Article

Key clinical point: Patients with migraine had significantly higher serum levels of interleukin (IL)-6, IL-1β, C-reactive protein (CRP), and tumor necrosis factor alpha (TNF-α) than healthy controls, with no significant difference being observed in the serum levels of IL-2 or IL-10.

Major finding: Patients with migraine vs. healthy controls had significantly higher serum levels of CRP (standardized mean difference [SMD] 1.48; P < .001), IL-1β (SMD 0.75; P < .001), IL-6 (SMD 1.18; P < .001), and TNF-α (SMD 0.69; P = .003); however, no significant difference was noted in serum IL-2 (P = .25) or IL-10 (P = .88) levels.

Study details: The data come from a meta-analysis of 10 studies that compared the peripheral cytokine levels between patients with migraine and healthy controls.

Disclosures: This study was supported by the Key Project of Henan Provincial Science and Technology Department. The authors declared no conflict of interests.

Source: Geng C et al. Aberrations in peripheral inflammatory cytokine levels in migraine: A systematic review and meta-analysis. J Clin Neurosci. 2022;98:213-218 (Feb 21). Doi: 10.1016/j.jocn.2022.02.026

Key clinical point: Patients with migraine had significantly higher serum levels of interleukin (IL)-6, IL-1β, C-reactive protein (CRP), and tumor necrosis factor alpha (TNF-α) than healthy controls, with no significant difference being observed in the serum levels of IL-2 or IL-10.

Major finding: Patients with migraine vs. healthy controls had significantly higher serum levels of CRP (standardized mean difference [SMD] 1.48; P < .001), IL-1β (SMD 0.75; P < .001), IL-6 (SMD 1.18; P < .001), and TNF-α (SMD 0.69; P = .003); however, no significant difference was noted in serum IL-2 (P = .25) or IL-10 (P = .88) levels.

Study details: The data come from a meta-analysis of 10 studies that compared the peripheral cytokine levels between patients with migraine and healthy controls.

Disclosures: This study was supported by the Key Project of Henan Provincial Science and Technology Department. The authors declared no conflict of interests.

Source: Geng C et al. Aberrations in peripheral inflammatory cytokine levels in migraine: A systematic review and meta-analysis. J Clin Neurosci. 2022;98:213-218 (Feb 21). Doi: 10.1016/j.jocn.2022.02.026

Key clinical point: Patients with migraine had significantly higher serum levels of interleukin (IL)-6, IL-1β, C-reactive protein (CRP), and tumor necrosis factor alpha (TNF-α) than healthy controls, with no significant difference being observed in the serum levels of IL-2 or IL-10.

Major finding: Patients with migraine vs. healthy controls had significantly higher serum levels of CRP (standardized mean difference [SMD] 1.48; P < .001), IL-1β (SMD 0.75; P < .001), IL-6 (SMD 1.18; P < .001), and TNF-α (SMD 0.69; P = .003); however, no significant difference was noted in serum IL-2 (P = .25) or IL-10 (P = .88) levels.

Study details: The data come from a meta-analysis of 10 studies that compared the peripheral cytokine levels between patients with migraine and healthy controls.

Disclosures: This study was supported by the Key Project of Henan Provincial Science and Technology Department. The authors declared no conflict of interests.

Source: Geng C et al. Aberrations in peripheral inflammatory cytokine levels in migraine: A systematic review and meta-analysis. J Clin Neurosci. 2022;98:213-218 (Feb 21). Doi: 10.1016/j.jocn.2022.02.026

Key clinical point: Diets with higher proinflammatory effects as indicated by higher Dietary Inflammatory Index (DII) values are significantly associated with an increased frequency and severity of migraine headaches.

Major finding: After adjusting for potential confounders, an increase in the DII score from −4.04 to −1.83 increased the headache frequency by 3.48 (β 3.48; P = .001) and was associated with a higher risk for severe headaches (odds ratio 2.25; P = .015).

Study details: Findings are from a population-based cross-sectional study including 262 patients with migraine having a body mass index of 18.5-30.0 kg/m² and daily energy consumption of 800-4,200 kcal/day.

Disclosures: The study was funded by Isfahan University of Medical Sciences, Iran. The authors declared no conflict of interests.

Source: Ghoreishy SM et al. Associations between potential inflammatory properties of the diet and frequency, duration, and severity of migraine headaches: a cross-sectional study. Sci Rep. 2022;12:2878 (Feb 21). Doi: 10.1038/s41598-022-06819-y

Key clinical point: Diets with higher proinflammatory effects as indicated by higher Dietary Inflammatory Index (DII) values are significantly associated with an increased frequency and severity of migraine headaches.

Major finding: After adjusting for potential confounders, an increase in the DII score from −4.04 to −1.83 increased the headache frequency by 3.48 (β 3.48; P = .001) and was associated with a higher risk for severe headaches (odds ratio 2.25; P = .015).

Study details: Findings are from a population-based cross-sectional study including 262 patients with migraine having a body mass index of 18.5-30.0 kg/m² and daily energy consumption of 800-4,200 kcal/day.

Disclosures: The study was funded by Isfahan University of Medical Sciences, Iran. The authors declared no conflict of interests.

Source: Ghoreishy SM et al. Associations between potential inflammatory properties of the diet and frequency, duration, and severity of migraine headaches: a cross-sectional study. Sci Rep. 2022;12:2878 (Feb 21). Doi: 10.1038/s41598-022-06819-y

Key clinical point: Diets with higher proinflammatory effects as indicated by higher Dietary Inflammatory Index (DII) values are significantly associated with an increased frequency and severity of migraine headaches.

Major finding: After adjusting for potential confounders, an increase in the DII score from −4.04 to −1.83 increased the headache frequency by 3.48 (β 3.48; P = .001) and was associated with a higher risk for severe headaches (odds ratio 2.25; P = .015).

Study details: Findings are from a population-based cross-sectional study including 262 patients with migraine having a body mass index of 18.5-30.0 kg/m² and daily energy consumption of 800-4,200 kcal/day.

Disclosures: The study was funded by Isfahan University of Medical Sciences, Iran. The authors declared no conflict of interests.

Source: Ghoreishy SM et al. Associations between potential inflammatory properties of the diet and frequency, duration, and severity of migraine headaches: a cross-sectional study. Sci Rep. 2022;12:2878 (Feb 21). Doi: 10.1038/s41598-022-06819-y

Key clinical point: Moderate-to-severe headache days in chronic migraine with medication overuse (CMMO) could be lowered with preventive medication irrespective of whether the overused symptomatic medication is continued or switched to a limited-use alternative.

Major finding: The number of monthly moderate-to-severe headache days achieved with the no switching strategy was not significantly different from that with the switching strategy both during weeks 1-2 (6.4 vs. 6.6 days; P = .57) and 9-12 (9.1 vs. 9.3 days; P = .75) after randomization.

Study details: The data come from MOTS trial including 720 patients aged ≥21 years with CMMO who were randomly assigned to receive migraine prophylactic medication and concurrently either switch from the overused medication to an alternative (≤2 days/week) or continue the overused medication with no maximum limit.

Disclosures: The study was sponsored by a Patient-Centered Outcomes Research Institute Award. Some authors reported receiving personal compensation, research grants, stock options, or royalties from various pharmaceutical companies.

Source: Schwedt T et al. Patient-centered treatment of chronic migraine with medication overuse: A prospective, randomized, pragmatic clinical trial. Neurology. 2022 (Feb 15). Doi: 10.1212/WNL.0000000000200117

Key clinical point: Moderate-to-severe headache days in chronic migraine with medication overuse (CMMO) could be lowered with preventive medication irrespective of whether the overused symptomatic medication is continued or switched to a limited-use alternative.

Major finding: The number of monthly moderate-to-severe headache days achieved with the no switching strategy was not significantly different from that with the switching strategy both during weeks 1-2 (6.4 vs. 6.6 days; P = .57) and 9-12 (9.1 vs. 9.3 days; P = .75) after randomization.

Study details: The data come from MOTS trial including 720 patients aged ≥21 years with CMMO who were randomly assigned to receive migraine prophylactic medication and concurrently either switch from the overused medication to an alternative (≤2 days/week) or continue the overused medication with no maximum limit.

Disclosures: The study was sponsored by a Patient-Centered Outcomes Research Institute Award. Some authors reported receiving personal compensation, research grants, stock options, or royalties from various pharmaceutical companies.

Source: Schwedt T et al. Patient-centered treatment of chronic migraine with medication overuse: A prospective, randomized, pragmatic clinical trial. Neurology. 2022 (Feb 15). Doi: 10.1212/WNL.0000000000200117

Key clinical point: Moderate-to-severe headache days in chronic migraine with medication overuse (CMMO) could be lowered with preventive medication irrespective of whether the overused symptomatic medication is continued or switched to a limited-use alternative.

Major finding: The number of monthly moderate-to-severe headache days achieved with the no switching strategy was not significantly different from that with the switching strategy both during weeks 1-2 (6.4 vs. 6.6 days; P = .57) and 9-12 (9.1 vs. 9.3 days; P = .75) after randomization.

Study details: The data come from MOTS trial including 720 patients aged ≥21 years with CMMO who were randomly assigned to receive migraine prophylactic medication and concurrently either switch from the overused medication to an alternative (≤2 days/week) or continue the overused medication with no maximum limit.

Disclosures: The study was sponsored by a Patient-Centered Outcomes Research Institute Award. Some authors reported receiving personal compensation, research grants, stock options, or royalties from various pharmaceutical companies.

Source: Schwedt T et al. Patient-centered treatment of chronic migraine with medication overuse: A prospective, randomized, pragmatic clinical trial. Neurology. 2022 (Feb 15). Doi: 10.1212/WNL.0000000000200117

Key clinical point: A higher proportion of patients with chronic migraine treated with eptinezumab vs. placebo showed an early treatment response, with most early responders maintaining the response for at least half of the entire 24-week treatment period.

Major finding: At 1 month, a ≥75% reduction in monthly migraine days was achieved by 30.9%, 36.9%, and 15.6% of patients receiving 100 mg eptinezumab, 300 mg eptinezumab, and placebo, respectively. Among patients who achieved a ≥75% migraine response at 1 month, more than one-third and two-thirds maintained the same for the next 5 months and ≥3 months, respectively.

Study details: This was a post hoc analysis of the PROMISE 2 trial, including 1,072 patients with chronic migraine who were randomly assigned to receive 100 mg eptinezumab, 300 mg eptinezumab, or placebo.

Disclosures: The study was funded by H. Lundbeck A/S, Copenhagen. R Cady and T Brevig declared being employees of Lundbeck or a subsidiary company or having equity in Lundbeck, and others declared serving on advisory panels for or receiving grant support, consulting support, or personal compensation from various sources, including Lundbeck.

Source: Buse DC et al. Early response to eptinezumab indicates high likelihood of continued response in patients with chronic migraine. J Headache Pain. 2022;23:29 (Feb 21). Doi: 10.1186/s10194-022-01387-y

Key clinical point: A higher proportion of patients with chronic migraine treated with eptinezumab vs. placebo showed an early treatment response, with most early responders maintaining the response for at least half of the entire 24-week treatment period.

Major finding: At 1 month, a ≥75% reduction in monthly migraine days was achieved by 30.9%, 36.9%, and 15.6% of patients receiving 100 mg eptinezumab, 300 mg eptinezumab, and placebo, respectively. Among patients who achieved a ≥75% migraine response at 1 month, more than one-third and two-thirds maintained the same for the next 5 months and ≥3 months, respectively.

Study details: This was a post hoc analysis of the PROMISE 2 trial, including 1,072 patients with chronic migraine who were randomly assigned to receive 100 mg eptinezumab, 300 mg eptinezumab, or placebo.

Disclosures: The study was funded by H. Lundbeck A/S, Copenhagen. R Cady and T Brevig declared being employees of Lundbeck or a subsidiary company or having equity in Lundbeck, and others declared serving on advisory panels for or receiving grant support, consulting support, or personal compensation from various sources, including Lundbeck.

Source: Buse DC et al. Early response to eptinezumab indicates high likelihood of continued response in patients with chronic migraine. J Headache Pain. 2022;23:29 (Feb 21). Doi: 10.1186/s10194-022-01387-y

Key clinical point: A higher proportion of patients with chronic migraine treated with eptinezumab vs. placebo showed an early treatment response, with most early responders maintaining the response for at least half of the entire 24-week treatment period.

Major finding: At 1 month, a ≥75% reduction in monthly migraine days was achieved by 30.9%, 36.9%, and 15.6% of patients receiving 100 mg eptinezumab, 300 mg eptinezumab, and placebo, respectively. Among patients who achieved a ≥75% migraine response at 1 month, more than one-third and two-thirds maintained the same for the next 5 months and ≥3 months, respectively.

Study details: This was a post hoc analysis of the PROMISE 2 trial, including 1,072 patients with chronic migraine who were randomly assigned to receive 100 mg eptinezumab, 300 mg eptinezumab, or placebo.

Disclosures: The study was funded by H. Lundbeck A/S, Copenhagen. R Cady and T Brevig declared being employees of Lundbeck or a subsidiary company or having equity in Lundbeck, and others declared serving on advisory panels for or receiving grant support, consulting support, or personal compensation from various sources, including Lundbeck.

Source: Buse DC et al. Early response to eptinezumab indicates high likelihood of continued response in patients with chronic migraine. J Headache Pain. 2022;23:29 (Feb 21). Doi: 10.1186/s10194-022-01387-y

Key clinical point: With its efficacy and safety in patients aged ≥50 years with migraine being similar to those in the overall study population in the PROMISE-1 and PROMISE-2 trials, eptinezumab could be an effective treatment option in this subpopulation.

Major finding: Compared with those in the total study population, similar changes in mean monthly migraine days were observed in patients with episodic (least squares mean [LSM] changes in days: 100 mg eptinezumab: −3.6; 300 mg eptinezumab: −4.4; placebo: −2.8) and chronic (LSM changes in days: 100 mg eptinezumab: −7.6; 300 mg `eptinezumab: −8.4; placebo: −6.0) migraine. The incidence of treatment-emergent adverse events was similar among treatment groups.

Study details: Of 1,960 patients with episodic or chronic migraine from the PROMISE-1 and PROMISE-2 trials, this post hoc analysis evaluated 385 patients aged ≥50 years who received eptinezumab or placebo.

Disclosures: H. Lundbeck A/S, Copenhagen, sponsored the study. V Martin and C Tassorelli declared being consultants, speakers, clinical trial investigators, or advisory board members for various companies, including Lundbeck; the rest are current/former employees of Lundbeck or a subsidiary/contracted company.

Source: Martin V et al. Eptinezumab for migraine prevention in patients 50 years or older. Acta Neurol Scand. 2022 (Feb 26). Doi: 10.1111/ane.13603

Key clinical point: With its efficacy and safety in patients aged ≥50 years with migraine being similar to those in the overall study population in the PROMISE-1 and PROMISE-2 trials, eptinezumab could be an effective treatment option in this subpopulation.

Major finding: Compared with those in the total study population, similar changes in mean monthly migraine days were observed in patients with episodic (least squares mean [LSM] changes in days: 100 mg eptinezumab: −3.6; 300 mg eptinezumab: −4.4; placebo: −2.8) and chronic (LSM changes in days: 100 mg eptinezumab: −7.6; 300 mg `eptinezumab: −8.4; placebo: −6.0) migraine. The incidence of treatment-emergent adverse events was similar among treatment groups.

Study details: Of 1,960 patients with episodic or chronic migraine from the PROMISE-1 and PROMISE-2 trials, this post hoc analysis evaluated 385 patients aged ≥50 years who received eptinezumab or placebo.

Disclosures: H. Lundbeck A/S, Copenhagen, sponsored the study. V Martin and C Tassorelli declared being consultants, speakers, clinical trial investigators, or advisory board members for various companies, including Lundbeck; the rest are current/former employees of Lundbeck or a subsidiary/contracted company.

Source: Martin V et al. Eptinezumab for migraine prevention in patients 50 years or older. Acta Neurol Scand. 2022 (Feb 26). Doi: 10.1111/ane.13603

Key clinical point: With its efficacy and safety in patients aged ≥50 years with migraine being similar to those in the overall study population in the PROMISE-1 and PROMISE-2 trials, eptinezumab could be an effective treatment option in this subpopulation.

Major finding: Compared with those in the total study population, similar changes in mean monthly migraine days were observed in patients with episodic (least squares mean [LSM] changes in days: 100 mg eptinezumab: −3.6; 300 mg eptinezumab: −4.4; placebo: −2.8) and chronic (LSM changes in days: 100 mg eptinezumab: −7.6; 300 mg `eptinezumab: −8.4; placebo: −6.0) migraine. The incidence of treatment-emergent adverse events was similar among treatment groups.

Study details: Of 1,960 patients with episodic or chronic migraine from the PROMISE-1 and PROMISE-2 trials, this post hoc analysis evaluated 385 patients aged ≥50 years who received eptinezumab or placebo.

Disclosures: H. Lundbeck A/S, Copenhagen, sponsored the study. V Martin and C Tassorelli declared being consultants, speakers, clinical trial investigators, or advisory board members for various companies, including Lundbeck; the rest are current/former employees of Lundbeck or a subsidiary/contracted company.

Source: Martin V et al. Eptinezumab for migraine prevention in patients 50 years or older. Acta Neurol Scand. 2022 (Feb 26). Doi: 10.1111/ane.13603

Key clinical point: A single intravenous (IV) dose of sodium valproate exerts a better analgesic effect than that of ibuprofen in the treatment of acute migraine attacks.

Major finding: Mean differences in the delta Numerical Rating Scale scores between the sodium valproate and ibuprofen groups were 1.69, 3.61, 4.11, and 3.92 (all P < .001) after 30, 60, 90, and 120 minutes from the time of presentation, respectively, with more patients achieving pain relief with IV sodium valproate (P < .001).

Study details: Findings are from a prospective, double-blinded study including 99 adult patients with migraine without aura who presented to the emergency department with acute headache and were randomly assigned to receive sodium valproate (n = 49) or ibuprofen (n = 50) by IV infusion over 5 minutes.

Disclosures: The authors reported receiving no financial support for the study and declared no conflict of interests.

Source: Dogruyol S et al. Intravenous ibuprofen versus sodium valproate in acute migraine attacks in the emergency department: A randomized clinical trial. Am J Emerg Med. 2022 (Mar 4). Doi:  10.1016/j.ajem.2022.02.046

Key clinical point: A single intravenous (IV) dose of sodium valproate exerts a better analgesic effect than that of ibuprofen in the treatment of acute migraine attacks.

Major finding: Mean differences in the delta Numerical Rating Scale scores between the sodium valproate and ibuprofen groups were 1.69, 3.61, 4.11, and 3.92 (all P < .001) after 30, 60, 90, and 120 minutes from the time of presentation, respectively, with more patients achieving pain relief with IV sodium valproate (P < .001).

Study details: Findings are from a prospective, double-blinded study including 99 adult patients with migraine without aura who presented to the emergency department with acute headache and were randomly assigned to receive sodium valproate (n = 49) or ibuprofen (n = 50) by IV infusion over 5 minutes.

Disclosures: The authors reported receiving no financial support for the study and declared no conflict of interests.

Source: Dogruyol S et al. Intravenous ibuprofen versus sodium valproate in acute migraine attacks in the emergency department: A randomized clinical trial. Am J Emerg Med. 2022 (Mar 4). Doi:  10.1016/j.ajem.2022.02.046

Key clinical point: A single intravenous (IV) dose of sodium valproate exerts a better analgesic effect than that of ibuprofen in the treatment of acute migraine attacks.

Major finding: Mean differences in the delta Numerical Rating Scale scores between the sodium valproate and ibuprofen groups were 1.69, 3.61, 4.11, and 3.92 (all P < .001) after 30, 60, 90, and 120 minutes from the time of presentation, respectively, with more patients achieving pain relief with IV sodium valproate (P < .001).

Study details: Findings are from a prospective, double-blinded study including 99 adult patients with migraine without aura who presented to the emergency department with acute headache and were randomly assigned to receive sodium valproate (n = 49) or ibuprofen (n = 50) by IV infusion over 5 minutes.

Disclosures: The authors reported receiving no financial support for the study and declared no conflict of interests.

Source: Dogruyol S et al. Intravenous ibuprofen versus sodium valproate in acute migraine attacks in the emergency department: A randomized clinical trial. Am J Emerg Med. 2022 (Mar 4). Doi:  10.1016/j.ajem.2022.02.046

Key clinical point: Anodal transcranial direct current stimulation (a-tDCS) of the left motor cortex shows significant prophylactic effects in patients with resistant chronic migraine (CM), including early and long-lasting beneficial effects after the stimulation period.

Major finding: The frequency of monthly migraine attacks reduced significantly in the a-tDCS vs. sham a-tDCS group from the end of the first month (−21.0% vs. −1.5%; P = .019) to the end of 3-month follow-up (−31.9% vs. −5.6%; P = .011), with the rate of responders being significantly higher in the a-tDCS vs. sham a-tDCS group at 3 months posttreatment (50% vs. 14%; P = .043).

Study details: Findings are from a patient-assessor–blinded trial including 36 patients with resistant CM who were randomly assigned to receive a-tDCS (n = 18) or sham a-tDCS (n = 18) over 2 months before a 3-month posttreatment follow-up.

Disclosures: The study received no specific funding. The authors declared no conflict of interests.

Source: Hodaj H et al. Long-term prophylactic efficacy of transcranial direct current stimulation in chronic migraine. A randomised, patient-assessor blinded, sham-controlled trial. Brain Stimul. 2022;15(2):441-453 (Feb 24). Doi: 10.1016/j.brs.2022.02.012

Key clinical point: Anodal transcranial direct current stimulation (a-tDCS) of the left motor cortex shows significant prophylactic effects in patients with resistant chronic migraine (CM), including early and long-lasting beneficial effects after the stimulation period.

Major finding: The frequency of monthly migraine attacks reduced significantly in the a-tDCS vs. sham a-tDCS group from the end of the first month (−21.0% vs. −1.5%; P = .019) to the end of 3-month follow-up (−31.9% vs. −5.6%; P = .011), with the rate of responders being significantly higher in the a-tDCS vs. sham a-tDCS group at 3 months posttreatment (50% vs. 14%; P = .043).

Study details: Findings are from a patient-assessor–blinded trial including 36 patients with resistant CM who were randomly assigned to receive a-tDCS (n = 18) or sham a-tDCS (n = 18) over 2 months before a 3-month posttreatment follow-up.

Disclosures: The study received no specific funding. The authors declared no conflict of interests.

Source: Hodaj H et al. Long-term prophylactic efficacy of transcranial direct current stimulation in chronic migraine. A randomised, patient-assessor blinded, sham-controlled trial. Brain Stimul. 2022;15(2):441-453 (Feb 24). Doi: 10.1016/j.brs.2022.02.012

Key clinical point: Anodal transcranial direct current stimulation (a-tDCS) of the left motor cortex shows significant prophylactic effects in patients with resistant chronic migraine (CM), including early and long-lasting beneficial effects after the stimulation period.

Major finding: The frequency of monthly migraine attacks reduced significantly in the a-tDCS vs. sham a-tDCS group from the end of the first month (−21.0% vs. −1.5%; P = .019) to the end of 3-month follow-up (−31.9% vs. −5.6%; P = .011), with the rate of responders being significantly higher in the a-tDCS vs. sham a-tDCS group at 3 months posttreatment (50% vs. 14%; P = .043).

Study details: Findings are from a patient-assessor–blinded trial including 36 patients with resistant CM who were randomly assigned to receive a-tDCS (n = 18) or sham a-tDCS (n = 18) over 2 months before a 3-month posttreatment follow-up.

Disclosures: The study received no specific funding. The authors declared no conflict of interests.

Source: Hodaj H et al. Long-term prophylactic efficacy of transcranial direct current stimulation in chronic migraine. A randomised, patient-assessor blinded, sham-controlled trial. Brain Stimul. 2022;15(2):441-453 (Feb 24). Doi: 10.1016/j.brs.2022.02.012

Key clinical point: Anti‐calcitonin gene‐related peptide (anti-CGRP) monoclonal antibodies were effective and safe over a 12-month treatment period in patients with treatment-resistant chronic migraine (CM) and medication overuse.

Major finding: Among patients followed up for 12 months, a ≥50% reduction in monthly migraine days and Migraine Disability Assessment score was achieved by 36.4%-66.6% and 84.4%-100% of patients, respectively. No severe treatment-related adverse events were observed.

Study details: Findings are from a prospective, monocentric, cohort study including 203 patients with CM (most also reporting medication overuse) who were resistant to ≥3 preventive treatments and commenced preventive therapy with erenumab, galcanezumab, or fremanezumab.

Disclosures: The study did not receive any financial support. P Geppetti and FD Cesaris reported receiving personal fees and research grants from various sources along with serving as an advisory board member or founding scientist for some sources.

Source: Iannone LF et al. Long-term effectiveness of three anti-CGRP monoclonal antibodies in resistant chronic migraine patients based on the MIDAS score. CNS Drugs. 2022;36:191-202 (Feb 11). Doi: 10.1007/s40263-021-00893-y

Key clinical point: Anti‐calcitonin gene‐related peptide (anti-CGRP) monoclonal antibodies were effective and safe over a 12-month treatment period in patients with treatment-resistant chronic migraine (CM) and medication overuse.

Major finding: Among patients followed up for 12 months, a ≥50% reduction in monthly migraine days and Migraine Disability Assessment score was achieved by 36.4%-66.6% and 84.4%-100% of patients, respectively. No severe treatment-related adverse events were observed.

Study details: Findings are from a prospective, monocentric, cohort study including 203 patients with CM (most also reporting medication overuse) who were resistant to ≥3 preventive treatments and commenced preventive therapy with erenumab, galcanezumab, or fremanezumab.

Disclosures: The study did not receive any financial support. P Geppetti and FD Cesaris reported receiving personal fees and research grants from various sources along with serving as an advisory board member or founding scientist for some sources.

Source: Iannone LF et al. Long-term effectiveness of three anti-CGRP monoclonal antibodies in resistant chronic migraine patients based on the MIDAS score. CNS Drugs. 2022;36:191-202 (Feb 11). Doi: 10.1007/s40263-021-00893-y

Key clinical point: Anti‐calcitonin gene‐related peptide (anti-CGRP) monoclonal antibodies were effective and safe over a 12-month treatment period in patients with treatment-resistant chronic migraine (CM) and medication overuse.

Major finding: Among patients followed up for 12 months, a ≥50% reduction in monthly migraine days and Migraine Disability Assessment score was achieved by 36.4%-66.6% and 84.4%-100% of patients, respectively. No severe treatment-related adverse events were observed.

Study details: Findings are from a prospective, monocentric, cohort study including 203 patients with CM (most also reporting medication overuse) who were resistant to ≥3 preventive treatments and commenced preventive therapy with erenumab, galcanezumab, or fremanezumab.

Disclosures: The study did not receive any financial support. P Geppetti and FD Cesaris reported receiving personal fees and research grants from various sources along with serving as an advisory board member or founding scientist for some sources.

Source: Iannone LF et al. Long-term effectiveness of three anti-CGRP monoclonal antibodies in resistant chronic migraine patients based on the MIDAS score. CNS Drugs. 2022;36:191-202 (Feb 11). Doi: 10.1007/s40263-021-00893-y

Previous studies exploring vaccination responses in the setting of certain disease-modifying therapies noted that B-cell–depleting agents and fingolimod were associated with poorer vaccination responses, as measured by antibody titers. Another prospective study explored mitigating strategies for people with MS treated with fingolimod and concluded that discontinuation of disease-modifying therapy improved the humoral response generated after SARS-CoV-2 vaccination (Achiron et al). Specifically, 20 people with MS treated with fingolimod therapy, who received the third dose of BNT162b2 (Pfizer-BioNTech) vaccine after not developing a humoral immunoglobulin (Ig) G immune response to the previous two doses, were randomly assigned to the fingolimod-continuation or fingolimod-discontinuation group. In this cohort, 80% vs. 20% of patients in the fingolimod-discontinuation vs. fingolimod-continuation group developed a positive humoral response against SARS-CoV-2 at 1 month after the third vaccine dose, with a significantly higher median G titer in the fingolimod-discontinuation vs. fingolimod-continuation group (202.3 vs. 26.4 binding antibody units/mL; P = .022). Certain B-cell–depleting agents adversely influence serum Ig levels, and other B-cell–"impacting" agents appear to not. In one study, extended ofatumumab treatment in a group of people with MS (N = 1969) for up to 3.5 years was both well tolerated and not associated with new risks. In this study, 83.8% and 9.7% of patients experienced at least one AE and one serious AE, respectively. Systemic injection-related reactions, infections, and cancers were reported in 24.8%, 54.3%, and 0.3% of patients, respectively. In most patients, the mean serum IgG and IgM levels were stable and above the lower limit of normal, and the risk for serious infections remained low, as seen with Ig deficiencies (Hauser et al).

Practical points for clinicians who treat MS to include in discussions with people with MS about choice of disease-modifying therapy and ongoing treatment include the safety and tolerability of vaccinations, the limited effect of vaccination on relapse in MS, the effect of specific disease-modifying therapies on vaccination responses and vaccine efficacy, and the importance of Ig levels and ongoing monitoring of Ig levels in routine care.

Previous studies exploring vaccination responses in the setting of certain disease-modifying therapies noted that B-cell–depleting agents and fingolimod were associated with poorer vaccination responses, as measured by antibody titers. Another prospective study explored mitigating strategies for people with MS treated with fingolimod and concluded that discontinuation of disease-modifying therapy improved the humoral response generated after SARS-CoV-2 vaccination (Achiron et al). Specifically, 20 people with MS treated with fingolimod therapy, who received the third dose of BNT162b2 (Pfizer-BioNTech) vaccine after not developing a humoral immunoglobulin (Ig) G immune response to the previous two doses, were randomly assigned to the fingolimod-continuation or fingolimod-discontinuation group. In this cohort, 80% vs. 20% of patients in the fingolimod-discontinuation vs. fingolimod-continuation group developed a positive humoral response against SARS-CoV-2 at 1 month after the third vaccine dose, with a significantly higher median G titer in the fingolimod-discontinuation vs. fingolimod-continuation group (202.3 vs. 26.4 binding antibody units/mL; P = .022). Certain B-cell–depleting agents adversely influence serum Ig levels, and other B-cell–"impacting" agents appear to not. In one study, extended ofatumumab treatment in a group of people with MS (N = 1969) for up to 3.5 years was both well tolerated and not associated with new risks. In this study, 83.8% and 9.7% of patients experienced at least one AE and one serious AE, respectively. Systemic injection-related reactions, infections, and cancers were reported in 24.8%, 54.3%, and 0.3% of patients, respectively. In most patients, the mean serum IgG and IgM levels were stable and above the lower limit of normal, and the risk for serious infections remained low, as seen with Ig deficiencies (Hauser et al).

Practical points for clinicians who treat MS to include in discussions with people with MS about choice of disease-modifying therapy and ongoing treatment include the safety and tolerability of vaccinations, the limited effect of vaccination on relapse in MS, the effect of specific disease-modifying therapies on vaccination responses and vaccine efficacy, and the importance of Ig levels and ongoing monitoring of Ig levels in routine care.

Previous studies exploring vaccination responses in the setting of certain disease-modifying therapies noted that B-cell–depleting agents and fingolimod were associated with poorer vaccination responses, as measured by antibody titers. Another prospective study explored mitigating strategies for people with MS treated with fingolimod and concluded that discontinuation of disease-modifying therapy improved the humoral response generated after SARS-CoV-2 vaccination (Achiron et al). Specifically, 20 people with MS treated with fingolimod therapy, who received the third dose of BNT162b2 (Pfizer-BioNTech) vaccine after not developing a humoral immunoglobulin (Ig) G immune response to the previous two doses, were randomly assigned to the fingolimod-continuation or fingolimod-discontinuation group. In this cohort, 80% vs. 20% of patients in the fingolimod-discontinuation vs. fingolimod-continuation group developed a positive humoral response against SARS-CoV-2 at 1 month after the third vaccine dose, with a significantly higher median G titer in the fingolimod-discontinuation vs. fingolimod-continuation group (202.3 vs. 26.4 binding antibody units/mL; P = .022). Certain B-cell–depleting agents adversely influence serum Ig levels, and other B-cell–"impacting" agents appear to not. In one study, extended ofatumumab treatment in a group of people with MS (N = 1969) for up to 3.5 years was both well tolerated and not associated with new risks. In this study, 83.8% and 9.7% of patients experienced at least one AE and one serious AE, respectively. Systemic injection-related reactions, infections, and cancers were reported in 24.8%, 54.3%, and 0.3% of patients, respectively. In most patients, the mean serum IgG and IgM levels were stable and above the lower limit of normal, and the risk for serious infections remained low, as seen with Ig deficiencies (Hauser et al).

Practical points for clinicians who treat MS to include in discussions with people with MS about choice of disease-modifying therapy and ongoing treatment include the safety and tolerability of vaccinations, the limited effect of vaccination on relapse in MS, the effect of specific disease-modifying therapies on vaccination responses and vaccine efficacy, and the importance of Ig levels and ongoing monitoring of Ig levels in routine care.

Dr Enrique Alvarez, Associate Professor at the University of Colorado, reviews updates in symptom management that were presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) 2022 meeting.

First, Dr Alvarez highlights two studies of nabiximols — a complex botanical mixture of tetrahydrocannabinol and cannabidiol — in patients with multiple sclerosis (MS). In both the GWSP0604 and SAVANT studies, patients taking nabiximols demonstrated significant spasticity improvement and reductions in spasm frequency.

Next, Dr Alvarez shares study results that compared patient responses to the responses of healthcare practitioners (HCPs) treating these patients for their MS. This analysis, which focused on cases of fatigue, mood, and cognition, found that patients reported significantly higher rates of these symptoms compared with HCP responses.

Another study assessed the importance of shared decision-making between HCPs and patients with MS, drawing from MEDLINE, EMBASE, and CINAHL databases. The researchers identified apparent challenges in patient education and access to information and recommended that shared decision-making be integrated into routine practice.

Dr Alvarez concludes with a review of new resources launched by the National Multiple Sclerosis Society, the goal of which is to inform and empower patients about dietary approaches for self-management and to support clinicians who are facilitating related discussions with their patients.

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Enrique Alvarez, MD, PhD, Vice Chair of Clinical Research, Associate Professor, Department of Neurology, Division Neuroimmunology, University of Colorado, Rocky Mountain MS Center Anschutz Medical Center, Aurora, Colorado

Enrique Alvarez, MD, PhD, has disclosed the following relevant financial relationships:

Received research grant from: Biogen; Genentech/Roche; Novartis; TG Therapeutics; Patient-Centered Outcomes Research Initiative; National Multiple Sclerosis Society; National Institutes of Health; Rocky Mountain MS Center

Received income in an amount equal to or greater than $250 from: Actelion

Dr Enrique Alvarez, Associate Professor at the University of Colorado, reviews updates in symptom management that were presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) 2022 meeting.

First, Dr Alvarez highlights two studies of nabiximols — a complex botanical mixture of tetrahydrocannabinol and cannabidiol — in patients with multiple sclerosis (MS). In both the GWSP0604 and SAVANT studies, patients taking nabiximols demonstrated significant spasticity improvement and reductions in spasm frequency.

Next, Dr Alvarez shares study results that compared patient responses to the responses of healthcare practitioners (HCPs) treating these patients for their MS. This analysis, which focused on cases of fatigue, mood, and cognition, found that patients reported significantly higher rates of these symptoms compared with HCP responses.

Another study assessed the importance of shared decision-making between HCPs and patients with MS, drawing from MEDLINE, EMBASE, and CINAHL databases. The researchers identified apparent challenges in patient education and access to information and recommended that shared decision-making be integrated into routine practice.

Dr Alvarez concludes with a review of new resources launched by the National Multiple Sclerosis Society, the goal of which is to inform and empower patients about dietary approaches for self-management and to support clinicians who are facilitating related discussions with their patients.

--

Enrique Alvarez, MD, PhD, Vice Chair of Clinical Research, Associate Professor, Department of Neurology, Division Neuroimmunology, University of Colorado, Rocky Mountain MS Center Anschutz Medical Center, Aurora, Colorado

Enrique Alvarez, MD, PhD, has disclosed the following relevant financial relationships:

Received research grant from: Biogen; Genentech/Roche; Novartis; TG Therapeutics; Patient-Centered Outcomes Research Initiative; National Multiple Sclerosis Society; National Institutes of Health; Rocky Mountain MS Center

Received income in an amount equal to or greater than $250 from: Actelion

Dr Enrique Alvarez, Associate Professor at the University of Colorado, reviews updates in symptom management that were presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) 2022 meeting.

First, Dr Alvarez highlights two studies of nabiximols — a complex botanical mixture of tetrahydrocannabinol and cannabidiol — in patients with multiple sclerosis (MS). In both the GWSP0604 and SAVANT studies, patients taking nabiximols demonstrated significant spasticity improvement and reductions in spasm frequency.

Next, Dr Alvarez shares study results that compared patient responses to the responses of healthcare practitioners (HCPs) treating these patients for their MS. This analysis, which focused on cases of fatigue, mood, and cognition, found that patients reported significantly higher rates of these symptoms compared with HCP responses.

Another study assessed the importance of shared decision-making between HCPs and patients with MS, drawing from MEDLINE, EMBASE, and CINAHL databases. The researchers identified apparent challenges in patient education and access to information and recommended that shared decision-making be integrated into routine practice.

Dr Alvarez concludes with a review of new resources launched by the National Multiple Sclerosis Society, the goal of which is to inform and empower patients about dietary approaches for self-management and to support clinicians who are facilitating related discussions with their patients.

--

Enrique Alvarez, MD, PhD, Vice Chair of Clinical Research, Associate Professor, Department of Neurology, Division Neuroimmunology, University of Colorado, Rocky Mountain MS Center Anschutz Medical Center, Aurora, Colorado

Enrique Alvarez, MD, PhD, has disclosed the following relevant financial relationships:

Received research grant from: Biogen; Genentech/Roche; Novartis; TG Therapeutics; Patient-Centered Outcomes Research Initiative; National Multiple Sclerosis Society; National Institutes of Health; Rocky Mountain MS Center

Received income in an amount equal to or greater than $250 from: Actelion