumab. Pharmaceuticals (Basel) 2021; 14:924. [PMID: 34577624 DOI: 10.3390/ph14090924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 12/27/2022] Open
Abstract
Migraine is the second cause of disability and of lost years of healthy life worldwide. Migraine is characterized by recurrent headache attacks and accompanying disabling symptoms lasting 4–48 h. In episodic migraine, attacks occur in less than 15 days per month and in chronic migraine, in more than 15 monthly days. Whilst successful translation of pharmacological discoveries into efficacious therapeutics has been achieved in the preventative therapy of chronic migraine, treatment of acute migraine suffers the lack of effective advancements. An effective treatment affords complete freedom from pain two hours after therapy and provides the absence of the most bothersome symptom (MBS) associated with migraine after 2 h. However, available anti-migraine abortive treatments for acute attacks do not represent an effective and safe treatment for all the populations treated. In particular, the most used specific treatment is represented by triptans that offer 2-h sustained freedom from pain achieved in 18–50% of patients but they are contraindicated in coronary artery disease, stroke and peripheral vascular disease due to the vasoconstriction at the basis of their pharmacologic action. The most novel therapies, i.e., gepants and ditans, are without sufficient post-marketing data for secure use. Here, an attempt is proposed to analyse the rational basis and evidence in favour of investigating the efficacy and safety in acute migraine attacks of eptinezumab, i.e., monoclonal antibody (mAb) directed towards calcitonin gene-related peptide (CGRP) unique for intravenous infusion administration.
Collapse
|
22
|
Kulkarni GB, Mathew T, Mailankody P. Medication Overuse Headache. Neurol India 2021; 69:S76-S82. [PMID: 34003151 DOI: 10.4103/0028-3886.315981] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Medication overuse headache (MOH) is one of the highly disabling headache disorder and affects about 1% of the population of the world. It is associated with the development of headache for 15 days or more, with consumption of acute symptomatic medications for 10-15 days (depending on the class of drug, like, simple analgesics, triptans, and opioids) in a month, used for relief of headache for three or more months, in a known patient of primary headache disorder. Objective The aim of this study was to review the topic of MOH and present the details of this disorder with an emphasis on recent updates in the field of pathophysiology and treatment. Material and Methods Literature search was performed in the PubMed/MEDLINE and Cochrane database with appropriate keywords and relevant full-text articles were reviewed for writing this article. Results Over the years, the concept of MOH has evolved, although the exact pathophysiology is still being explored. In a susceptible individual interplay of genetics, change in pain pathways, changes in areas of the brain associated with the perception of pain, and changes in the neurotransmitters have been implicated. It has to be differentiated from other secondary chronic daily headache disorders, by a careful history, targeted examination, details of intake of medications. Treatment predominantly involves patient education, removal of the offending agent, and initiation of prophylactic medications for primary headache disorder in the outpatient or inpatient services. Conclusions MOH is a secondary headache disorder, which should be considered in any chronic headache patient. There are various pathophysiological mechanisms attributed to its development. Management includes educating the patients about the disorder, detoxification, and prophylactic therapy.
Collapse
Affiliation(s)
| | - Thomas Mathew
- Department of Neurology, St. Johns Medical College Hospital, Bengaluru, Karnataka, India
| | | |
Collapse
|
23
|
Ornello R, De Matteis E, Di Felice C, Caponnetto V, Pistoia F, Sacco S. Acute and Preventive Management of Migraine during Menstruation and Menopause. J Clin Med 2021; 10:jcm10112263. [PMID: 34073696 PMCID: PMC8197159 DOI: 10.3390/jcm10112263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/29/2021] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
Migraine course is influenced by female reproductive milestones, including menstruation and perimenopause; menstrual migraine (MM) represents a distinct clinical entity. Increased susceptibility to migraine during menstruation and in perimenopause is probably due to fluctuations in estrogen levels. The present review provides suggestions for the treatment of MM and perimenopausal migraine. MM is characterized by long, severe, and poorly treatable headaches, for which the use of long-acting triptans and/or combined treatment with triptans and common analgesics is advisable. Short-term prophylaxis with triptans and/or estrogen treatment is another viable option in women with regular menstrual cycles or treated with combined hormonal contraceptives; conventional prevention may also be considered depending on the attack-related disability and the presence of attacks unrelated to menstruation. In women with perimenopausal migraine, hormonal treatments should aim at avoiding estrogen fluctuations. Future research on migraine treatments will benefit from the ascertainment of the interplay between female sex hormones and the mechanisms of migraine pathogenesis, including the calcitonin gene-related peptide pathway.
Collapse
|
24
|
Abstract
Introduction: Migraine is currently listed as the second cause of 'years lived with disability' and the sixth cause of global disability. Despite the burden associated to the disease, availability of specific drugs is still limited.Areas covered: The authors have evaluated lasmiditan, the first 'ditan' approved by the Food and Drugs Administration in 2019, from a global perspective: basic chemistry, pharmacodynamic and pharmacokinetic profiles, efficacy in migraine as a 5-HT1F receptor selective agonist, tolerability and clinical safety, and impact on migraine-related disability. Our evaluation considered original papers and review articles published from 2010 to 2020.Expert opinion: Available data point to the efficacy of lasmiditan in reducing migraine pain and the most bothersome symptoms within 2 hours from oral administration. Moreover, lasmiditan has a positive effect on migraine-related disability. Its side effects mostly reflect an involvement of the central nervous system or the vestibular system, while cardiovascular side effects are rare and mild.Lasmiditan can be safely prescribed in patients who have failed non-steroid anti-inflammatory drugs or triptans or with cardiovascular risk factors. Caution is advised in frequent users, due to lack of reliable data on its abuse potential. Further data are necessary to determine the usability of lasmiditan in particular populations, e.g. children and adolescents, pregnancy.
Collapse
Affiliation(s)
- Daniele Martinelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Vito Bitetto
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
25
|
Amundsen S, Nordeng H, Fuskevåg OM, Nordmo E, Sager G, Spigset O. Transfer of triptans into human breast milk and estimation of infant drug exposure through breastfeeding. Basic Clin Pharmacol Toxicol 2021; 128:795-804. [PMID: 33730376 DOI: 10.1111/bcpt.13579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/19/2021] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
Clinical data on the transfer of triptans into human breast milk remain scarce. In a lactation study including 19 breastfeeding women with migraine, we examined the excretion of six different triptans into milk. Following intake of a single dose, each participant collected seven breast milk samples at predefined intervals up to 24 hours after dose. Triptan concentrations in milk were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Infant drug exposure was estimated by calculating the relative infant dose (RID). Twenty-two breast milk sample sets were obtained for sumatriptan (n = 8), rizatriptan (n = 5), zolmitriptan (n = 4), eletriptan (n = 3), almotriptan (n = 1) and naratriptan (n = 1). Based on the average concentration in milk throughout the day, estimated mean RIDs (with range in parenthesis) were as follows: eletriptan 0.6% (0.3%-0.8%), sumatriptan 0.7% (0.2%-1.8%), rizatriptan 0.9% (0.3%-1.4%), almotriptan 1.8% (-), zolmitriptan 2.1% (0.7%-5.3%) and naratriptan 5.0% (-). Infant drug exposure through breastfeeding appears to be low and indicates that use of the triptans in this study is compatible with breastfeeding. Naratriptan may not be first choice in breastfeeding mothers initiating triptans during the neonatal period.
Collapse
Affiliation(s)
- Siri Amundsen
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway.,Experimental and Clinical Pharmacology Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Ole-Martin Fuskevåg
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway.,Experimental and Clinical Pharmacology Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Elisabet Nordmo
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), University Hospital of North Norway, Tromsø, Norway
| | - Georg Sager
- Experimental and Clinical Pharmacology Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
26
|
Wienholtz NKF, Christensen CE, Zhang DG, Coskun H, Ghanizada H, Al-Karagholi MAM, Hannibal J, Egeberg A, Thyssen JP, Ashina M. Early treatment with sumatriptan prevents PACAP38-induced migraine: A randomised clinical trial. Cephalalgia 2021; 41:731-748. [PMID: 33567890 DOI: 10.1177/0333102420975395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine whether early treatment with sumatriptan can prevent PACAP38-induced migraine attacks. METHODS A total of 37 patients with migraine without aura were enrolled between July 2018 to December 2019. All patients received an intravenous infusion of 10 picomole/kg/min of PACAP38 over 20 min followed by an intravenous infusion of 4 mg sumatriptan or placebo over 10 min on two study days in a randomised, double-blind, placebo-controlled, crossover study. RESULTS Of 37 patients enrolled, 26 (70.3%) completed the study and were included in analyses. Of the 26 patients, four (15%) developed a PACAP38-induced migraine attack on sumatriptan and 11 patients (42%) on placebo (p = 0.016). There were no differences in area under the curve for headache intensity between sumatriptan (mean AUC 532) and placebo (mean AUC 779) (p = 0.35). Sumatriptan significantly constricted the PACAP38-dilated superficial temporal artery immediately after infusion (T30) compared with infusion of placebo (p < 0.001).Conclusions and relevance: Early treatment with intravenously administered sumatriptan prevented PACAP38-induced migraine. Prevention of migraine attacks was associated with vasoconstriction by sumatriptan in the earliest phases of PACAP provocation. These results suggest that sumatriptan prevents PACAP38-induced migraine by modulation of nociceptive transmission within the trigeminovascular system.Trial Registration: ClinicalTrials.gov (NCT03881644).
Collapse
Affiliation(s)
- Nita Katarina Frifelt Wienholtz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Casper Emil Christensen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Ditte Georgina Zhang
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Hande Coskun
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Hashmat Ghanizada
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Mohammad Al-Mahdi Al-Karagholi
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Jens Hannibal
- Department of Clinical Biochemistry, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg, Denmark
| | - Alexander Egeberg
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| |
Collapse
|
27
|
Dolezil D, Markova J, Klimes J, Pocikova Z, Dostal F, Stepanova R, Svobodnik A. An Investigation into the Prevalence of Migraine and Its Prophylactic Treatment Patterns in the Czech Republic: An Observational Study. J Pain Res 2020; 13:2895-2906. [PMID: 33209057 PMCID: PMC7669514 DOI: 10.2147/jpr.s273119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/21/2020] [Accepted: 10/16/2020] [Indexed: 01/23/2023] Open
Abstract
Purpose A national primary and secondary healthcare-level study in the Czech Republic has not yet been conducted to evaluate the prevalence of migraine. We analyzed the current treatment patterns (acute and prophylactic) in migraine patients and the number of migraine patients potentially eligible for treatment with recent calcitonin gene-related peptide (CGRP) pathway-targeted therapies. Methods This retrospective study utilized the Ministry of the Interior Health Insurance Fund claims database of the Czech Republic wherein every citizen is insured. Migraine patients with or without aura, and potentially on triptan therapy were included in this study (index years 2012–2016). The prevalence approach included all patients (new and old) present in each index year. Prophylactic therapies were followed f0or three and seven years prior to the index year, including the index year, until 2010. The incidence approach included all patients first diagnosed in each index year. Prophylactic therapies were followed for the next three years, including the index year, until 2017 following incidence approach. The primary endpoint of this study was to determine the rate of migraine prevalence and diagnosis for each index year during the period 2012–2016. The study also evaluated prophylactic and acute treatment patterns and comorbidities among patients in 2016. Results The rate of migraine prevalence was 1% and the rate of diagnosis was 0.2–0.4%. By prevalence approach, approximately 39% of the patients were on prophylactics, and 11.2% and 21.6% of the patient population had two prior treatment failures (three- and seven-year recall period, respectively). Antiepileptics (26%) and beta blockers (15.8%) were the most prescribed prophylactics, and sumatriptan was the predominant triptan used (12%) for acute treatment. Conclusion Taking into account the number of inhabitants in the Czech Republic (10.7 million), there could be up to 23,000 adult patients eligible for novel CGRP therapies.
Collapse
Affiliation(s)
- David Dolezil
- Prague Headache Center, DADO MEDICAL s.r.o., Prague, Czech Republic
| | | | - Jiri Klimes
- Novartis, s.r.o., Prague, Czech Republic.,Faculty of Pharmacy, Department of Social and Clinical Pharmacy, Charles University in Prague, Prague, Czech Republic
| | - Zuzana Pocikova
- Novartis, s.r.o., Prague, Czech Republic.,Faculty of Pharmacy, Department of Social and Clinical Pharmacy, Charles University in Prague, Prague, Czech Republic
| | - Filip Dostal
- Novartis, s.r.o., Prague, Czech Republic.,Faculty of Pharmacy, Department of Social and Clinical Pharmacy, Charles University in Prague, Prague, Czech Republic
| | - Radka Stepanova
- Aixial, s.r.o., Brno, Czech Republic.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Adam Svobodnik
- Aixial, s.r.o., Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| |
Collapse
|
28
|
Berger AA, Winnick A, Popovsky D, Kaneb A, Berardino K, Kaye AM, Cornett EM, Kaye AD, Viswanath O, Urits I. Lasmiditan for the Treatment of Migraines With or Without Aura in Adults. Psychopharmacol Bull 2020; 50:163-188. [PMID: 33633424 PMCID: PMC7901123] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Migraines are a common form of primary headache, affecting women more than men (17.4% and 5.7% of US population, respectively, a total of 12%) that carry significant morbidity and disability, as well as a hefty healthcare price tag. They are most prevalent in women of reproductive ages and are estimated to be the 6th disease in order of causing global burden. They are estimated to cause 45.1 million years lived with disability, or 2.9% of global years lost to disability. Migraine treatment divides into acute, abortive treatment for relief of an ongoing migraine attack, and prophylactic therapy to reduce the occurrence of migraines, specifically for patients suffering from chronic and frequent episodic migraines. Traditional abortive treatment usually begins with NSAID and non-specific analgesics that are effective in curbing mild to moderate attacks. 5HT1-agonists, such as triptans, are often used for second-line and for severe attacks. Triptans are generally better tolerated in the longterm than NSAIDs and other analgesics, though they carry a significant side-effect profile and are contraindicated in large parts of the population. Prophylactic therapy is usually reserved for patients with frequent recurrence owing to medication side effects and overall poor adherence to the medication schedule. Importantly, medication overuse may actually lead to the development of chronic migraines from previously episodic attacks. Recent research has shed more light on the pathophysiology of migraine and the role of CGRP in the trigeminovascular system. Recent pharmacological advances were made in developing more specific drugs based on this knowledge, including CGRP neutralizing antibodies, receptor antagonists, and the development of ditans. These novel drugs are highly specific to peripheral and central 5-HT1F receptors and effective in the treatment of acute migraine attacks. Binding these receptors reduces the production of CGRP and Glutamate, two important ligands in the nociceptive stimulus involved with the generation and propagation of migraines. Several large clinical studies showed Lasmiditan to be effective in the treatment of acute migraine attacks. Importantly, due to its receptor specificity, it lacks the vasoconstriction that is associated with triptans and is thus safer is larger parts of the population, specifically in patients with cardiac and vascular disease. Though more research is required, specifically with aftermarket surveillance to elucidate rare potential side effects, Lasmiditan is a targeted anti-migraine drug that is both safe and effective, and carries an overall superior therapeutic profile to its predecessors. It joins the array of medications that target CGRP signaling, such as gepants and CGRP-antibodies, to establish a new line of care for this common disabling condition.
Collapse
Affiliation(s)
- Amnon A Berger
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Ariel Winnick
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Daniel Popovsky
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Alicia Kaneb
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Kevin Berardino
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Adam M Kaye
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Elyse M Cornett
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Alan D Kaye
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Omar Viswanath
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Ivan Urits
- Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; School of Optometry, University of California, Berkeley, Berkeley, CA. Popovsky, MS, Kaneb, BA, Berardino, BS, Georgetown University School of Medicine, Washington DC. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Cornett, PhD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
29
|
Ernstsen C, Christensen SL, Olesen J, Kristensen DM. No additive effect of combining sumatriptan and olcegepant in the GTN mouse model of migraine. Cephalalgia 2020; 41:329-339. [PMID: 33059476 DOI: 10.1177/0333102420963857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/16/2022]
Abstract
INTRODUCTION Despite recent advances in migraine treatment there is a need for therapies with higher clinical efficacy and/or fewer side effects. Triptans (5-HT1B/1D/1F agonists) are essential in the present treatment regime and gepants (CGRP-receptor antagonists) are recognized as effective in acute migraine treatment. Triptans and gepants have different mechanisms of action and here we tested the hypothesis that a combination of these drugs (sumatriptan and olcegepant) would result in an additive effect. METHODS Using the validated glyceryl trinitrate mouse model of migraine, we initially tested dose-response relationships of sumatriptan (0.1, 0.3, and 0.6 mg/kg IP) and olcegepant (0.25, 0.50, and 1.0 mg/kg IP) to find suitable high and low doses. Subsequently, we performed a combination study of the two drugs with a low and a high dose. All experiments were vehicle (placebo) controlled and blinded. RESULTS Sumatriptan significantly reduced glyceryl trinitrate-induced allodynia (F(4,54) = 13.51, p < 0.0001) at all doses. Olcegepant also reduced glyceryl trinitrate-induced allodynia (F(4,53) = 16.11, p < 0.0001) with the two higher doses being significantly effective. Combining 0.50 mg/kg olcegepant with 0.1 or 0.6 mg/kg sumatriptan did not have any improved effect compared to either drug alone (p > 0.50 on all days) in our mouse model. CONCLUSION Combining olcegepant and sumatriptan did not have an additive effect compared to single-drug treatment in this study. Triptan-gepant combinations will therefore most likely not improve migraine treatment. Nevertheless, further studies are necessary, and combinations should also be examined in patients with migraine.
Collapse
Affiliation(s)
- Charlotte Ernstsen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Sarah L Christensen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
| | - David M Kristensen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark.,University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| |
Collapse
|
30
|
Abstract
INTRODUCTION Migraine patients prioritize early complete relief of headache and associated symptoms, sustained freedom of pain, and good tolerability. One major obstacle for the successful use of drug treatment of migraine attack is that the speed of action of triptans, 5-HT1B/1D receptor agonists, is delayed. AREAS COVERED In this review, the author discusses the following features of acute migraine drugs: pharmacology; pharmacokinetics, and absorption of drugs during migraine attacks. Next, dose-response curves for effect; and the delayed onset of action is reviewed. In the more clinical part of the review, the following items are discussed: overall clinical judgments; comparison of triptans; comparison of triptans with NSAIDs; early intervention with triptans; medication-overuse headache; comments on the effect of gepants; and the general principle of acute migraine therapy. EXPERT OPINION The delay in the onset of effect of acute migraine drugs is likely due to a complex antimigraine system involving more than one site of action. Investigations into the mechanisms of the delay should have a high priority, both in studies with animals, migraine models, and in migraine patients during attacks. Non-oral administration of antimigraine drugs resulting in early absorption of drugs should be developed as they possibly also can increase Emax.
Collapse
Affiliation(s)
- Peer Tfelt-Hansen
- From Danish Headache Center, Department of Neurology, Rigshospital Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen , Glostrup, Denmark
| |
Collapse
|
31
|
Drugs for Migraine. Med Lett Drugs Ther 2020; 62:153-60. [PMID: 33434187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
32
|
Abstract
Migraine causes significant lost time from everyday activities. Addressing lifestyle triggers and comorbidities in patients with migraine is the first step of management Acute migraine treatments primarily manage the headache component and should be started as early as possible in the migraine attack Prophylaxis may be recommended if a patient is having three or more migraines a month or if their migraines are difficult to manage The choice of prophylactic drugs should be tailored to the individual’s potential for adverse effects, interactions and comorbidities
Collapse
|
33
|
Abstract
BACKGROUND Migraine patients want acute treatment to provide complete relief of the migraine attack within 30 minutes. Traditionally, "speed of onset of effect" is evaluated by estimating the time-point for first statistical separation of drug and placebo. The estimated onset of effect can be a few percent difference of patients being pain free in very large randomised, controlled trials. This difference, however, can be clinically irrelevant. METHODS Placebo-controlled randomised, controlled trials with pain freedom results from 30 min to 2-4 hours were retrieved from the literature. For each time-point, the therapeutic gain (drug minus placebo) (TG) was calculated. Therapeutic gain for being pain free of 5% was chosen for the definition of "onset of action", since this is approximately 1/3 of the 16% TG and 1/4 of 21% of TG for sumatriptan 50 mg and 100 mg, respectively. RESULTS A total of 22 time-effect curves based on randomised, controlled trials were analysed. Based on the "onset of action" of 5% pain freedom, the evaluated drugs and administration forms can be classified as follows: i) Early time to onset, ≤30 min (three randomised, controlled trials); ii) medium time to onset, 60 min (nine randomised, controlled trials); iii) delayed time to onset, 90-120 min (10 randomised, controlled trials). CONCLUSION Only three non-oral administration forms with a triptan (subcutaneous sumatriptan and nasal zolmitriptan) resulted in an "onset of action" at ≥30 min; in the future, early onset of action should be a priority in the development of new drugs or new administration-forms for the treatment of acute migraine attacks.
Collapse
Affiliation(s)
- Peer Tfelt-Hansen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Essen, Germany
| |
Collapse
|
34
|
Cape S. Access to Migraine Treatments in Ontario, Canada: A Review of the Ontario Drug Benefit Program. Headache 2020; 60:1888-1900. [PMID: 32757445 DOI: 10.1111/head.13918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/29/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This paper provides a critical review of the decision-making process of the Ontario Ministry of Health and Long-Term Care (MOHLTC) regarding which migraine treatment drugs will be covered under the Ontario Drug Benefit Formulary (ODB). MAIN TEXT Under MOHLTC policy, triptans and OnabotulinumtoxinA are available to patients only through the Exceptional Access Program (EAP). This policy, and justifications for it, are examined with reference to clinical guidelines, patient experiences, and health policy literature. The contexts and consequences of compromised access are outlined. Improvements in access to these treatments are suggested by highlighting how a country with similar healthcare infrastructure - Australia - employs policies that more adequately meet the needs of migraine patients as they secure treatments. CONCLUSIONS Despite clinically significant gains in the discovery of safe and effective migraine-specific treatments the ODB thus far has failed to align its practice with current clinical recommendations. This forces patients to rely heavily on medication that, while still effective for some, is potentially suboptimal. This review concludes it is prudent, at minimum, to follow clinical recommendations that advocate for the removal of triptans from EAP and recategorize them as Limited Use drugs. Ideally, moving them to a general benefit would further remove the barriers experienced by patients attempting to access this treatment.
Collapse
Affiliation(s)
- Susan Cape
- School of Social Work, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
35
|
Harris GME, Wood M, Nordeng H. Modeling exposures of medications used episodically during pregnancy: Triptans as a motivating example. Pharmacoepidemiol Drug Saf 2020; 29:1111-1119. [PMID: 32748540 DOI: 10.1002/pds.5089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/27/2019] [Revised: 05/14/2020] [Accepted: 07/09/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE To assess the validity of dispensed prescription to classify exposure to medications used episodically during pregnancy, and to explore individual trajectories of episodic medication use across pregnancy, using triptans for migraine as the motivating example. METHODS We compared self-reported triptan use during pregnancy in The Norwegian Mother, Father and Child Cohort Study (MoBa) to dispensed prescriptions in The Norwegian Prescription Database and calculated Cohen's kappa coefficient (κ), sensitivity, specificity and predictive values using MoBa as reference standard. We used group-based trajectory modeling to estimate exposure trajectories in MoBa according to probability of triptan use across pregnancy. RESULTS We identified 6051 pregnancies where mothers filled at least one triptan prescription or reported migraine or triptan use in the 6 months before or during pregnancy. Sensitivity of prescribed triptans during pregnancy was low (39.1%), but specificity was quite high (95.4%). Agreement between the two data sources was fair (κ 0.36). We identified three trajectory groups in MoBa including constant-high, decreasing-medium and decreasing-low probability of triptan use across pregnancy. CONCLUSIONS Using dispensed prescriptions rather than self-report to classify exposure to triptans during pregnancy is likely to result in substantial under-estimation of exposure. In this study, traditional definitions of ever-exposed vs never-exposed failed to capture variations in drug utilization during pregnancy.
Collapse
Affiliation(s)
- Gerd-Marie Eskerud Harris
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Mollie Wood
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
36
|
Jakate A, Boinpally R, Butler M, Lu K, McGeeney D, Periclou A. Evaluation of the Pharmacokinetic Interaction of Ubrogepant Coadministered With Sumatriptan and of the Safety of Ubrogepant With Triptans. Headache 2020; 60:1340-1350. [PMID: 32573795 PMCID: PMC7496299 DOI: 10.1111/head.13862] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 11/19/2019] [Revised: 03/30/2020] [Accepted: 04/27/2020] [Indexed: 01/03/2023]
Abstract
Objective To evaluate the potential for pharmacokinetic interaction and the safety and tolerability when ubrogepant and sumatriptan are coadministered in a Phase 1 study in healthy participants, and to inform the safety and tolerability of ubrogepant alone and in combination with triptans in Phase 3 trials in participants with migraine. Background Calcitonin gene–related peptide is a potent vasodilatory neurotransmitter believed to play a key role in the pathophysiology of migraine. Ubrogepant (UBRELVY™) is a potent and selective antagonist of the human calcitonin gene–related peptide receptor approved for the acute treatment of migraine. Sumatriptan is a serotonin receptor agonist and the most commonly used triptan for the acute treatment of migraine. Ubrogepant could be prescribed with triptans. Design The Phase 1 study was a single‐center, open‐label, randomized, 3‐way crossover, single‐dose, pharmacokinetic interaction study, where participants received each of 3 oral treatments with a 7‐day washout period between treatments: single dose of ubrogepant 100 mg, single dose of sumatriptan 100 mg, and ubrogepant 100 mg plus sumatriptan 100 mg. Pharmacokinetic parameters were calculated using a model‐independent approach. The ACHIEVE I and II trials were 2 multicenter, single‐attack, randomized, Phase 3 trials in adults with a history of migraine with or without aura. Participants had the option to take a second dose of study medication or rescue medication to treat a nonresponding migraine or a migraine recurrence from 2 to 48 hours after the initial dose of study medication. Rescue medication options included acetaminophen, nonsteroidal anti‐inflammatory drugs, opioids, anti‐emetics, or triptans. Treatment‐emergent adverse events were evaluated up to 30 days after the last dose in the Phase 1 and Phase 3 studies. Results Ubrogepant median time to maximum plasma concentration was delayed (3 hours [range: 1‐5 hours] vs 1.5 hours [range: 1‐4 hours]), mean maximum plasma concentration was reduced by 24% (coefficient of variation: 37.4%) when ubrogepant was coadministered with sumatriptan (n = 29) compared with ubrogepant administered alone (N = 30). No significant effect was observed on the area under the plasma concentration‐time curve of ubrogepant. Sumatriptan area under the curve and maximum plasma concentration showed no significant change when sumatriptan was coadministered with ubrogepant (n = 29), but the sumatriptan time to maximum plasma concentration was delayed (1 hour [range: 0.5‐5 hours] vs 3 hours [range: 0.5‐6 hours]. No treatment‐emergent adverse events were reported with the coadministration of ubrogepant 100 mg and sumatriptan 100 mg in the Phase 1 study. The pooled safety data from ACHIEVE trials (N = 1938) showed similar rates of treatment‐related treatment‐emergent adverse events between participants who took ubrogepant alone and participants who took ubrogepant and a triptan as a rescue medication (14.9% [53/355] vs 12.8% [5/39] in the ubrogepant 100 mg treatment group, respectively). Conclusions Although there were slight alterations in ubrogepant pharmacokinetic parameters when coadministered with sumatriptan, such changes are expected to have minimal clinical relevance, especially because no changes were seen in sumatriptan area under the curve and maximum plasma concentration when coadministered with ubrogepant. Coadministration of ubrogepant with sumatriptan was well tolerated in healthy participants in the Phase 1 study, and coadministration of ubrogepant with triptans was well tolerated in participants with migraine in the Phase 3 trials. No new safety concerns for ubrogepant were identified across all trials.
Collapse
|
37
|
Aviram J, Vysotski Y, Berman P, Lewitus GM, Eisenberg E, Meiri D. Migraine Frequency Decrease Following Prolonged Medical Cannabis Treatment: A Cross-Sectional Study. Brain Sci 2020; 10:E360. [PMID: 32526965 DOI: 10.3390/brainsci10060360] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Medical cannabis (MC) treatment for migraine is practically emerging, although sufficient clinical data are not available for this indication. This cross-sectional questionnaire-based study aimed to investigate the associations between phytocannabinoid treatment and migraine frequency. Methods: Participants were migraine patients licensed for MC treatment. Data included self-reported questionnaires and MC treatment features. Patients were retrospectively classified as responders vs. non-responders (≥50% vs. <50% decrease in monthly migraine attacks frequency following MC treatment initiation, respectively). Comparative statistics evaluated differences between these two subgroups. Results: A total of 145 patients (97 females, 67%) with a median MC treatment duration of three years were analyzed. Compared to non-responders, responders (n = 89, 61%) reported lower current migraine disability and lower negative impact, and lower rates of opioid and triptan consumption. Subgroup analysis demonstrated that responders consumed higher doses of the phytocannabinoid ms_373_15c and lower doses of the phytocannabinoid ms_331_18d (3.40 95% CI (1.10 to 12.00); p < 0.01 and 0.22 95% CI (0.05–0.72); p < 0.05, respectively). Conclusions: These findings indicate that MC results in long-term reduction of migraine frequency in >60% of treated patients and is associated with less disability and lower antimigraine medication intake. They also point to the MC composition, which may be potentially efficacious in migraine patients.
Collapse
|
38
|
Wang G, Tan T, Liu Y, Hong P. Drugs for Acute Attack of Pediatric Migraine: A Network Meta-analysis of Randomized Controlled Trials. Clin Neurol Neurosurg 2020; 195:105853. [PMID: 32464520 DOI: 10.1016/j.clineuro.2020.105853] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Abstract
Migraine in pediatric is a common neurological disease, and its prevalence is varying widely. The medication for the acute attack of pediatric migraine is various. we take advantage of network meta-analysis to address the efficacy and rank of these medications. Database including Pubmed and Cochrane Library were queried using a specific searching strategy. The quality of trials enrolled was assessed according to the Cochrane collaboration'tool for assessing risk of bias. The data analysis was conducted by using the core software for Cochrane reviews (Rev Man 5.3) and the Aggregate Data Drug Information System (Addis v1.16.8). The outcomes were pain-free and pain relief at 2 hours post-dose. Totally, twenty trials with high quality including 6029 migraineurs with 6912 attacks randomly assigned to 14 different drugs. The data of ketorolac and prochlorperazine were missing. We found that sumatriptan nasal spray and zolmitriptan nasal spray were superior to placebo in the two efficacy outcomes, whereas almotriptan, rizatriptan, sumatriptan with naproxen sodium, ibuprofen and ibuprofen suspension were superior to placebo only in one of the efficacy outcomes. And in network meta-analysis, we found the best 3 treatments were ibuprofen, sumatriptan with naproxen sodium and ibuprofen suspension in achieving pain-free. Meanwhile, the best 3 treatments were ibuprofen suspension, ibuprofen, and rizatriptan in achieving pain relief. In conclusion, in acute treatments of pediatric migraine, most triptans and NSAIDS were effective to achieve pain-free or pain-relief. And the most effective treatment to achieve pain-free is sumatriptan with naproxen sodium. Ibuprofen and ibuprofen suspension were the most effective treatments to achieve pain-relief.
Collapse
Affiliation(s)
- Guihua Wang
- Department of Geriatric Medicine and Neurology,West China School of Public Health and West China Fourth Hospital,Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tianlin Tan
- Xindu Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Yao Liu
- Xindu Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Peiwei Hong
- Department of Geriatric Medicine and Neurology,West China School of Public Health and West China Fourth Hospital,Sichuan University, Chengdu, Sichuan, People's Republic of China.
| |
Collapse
|
39
|
Iljazi A, Chua A, Rich-Fiondella R, Veronesi M, Melo-Carrillo A, Ashina S, Burstein R, Grosberg B. Unrecognized challenges of treating status migrainosus: An observational study. Cephalalgia 2020; 40:818-827. [PMID: 32162976 DOI: 10.1177/0333102420911461] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Status migrainosus is a condition with limited epidemiological knowledge, and no evidence-based treatment guideline or rational-driven assessment of successful treatment outcome. To fill this gap, we performed a prospective observational study in which we documented effectiveness of treatment approaches commonly used in a tertiary headache clinic. MATERIAL AND METHODS Patients with episodic and chronic migraine who experienced continuous and prolonged attacks for more than 72 hours were treated with dexamethasone (4 mg orally twice daily for 3 days), ketorolac (60 mg intramuscularly), bilateral nerve blocks (1-2% lidocaine, 0.1-0.2 ml for both supraorbital and supratrochlear nerves, 1 ml for both auriculotemporal nerves, and 1 ml for both greater occipital nerves), or naratriptan (2.5 mg twice daily for 5 days). Hourly (for the first 24 hours) and daily (for first 30 days) change in headache intensity was documented using appropriate headache diaries. RESULTS Fifty-four patients provided eligible data for 60 treatment attempts. The success rate of rendering patients pain free within 24 hours and maintaining the pain-free status for 48 hours was 4/13 (31%) for dexamethasone, 7/29 (24%) for nerve blocks, 1/9 (11%) for ketorolac and 1/9 (11%) for naratriptan. These success rates depended on time to remission, as the longer we allowed the treatments to begin to work and patients to become pain free (i.e. 2, 12, 24, 48, 72, or 96 hours), the more likely patients were to achieve and maintain a pain-free status for at least 48 hours. DISCUSSION These findings suggest that current treatment approaches to terminating status migrainosus are not satisfactory and call attention to the need to develop a more scientific approach to define a treatment response for status migrainosus.
Collapse
Affiliation(s)
- Afrim Iljazi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Denmark
| | - Abigail Chua
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Raymond Rich-Fiondella
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, CT, USA
| | - Maria Veronesi
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, CT, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Brian Grosberg
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| |
Collapse
|
40
|
Salhofer-Polanyi S, Zebenholzer K, Berndl T, Kastrati K, Raab S, Schweitzer P, Stria T, Topic P, Wöber C. Medication overuse headache in 787 patients admitted for inpatient treatment over a period of 32 years. Cephalalgia 2020; 40:808-817. [PMID: 32153204 DOI: 10.1177/0333102420911210] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Definitions of medication overuse headache have changed over time. OBJECTIVE To evaluate the clinical characteristics of medication overuse headache patients admitted for inpatient withdrawal therapy over a period of 32 years. METHODS We included all patients with medication overuse headache treated from 1 January 1984 to 31 December 2015. We obtained all data from the medical reports and defined three periods, P1 (1984-1993), P2 (1994-2003), and P3 (2004-2015). The p-value adjusted for multiple comparisons was set to 0.005. RESULTS Within 32 years, a total of 787 patients accounted for 904 admissions for MOH. From P1 to P3, the proportion of patients with preexisting migraine increased from 44.3% to 53.3% (chi2 = 9.0, p = 0.01) and that with preexisting tension-type headache decreased from 47.9% to 34.6% (chi2 = 9.3, p < 0.01). The median time since onset of headache and medication overuse headache decreased from 20 to 15 years (p < 0.001) and from 3 to 2 years (p < 0.001). The median cumulative number of single doses decreased from 120 to 90 per month (p = 0.002). Overuse of triptans, non-opioid analgesics, and opioids increased, whereas overuse of ergotamines decreased over time (p < 0.001 for all tests). The use of prophylactic medication before admission increased from 8.3% to 29.9% (chi2 = 89.5, p < 0.001). CONCLUSION This retrospective study in a large number of patients with medication overuse headache admitted for inpatient withdrawal therapy over a period of 32 years shows a trend towards changes in the preexisting headache type, a decrease in the time since onset of headache and medication overuse headache, a decrease in the number of drug doses used per month, changes in the type of drugs overused, and an increase in, but still low rate, of prophylactic medication prior to admission.
Collapse
Affiliation(s)
- Sabine Salhofer-Polanyi
- Department of Neurology, Krankenhaus Hietzing mit Neurologischem Zentrum [General Hospital Hietzing with Neurological Center] Rosenhügel, Vienna, Austria
| | - Karin Zebenholzer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berndl
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Kastriot Kastrati
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sandra Raab
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Tim Stria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Pavao Topic
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
41
|
Knievel K, Buchanan AS, Lombard L, Baygani S, Raskin J, Krege JH, Loo LS, Komori M, Tobin J. Lasmiditan for the acute treatment of migraine: Subgroup analyses by prior response to triptans. Cephalalgia 2019; 40:19-27. [PMID: 31744319 PMCID: PMC6950889 DOI: 10.1177/0333102419889350] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/03/2023]
Abstract
Background Lasmiditan demonstrated superiority to placebo in the acute treatment of
migraine in adults with moderate/severe migraine disability in two similarly
designed Phase 3 trials, SAMURAI and SPARTAN. Post-hoc integrated analyses
evaluated the efficacy of lasmiditan in patients who reported a good or
insufficient response to triptans and in those who were triptan naïve. Methods Subgroups of patients reporting an overall response of “good” or “poor/none”
to the most recent use of a triptan at baseline (defined as good or
insufficient responders, respectively) and a triptan-naïve subpopulation
were derived from combined study participants randomized to receive
lasmiditan 50 mg (SPARTAN only), 100 mg or 200 mg, or placebo, as the first
dose. Outcomes including headache pain-freedom, most bothersome
symptom-freedom, and headache pain relief 2 hours post-first dose of
lasmiditan were compared with placebo. Treatment-by-subgroup analyses
additionally investigated whether therapeutic benefit varied according to
prior triptan response (good or insufficient). Results Regardless of triptan response, lasmiditan showed higher efficacy than
placebo (most comparisons were statistically significant).
Treatment-by-subgroup analyses found that the benefit over placebo of
lasmiditan did not vary significantly between patients with a good response
and those with an insufficient response to triptans. Lasmiditan also showed
higher efficacy than placebo in triptan-naïve patients. Conclusions Lasmiditan demonstrated comparable efficacy in patients who reported a good
or insufficient response to prior triptan use. Lasmiditan also showed
efficacy in those who were triptan naïve. Lasmiditan may be a useful
therapeutic option for patients with migraine. Trial Registration SAMURAI (NCT02439320); SPARTAN (NCT02605174).
Collapse
Affiliation(s)
| | - Andrew S Buchanan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Louise Lombard
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Simin Baygani
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Joel Raskin
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - John H Krege
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Li Shen Loo
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Mika Komori
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Joshua Tobin
- 21st Century Neurology, Xenoscience, Phoenix, AZ, USA
| |
Collapse
|
42
|
Mohan J, Parekh A, DeYoung M. Sumatriptan Induced Takotsubo Cardiomyopathy; the Headache of the Heart: A Case Report. Front Cardiovasc Med 2019; 6:134. [PMID: 31620447 PMCID: PMC6759782 DOI: 10.3389/fcvm.2019.00134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/03/2019] [Accepted: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
Takotsubo Cardiomyopathy (TCM) is an increasing recognized form of acute reversible left ventricular systolic dysfunction not related to obstructive coronary disease. The exact physiology of this disorder is not yet known, however multiple agents have been hypothesized to have a link to this condition. Most commonly, TCM has been hypothesized as being triggered by a catecholamine surge after an inciting event. New evidence now suggests certain medications as a link to the disease. We describe a unique case of TCM in a woman after taking Treximet (naproxen and sumatriptan) as abortive therapy for a migraine.
Collapse
Affiliation(s)
- Jay Mohan
- Department of Cardiology, McLaren Macomb Regional Medical Center, Mount Clemens, MI, United States
| | - Akarsh Parekh
- Department of Internal Medicine, McLaren Macomb Regional Medical Center, Mount Clemens, MI, United States
| | - Michael DeYoung
- Department of Cardiology, McLaren Macomb Regional Medical Center, Mount Clemens, MI, United States
| |
Collapse
|
43
|
Lipton RB, Hutchinson S, Ailani J, Reed ML, Fanning KM, Manack Adams A, Buse DC. Discontinuation of Acute Prescription Medication for Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2019; 59:1762-1772. [PMID: 31544244 PMCID: PMC6899725 DOI: 10.1111/head.13642] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Accepted: 08/10/2019] [Indexed: 12/26/2022]
Abstract
Objective This analysis assessed migraine‐related burden and treatment decisions in Chronic Migraine Epidemiology and Outcomes (CaMEO) Study survey respondents who stopped taking acute prescription medications for migraine. Background Migraine is a common yet underdiagnosed and undertreated neurological disease often associated with significant disability. Acute prescription medications are underused, in part because patients discontinue treatment. Rates and reasons for discontinuing acute prescription medications require exploration. Methods The CaMEO Study is a longitudinal, Internet‐based survey that identified and followed people who met modified ICHD‐3 migraine criteria. For this analysis, eligible respondents had used acute prescription medication for migraine in the past but no longer used or kept these treatments on hand (discontinued users). Respondents who reported discontinuing acute prescription treatment answered questions about length of time since last use and reasons for stopping. Reasons for discontinuing were thematically summarized. Monthly headache day frequency, Migraine Disability Assessment (MIDAS), Patient Health Questionnaire 9‐item depression screener, Generalized Anxiety Disorder 7‐item screener, and the 12‐item Allodynia Symptom Checklist were also assessed. Results Of 13,624 respondents with migraine, 4840 (35.5%) had ever used acute prescription medications and 1719 (35.5%) of those were discontinued users. Discontinued users had a mean (SD) age of 42.1 (14) years, and 1348/1719 (78.4%) were female. Monthly headache frequency of 0‐4 days was reported by 1073/1719 (62.4%) of respondents, 5‐9 days by 322/1719 (18.7%), 10‐14 days by 135/1719 (7.9%), and ≥15 days by 189/1719 (11.0%). Two‐thirds (1160/1719 [67.5%]) of discontinued users reported a receiving migraine (or chronic migraine) diagnosis from a doctor or other health professional in the past. Although all had spoken to a doctor about their headaches, 1504/1719 (87.5%) had stopped having their headaches managed or treated by a doctor for at least 12 months. Only 1 in 5 discontinued users reported being able to work or function normally with a headache, and 717/1719 (41.7%) had moderate to severe disability (MIDAS). Among the most commonly reported reasons for prescription medication discontinuation were switching to non‐prescription pain medication (782/1719 [45.5%]), as well as concerns about prescription medication efficacy (484/1719 [28.2%]) and tolerability (428/1719 [24.9%]). Nearly half of respondents who reported either efficacy or tolerability concerns had moderate to severe disability. Conclusions People with migraine who discontinue acute prescription medication have a high level of unmet treatment need. The majority cannot work or function normally with headaches, with 646/1719 (37.6%) of discontinued users reporting 5 or more headache days per month.
Collapse
Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Jessica Ailani
- Medstar Georgetown University Hospital, Washington, DC, USA
| | | | | | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
44
|
Donnet A, Emery C, Aly S, Allaf B, Cayre F, Mahieu N, Gourmelen J, Levy P, Fagnani F. Migraine burden and costs in France: a nationwide claims database analysis of triptan users. J Med Econ 2019; 22:616-624. [PMID: 30836035 DOI: 10.1080/13696998.2019.1590841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 01/03/2023]
Abstract
Objectives: To estimate the burden of migraine in the population of French patients identified as specific migraine acute treatment users compared to a control group. Methods: A cross-sectional retrospective analysis was performed on the Echantillon Généraliste des Bénéficiaires claims database, a 1/97 random sample of the French public insurance database. A representative sample of all adults with at least one delivery of triptans, ergot derivatives or acetylsalicylic acid/metoclopramide (all drugs with a specific label in migraine acute treatment - SMAT) in 2014 was selected with a control group matched on age, gender and geographic region. Among triptan users, a sub-group of over-users was defined according to their level of triptan uptake expressed in defined daily doses (DDD - a standard daily dose of treatment of acute migraine) per month over 3 months and more, was also compared with controls. The cost analysis was performed in a societal perspective for direct costs. Sick leave indirect costs were estimated using the human capital approach. Results: In total 8639 SMAT users (mean age: 44.6 years; 78.7% women) were selected representing a crude prevalence rate of 1.7%. The annual per capita total healthcare expenditures were higher by €280 in this group compared to controls (€2463 vs. €2183). Triptans contributed 47.8% to this extra cost. They used significantly (p < .0001) more frequently than controls antidepressants (20.8% vs. 11.0%), anxiolytics (29.4% vs. 18.8%) and analgesics (53.8% vs. 35.8%). The per capita annual productivity loss associated with sick leave was higher by €295 (€1712 vs. €1417). Among triptan users, there were 2.9% over-users. This last group was characterized by substantially higher per capita annual extra direct (+ €1805) and indirect costs (productivity loss +€706) compared to controls. Conclusions: Due to its high prevalence, migraine costs generate a significant societal burden. The group of over-users concentrates high per capita direct and indirect costs.
Collapse
Affiliation(s)
| | | | - Samia Aly
- c Novartis Pharma , Rueil-Malmaison , France
| | | | - Fanny Cayre
- c Novartis Pharma , Rueil-Malmaison , France
| | | | | | - Pierre Levy
- e Université Paris-Dauphine, PSL Research University, LEDa [LEGOS] , Paris , France
| | | |
Collapse
|
45
|
Merki-Feld GS, Imthurn B, Gantenbein AR, Sandor P. Effect of desogestrel 75 µg on headache frequency and intensity in women with migraine: a prospective controlled trial. EUR J CONTRACEP REPR 2019; 24:175-181. [PMID: 31094588 DOI: 10.1080/13625187.2019.1605504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/28/2023]
Abstract
Objective: In contrast with combined hormonal contraception, progestin-only contraception is not associated with an increase in venous thromboembolism or stroke. Women with migraine are at increased risk of ischaemic stroke. Several studies have reported a reduction in migraine frequency and intensity with desogestrel 75 µg, a progestin-only pill. At present the quality of data is limited by retrospective study designs, lack of control groups and small sample sizes. We present the first prospective nonrandomised controlled trial. Methods: A total of 150 women with migraine visiting our clinic for contraceptive counselling were screened. The intervention group comprised women who opted for contraception with desogestrel (n = 98); the control group comprised women who continued their usual contraceptive (n = 36). Participants completed daily diaries for 90 days before the intervention and 180 days after the intervention. Results: In the intervention group, we found improvements in migraine frequency (p < .001), migraine intensity (p < .001) and the number of triptans used (p < .001). These improvements were already significant after 90 days of desogestrel use (p < .001). Disability scores also decreased significantly. No improvement was seen in the nonintervention group. Conclusion: These data demonstrate for the first time in a prospective controlled setting that daily use of the progestin desogestrel is associated with a decrease in migraine frequency, migraine intensity and pain medication use in women with migraine, with and without aura, who had previously been experiencing at least three days of migraine per month. Trial registration: The study is registered in the University of Zürich database ( www.research-projects.uzh.ch/unizh.htm ).
Collapse
Affiliation(s)
- Gabriele S Merki-Feld
- a Department of Reproductive Endocrinology , Zürich University Hospital , Zürich , Switzerland
| | - Bruno Imthurn
- b Department of Neurorehabilitation , RehaClinic , Bad Zurzach , Switzerland
| | | | - Peter Sandor
- b Department of Neurorehabilitation , RehaClinic , Bad Zurzach , Switzerland
| |
Collapse
|
46
|
Pascual J, Vila C. Almotriptan: a review of 20 years' clinical experience. Expert Rev Neurother 2019; 19:759-768. [PMID: 30845850 DOI: 10.1080/14737175.2019.1591951] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Almotriptan (ALT), a serotonin 5-HT1B/1D agonist has been used in the acute treatment of migraine with or without aura for 20 years, accumulating data on more than 15,000 patients in studies and from an estimated >150 million treated migraine attacks in daily clinical practice. The last major review of ALT was written almost 10 years ago. The current narrative review provides an overview of the experience gained with almotriptan over that time, and highlights data published in the last decade. Areas covered: Randomized clinical trials, observational studies, postmarketing studies and meta-analyses involving ALT for the treatment of acute migraine identified through a systematic literature search. Expert opinion: Triptans are a mainstay of anti-migraine treatment. Findings with ALT over the last 10 years have reinforced the positive efficacy and tolerability results that were reported during the first 10 years following its introduction. In particular, more recent clinical results have confirmed its efficacy in women with menstrual migraine, the usefulness of early intervention, long-term benefit in adults, and also its efficacy and safety in adolescents. Overall, ALT can be considered an optimal choice for managing acute migraine resistant to first-line drugs.
Collapse
Affiliation(s)
- Julio Pascual
- a Neurology Service , University Hospital Marqués de Valdecilla and IDIVAL , Santander , Spain
| | - Carlos Vila
- b Global Medical Affairs , Almirall S.A , Barcelona , Spain
| |
Collapse
|
47
|
Cargnin S, Viana M, Sances G, Cantello R, Tassorelli C, Terrazzino S. Using a Genetic Risk Score Approach to Predict Headache Response to Triptans in Migraine Without Aura. J Clin Pharmacol 2018; 59:288-294. [PMID: 30256423 DOI: 10.1002/jcph.1320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/19/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022]
Abstract
A large meta-analysis of genome-wide association studies has recently identified a number of risk loci for migraine without aura (MwoA). In this study, we tested the hypothesis that a genetic risk score based on single-nucleotide polymorphisms (SNPs), previously reported to be associated with MwoA at genome-wide significance, may influence headache response to triptans in patients with migraine without aura. Genotyping of rs9349379, rs2078371, rs6478241, rs11172113, rs1024905, and rs6724624 was conducted with a real-time PCR allelic discrimination assay in 172 MwoA patients, of whom 36.6% were inconsistent responders to triptans. Each genetic risk score model was constructed as an unweighted score, calculated by adding the number of risk alleles for MwoA across each SNP at selected loci. The association with headache response to triptans was evaluated by logistic regression analysis adjusted for triptan, and the P values were corrected for the false discovery rate. The genetic risk score including susceptibility risk alleles at TRPM8 rs6724624 and FGF6 rs1024905 was found to be inversely associated with risk of inconsistent response to triptans (OR, 0.62; 95%CI, 0.43-0.89; false discovery rate q value, 0.045). In addition, adding this genetic risk score to the triptan-adjusted logistic regression model significantly improved (P = .037) the discrimination accuracy, from 0.57 (95%CI, 0.50-0.65) to 0.64 (95%CI, 0.57-0.72). A modest but significant effect on risk of inconsistent response to triptans was identified for a genetic risk score model composed of 2 known risk alleles for MwoA, suggesting its potential utility in predicting headache response to triptan therapy.
Collapse
Affiliation(s)
- Sarah Cargnin
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Michele Viana
- Headache Science Centre, National Neurological Institute C. Mondino, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, National Neurological Institute C. Mondino, Pavia, Italy
| | - Roberto Cantello
- Department of Neurology, Oriental Piedmont University, Maggiore della Carità Hospital, Novara, Italy
| | - Cristina Tassorelli
- Headache Science Centre, National Neurological Institute C. Mondino, Pavia, Italy.,Department of Brain and Behaviour, University of Pavia, Pavia, Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| |
Collapse
|
48
|
Yusuf A, Chia V, Xue F, Mikol DD, Bollinger L, Cangialose C. Use of existing electronic health care databases to evaluate medication safety in pregnancy: Triptan exposure in pregnancy as a case study. Pharmacoepidemiol Drug Saf 2018; 27:1309-1315. [PMID: 30240072 PMCID: PMC6586074 DOI: 10.1002/pds.4658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/13/2017] [Revised: 05/25/2018] [Accepted: 08/18/2018] [Indexed: 12/04/2022]
Abstract
Purpose The recent expansion of electronic health and medical record systems may present an opportunity to generate robust post‐approval safety data and obviate the limitations of prospective pregnancy exposure registries. We examined and compared, over the same time frame, the outcomes of triptan exposure in pregnancy using (1) a retrospective claims database and (2) a previously completed pregnancy registry. Methods Using the Marketscan database, the risk of major birth defects was ascertained in live‐born infants whose birth mothers were exposed to sumatriptan, naratriptan, or sumatriptan/naproxen during pregnancy. The frequencies of outcomes observed were compared with the findings of the 16‐year sumatriptan, naratripan, and sumatriptan/naproxen prospective pregnancy registry. Results About 5120 pregnancies were identified in the retrospective claims cohort in contrast to 617 included in the prospective registry during the same time frame. The proportion of major birth defects among first‐semester sumatriptan exposures was 4.0%, which is exactly the same as the proportion of major birth defects reported for first‐semester sumatriptan exposures in the registry. There were very few non‐livebirth outcomes in both the claims analyses and registry. Conclusions These results confirm broad agreement between the database analysis and the registry regarding the safety of triptans during pregnancy. Of note, the number of triptan‐exposed pregnancies identified in this large US database was about 7‐fold that included in the prospective registry over the same time frame. The findings of this study support an approach of using existing health care database (s) in the post‐approval assessment of medication exposure in pregnancy.
Collapse
Affiliation(s)
| | | | - Fei Xue
- Amgen, Inc., Thousand Oaks, CA, USA
| | | | | | | |
Collapse
|
49
|
Harris GME, Wood M, Ystrom E, Nordeng H. Prenatal triptan exposure and neurodevelopmental outcomes in 5-year-old children: Follow-up from the Norwegian Mother and Child Cohort Study. Paediatr Perinat Epidemiol 2018; 32:247-255. [PMID: 29569251 DOI: 10.1111/ppe.12461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Triptans are commonly used to treat migraine headaches, but data on the long-term safety of these medications during pregnancy are sparse. Triptans have a biologically plausible mechanism for effects on the fetal brain through binding to 5-HT1 -receptors, and previous studies show increased risks of externalising behaviour problems in toddlers exposed to triptans during pregnancy. METHODS We included 3784 children in the Norwegian Mother and Child Cohort Study, whose mothers returned the 5-year-questionnaire and reported a history of migraine or triptan use; 353 (9.3%) mothers reported use of triptans during pregnancy, 1509 (39.9%) reported migraine during pregnancy but no triptan use, and 1922 (50.8%) had migraine prior to pregnancy only. We used linear and log-binomial models with inverse probability weights to examine the association between prenatal triptan exposure and internalising and externalising behaviour, communication, and temperament in 5-year-old children. RESULTS Triptan-exposed children scored higher on the sociability trait than unexposed children of mothers with migraine (β 1.66, 95% confidence interval [0.30, 3.02]). We found no other differences in temperament, or increased risk of behaviour or communication problems. CONCLUSIONS Contrary to results from previous studies in younger children, we found no increased risk of externalising behaviour problems in 5-year-old children exposed to triptans in fetal life. Triptan-exposed children did have slightly more sociable temperaments, but the clinical meaning of this finding is uncertain.
Collapse
Affiliation(s)
- Gerd-Marie Eskerud Harris
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Mollie Wood
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Eivind Ystrom
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
50
|
Abstract
Introduction A potentially illuminating way of looking at gender differences in health and disease is to study differences in drug utilization. The aim of this study was to describe gender differences in dispensed analgesics (including nonsteroidal anti-inflammatory drugs [NSAIDs]) in Sweden during 2006–2015. Materials and Methods The Swedish Board of Health and Welfare holds an open, Anatomical Therapeutic Chemical (ATC)–based statistical database containing aggregated data on all dispensed prescription drugs in Swedish pharmacies since 2006. The database is searchable according to sex, age (5-year intervals), and Swedish regions. Results Nationwide, whole-population information was retrieved for all ATC codes at the second level for individuals ≥20 years of age, focusing on sex-related differences. More in-depth analyses were made for analgesics, including NSAIDs. Descriptive statistics were used. Gender differences in drug prescription are pervasive in Sweden; the yearly prevalence in 2015 was higher in women for 72 out of 84 ATC groups (not adjusted for age). Analgesics, including NSAIDs, were more commonly used by women in all age groups. Gender differences were sustained over time (2006–2015) and were particularly striking for triptans. For both men and women, the yearly prevalence of opioids was stable during 2006–2015, whereas it increased for paracetamol and decreased for NSAIDs. The increase in paracetamol prescription was most noticeable for young females, and the decrease in NSAID prescription was largest in older patients (irrespective of sex). Conclusion Gender differences in the use of analgesics probably mirror the higher prevalence of chronic pain in women.
Collapse
Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|