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Head-to-head comparison of migraine meds reveals top options
BOSTON – , a new real-world analysis of data on more than 3 million migraine attacks shows.
The findings “align with results of clinical trials and recommendations from clinical treatment guidelines” and provide insights to complement clinical practice, said study investigator Chia-Chun Chiang, MD, a neurologist with Mayo Clinic, Rochester, Minn.
The findings were presented at the 2023 annual meeting of the American Academy of Neurology.
The power of big data
Despite a wide variety of acute migraine medications that are available, large-scale, head-to-head comparisons of treatment effectiveness from real-world patient experience reports are lacking, Dr. Chiang explained.
“To the best of our knowledge, this is the first study that simultaneously compared multiple acute migraine medications using a Big Data analysis approach based on real-world patient-provided data,” she said.
The researchers extracted more than 10 million self-reported migraine attack records from a migraine smartphone app called Migraine Buddy, where users can document whether a treatment was helpful, somewhat helpful, unsure, or unhelpful.
They analyzed 25 acute medications among seven classes: acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, combination analgesics (acetaminophen/aspirin/caffeine), ergots, antiemetics, and opioids. The newer gepants and ditan medication classes of medications were not included because of the relatively lower numbers of usage when data was extracted (2014-2020).
The researchers employed a two-level nested logistic regression model to analyze the odds of treatment effectiveness of each medication by adjusting concurrent medications and the covariance within the same user.
The final analysis included more than 3.1 million migraine attacks among 278,000 users globally.
Using ibuprofen as the reference, triptans, ergots, and antiemetics had the highest efficacy with mean odds ratios of 4.8, 3.02, and 2.67, respectively, followed by opioids (OR, 2.49), NSAIDs (OR, 1.94), combination analgesics (OR, 1.69), others (OR, 1.49), and acetaminophen (OR, 0.83).
Individual medications with the highest patient-reported effectiveness were eletriptan (Relpax; OR, 6.1), zolmitriptan (Zomig; OR, 5.7) and sumatriptan (Zecuity; OR, 5.2).
This migraine medication comparative effectiveness analysis, based on patient-reported outcomes, “supports and complements the treatment recommendations from national headache societies based on randomized controlled trials and meta-analyses and strongly supports the use of triptans,” Dr. Chiang said.
End of trial-and-error?
Commenting on this research, Shaheen Lakhan, MD, PhD, a neurologist and researcher in Boston, said “This is a great study of Big Data in that it shows the power of the smartphone to collect real-world data and smart researchers like at Mayo Clinic to analyze them.”
“The study sheds light on how different therapeutics compare with each other. The next iteration of this line of research, I would hope, would be to determine if particular medications are effective for a particular migraine population, and even down to individuals with migraine,” said Dr. Lakhan, who wasn’t involved in the study.
“Once those models are appropriately built, long gone will be the era of trial-and-error medicine,” Dr. Lakhan added.
The study had no specific funding. Dr. Chiang has served as a consultant for Satsuma. Dr. Lakhan reports no relevant financial relationships.
A version of this article originally appeared on Medscape.com.
BOSTON – , a new real-world analysis of data on more than 3 million migraine attacks shows.
The findings “align with results of clinical trials and recommendations from clinical treatment guidelines” and provide insights to complement clinical practice, said study investigator Chia-Chun Chiang, MD, a neurologist with Mayo Clinic, Rochester, Minn.
The findings were presented at the 2023 annual meeting of the American Academy of Neurology.
The power of big data
Despite a wide variety of acute migraine medications that are available, large-scale, head-to-head comparisons of treatment effectiveness from real-world patient experience reports are lacking, Dr. Chiang explained.
“To the best of our knowledge, this is the first study that simultaneously compared multiple acute migraine medications using a Big Data analysis approach based on real-world patient-provided data,” she said.
The researchers extracted more than 10 million self-reported migraine attack records from a migraine smartphone app called Migraine Buddy, where users can document whether a treatment was helpful, somewhat helpful, unsure, or unhelpful.
They analyzed 25 acute medications among seven classes: acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, combination analgesics (acetaminophen/aspirin/caffeine), ergots, antiemetics, and opioids. The newer gepants and ditan medication classes of medications were not included because of the relatively lower numbers of usage when data was extracted (2014-2020).
The researchers employed a two-level nested logistic regression model to analyze the odds of treatment effectiveness of each medication by adjusting concurrent medications and the covariance within the same user.
The final analysis included more than 3.1 million migraine attacks among 278,000 users globally.
Using ibuprofen as the reference, triptans, ergots, and antiemetics had the highest efficacy with mean odds ratios of 4.8, 3.02, and 2.67, respectively, followed by opioids (OR, 2.49), NSAIDs (OR, 1.94), combination analgesics (OR, 1.69), others (OR, 1.49), and acetaminophen (OR, 0.83).
Individual medications with the highest patient-reported effectiveness were eletriptan (Relpax; OR, 6.1), zolmitriptan (Zomig; OR, 5.7) and sumatriptan (Zecuity; OR, 5.2).
This migraine medication comparative effectiveness analysis, based on patient-reported outcomes, “supports and complements the treatment recommendations from national headache societies based on randomized controlled trials and meta-analyses and strongly supports the use of triptans,” Dr. Chiang said.
End of trial-and-error?
Commenting on this research, Shaheen Lakhan, MD, PhD, a neurologist and researcher in Boston, said “This is a great study of Big Data in that it shows the power of the smartphone to collect real-world data and smart researchers like at Mayo Clinic to analyze them.”
“The study sheds light on how different therapeutics compare with each other. The next iteration of this line of research, I would hope, would be to determine if particular medications are effective for a particular migraine population, and even down to individuals with migraine,” said Dr. Lakhan, who wasn’t involved in the study.
“Once those models are appropriately built, long gone will be the era of trial-and-error medicine,” Dr. Lakhan added.
The study had no specific funding. Dr. Chiang has served as a consultant for Satsuma. Dr. Lakhan reports no relevant financial relationships.
A version of this article originally appeared on Medscape.com.
BOSTON – , a new real-world analysis of data on more than 3 million migraine attacks shows.
The findings “align with results of clinical trials and recommendations from clinical treatment guidelines” and provide insights to complement clinical practice, said study investigator Chia-Chun Chiang, MD, a neurologist with Mayo Clinic, Rochester, Minn.
The findings were presented at the 2023 annual meeting of the American Academy of Neurology.
The power of big data
Despite a wide variety of acute migraine medications that are available, large-scale, head-to-head comparisons of treatment effectiveness from real-world patient experience reports are lacking, Dr. Chiang explained.
“To the best of our knowledge, this is the first study that simultaneously compared multiple acute migraine medications using a Big Data analysis approach based on real-world patient-provided data,” she said.
The researchers extracted more than 10 million self-reported migraine attack records from a migraine smartphone app called Migraine Buddy, where users can document whether a treatment was helpful, somewhat helpful, unsure, or unhelpful.
They analyzed 25 acute medications among seven classes: acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, combination analgesics (acetaminophen/aspirin/caffeine), ergots, antiemetics, and opioids. The newer gepants and ditan medication classes of medications were not included because of the relatively lower numbers of usage when data was extracted (2014-2020).
The researchers employed a two-level nested logistic regression model to analyze the odds of treatment effectiveness of each medication by adjusting concurrent medications and the covariance within the same user.
The final analysis included more than 3.1 million migraine attacks among 278,000 users globally.
Using ibuprofen as the reference, triptans, ergots, and antiemetics had the highest efficacy with mean odds ratios of 4.8, 3.02, and 2.67, respectively, followed by opioids (OR, 2.49), NSAIDs (OR, 1.94), combination analgesics (OR, 1.69), others (OR, 1.49), and acetaminophen (OR, 0.83).
Individual medications with the highest patient-reported effectiveness were eletriptan (Relpax; OR, 6.1), zolmitriptan (Zomig; OR, 5.7) and sumatriptan (Zecuity; OR, 5.2).
This migraine medication comparative effectiveness analysis, based on patient-reported outcomes, “supports and complements the treatment recommendations from national headache societies based on randomized controlled trials and meta-analyses and strongly supports the use of triptans,” Dr. Chiang said.
End of trial-and-error?
Commenting on this research, Shaheen Lakhan, MD, PhD, a neurologist and researcher in Boston, said “This is a great study of Big Data in that it shows the power of the smartphone to collect real-world data and smart researchers like at Mayo Clinic to analyze them.”
“The study sheds light on how different therapeutics compare with each other. The next iteration of this line of research, I would hope, would be to determine if particular medications are effective for a particular migraine population, and even down to individuals with migraine,” said Dr. Lakhan, who wasn’t involved in the study.
“Once those models are appropriately built, long gone will be the era of trial-and-error medicine,” Dr. Lakhan added.
The study had no specific funding. Dr. Chiang has served as a consultant for Satsuma. Dr. Lakhan reports no relevant financial relationships.
A version of this article originally appeared on Medscape.com.
AT AAN 2023
FDA expands atogepant approval to include chronic migraine
The approval makes atogepant the first, and only, oral calcitonin gene-related peptide receptor antagonist approved to prevent migraine across frequencies, including episodic and chronic, the company said in a news release.
The FDA initially approved atogepant in 2021 for the prevention of episodic migraine in adults.
Once-daily atogepant is available in three doses – 10 mg, 30 mg, and 60 mg – for prevention of episodic migraine. However, only the 60-mg dose of medication is indicated for the preventive treatment of chronic migraine.
The expanded indication in chronic migraine is based on positive results of the phase 3 PROGRESS trial, which evaluated atogepant in more than 700 adults with chronic migraine.
The trial met the primary endpoint of statistically significant reduction from baseline in mean monthly migraine days with atogepant compared with placebo across the 12-week treatment period.
Treatment with atogepant also led to statistically significant improvements in all six secondary endpoints, including the proportion of patients that achieved at least a 50% reduction in mean monthly migraine days across 12 weeks and improvements in function and reduction in activity impairment caused by migraine.
The efficacy results are consistent with those in the ADVANCE episodic migraine trial.
The overall safety profile of atogepant is consistent with the episodic migraine patient population, with the most common adverse events including constipation, nausea, and fatigue/sleepiness.
“The FDA approval is an important milestone, providing those most impacted by migraine with a new, safe, and effective treatment option in a convenient, once-daily pill,” Peter McAllister, MD, director of the New England Center for Neurology and Headache, Stamford, Conn., said in the news release.
The data demonstrate that atogepant “helps reduce the burden of migraine by delivering improvements in function, with high response rates and sustained efficacy over 12 weeks. These are critical factors neurologists and headache specialists consider when prescribing a treatment option, particularly for those with chronic migraine,” Dr. McAllister added.
A version of this article originally appeared on Medscape.com.
The approval makes atogepant the first, and only, oral calcitonin gene-related peptide receptor antagonist approved to prevent migraine across frequencies, including episodic and chronic, the company said in a news release.
The FDA initially approved atogepant in 2021 for the prevention of episodic migraine in adults.
Once-daily atogepant is available in three doses – 10 mg, 30 mg, and 60 mg – for prevention of episodic migraine. However, only the 60-mg dose of medication is indicated for the preventive treatment of chronic migraine.
The expanded indication in chronic migraine is based on positive results of the phase 3 PROGRESS trial, which evaluated atogepant in more than 700 adults with chronic migraine.
The trial met the primary endpoint of statistically significant reduction from baseline in mean monthly migraine days with atogepant compared with placebo across the 12-week treatment period.
Treatment with atogepant also led to statistically significant improvements in all six secondary endpoints, including the proportion of patients that achieved at least a 50% reduction in mean monthly migraine days across 12 weeks and improvements in function and reduction in activity impairment caused by migraine.
The efficacy results are consistent with those in the ADVANCE episodic migraine trial.
The overall safety profile of atogepant is consistent with the episodic migraine patient population, with the most common adverse events including constipation, nausea, and fatigue/sleepiness.
“The FDA approval is an important milestone, providing those most impacted by migraine with a new, safe, and effective treatment option in a convenient, once-daily pill,” Peter McAllister, MD, director of the New England Center for Neurology and Headache, Stamford, Conn., said in the news release.
The data demonstrate that atogepant “helps reduce the burden of migraine by delivering improvements in function, with high response rates and sustained efficacy over 12 weeks. These are critical factors neurologists and headache specialists consider when prescribing a treatment option, particularly for those with chronic migraine,” Dr. McAllister added.
A version of this article originally appeared on Medscape.com.
The approval makes atogepant the first, and only, oral calcitonin gene-related peptide receptor antagonist approved to prevent migraine across frequencies, including episodic and chronic, the company said in a news release.
The FDA initially approved atogepant in 2021 for the prevention of episodic migraine in adults.
Once-daily atogepant is available in three doses – 10 mg, 30 mg, and 60 mg – for prevention of episodic migraine. However, only the 60-mg dose of medication is indicated for the preventive treatment of chronic migraine.
The expanded indication in chronic migraine is based on positive results of the phase 3 PROGRESS trial, which evaluated atogepant in more than 700 adults with chronic migraine.
The trial met the primary endpoint of statistically significant reduction from baseline in mean monthly migraine days with atogepant compared with placebo across the 12-week treatment period.
Treatment with atogepant also led to statistically significant improvements in all six secondary endpoints, including the proportion of patients that achieved at least a 50% reduction in mean monthly migraine days across 12 weeks and improvements in function and reduction in activity impairment caused by migraine.
The efficacy results are consistent with those in the ADVANCE episodic migraine trial.
The overall safety profile of atogepant is consistent with the episodic migraine patient population, with the most common adverse events including constipation, nausea, and fatigue/sleepiness.
“The FDA approval is an important milestone, providing those most impacted by migraine with a new, safe, and effective treatment option in a convenient, once-daily pill,” Peter McAllister, MD, director of the New England Center for Neurology and Headache, Stamford, Conn., said in the news release.
The data demonstrate that atogepant “helps reduce the burden of migraine by delivering improvements in function, with high response rates and sustained efficacy over 12 weeks. These are critical factors neurologists and headache specialists consider when prescribing a treatment option, particularly for those with chronic migraine,” Dr. McAllister added.
A version of this article originally appeared on Medscape.com.
Atogepant prevents episodic migraine in some difficult-to-treat cases
BOSTON – , according to findings from a study presented at the 2023 annual meeting of the American Academy of Neurology.
Initial results from the double-blind ELEVATE trial showed the oral atogepant group had significantly fewer mean monthly migraine days (MMD) compared with a placebo group. There was also a significant difference in the number of participants who achieved 50% or greater reduction in the number of mean MMDs and a significant reduction in acute medication use days compared with the placebo group, according to Patricia Pozo-Rosich, MD, PhD, a headache specialist in the neurology department and director of the headache and craniofacial pain clinical unit and the Migraine Adaptive Brain Center at the Vall d’Hebron University Hospital in Barcelona, and colleagues.
The oral calcitonin gene-related peptide (CGRP) receptor antagonist is currently approved in the United States by the Food and Drug Administration as a preventative for both episodic and chronic migraine.
Results from ELEVATE
Overall, ELEVATE’s initial efficacy analysis population consisted of 309 adults aged between 18 and 80 years from North America and Europe with episodic migraine who had 4-14 MMDs and had treatment failure with at least two classes of conventional oral medication. After a 28-day screening period, participants received either 60 mg of oral atogepant once per day (154 participants) or a placebo (155 participants). In the efficacy analysis population, 56.0% of participants had failed two oral migraine preventative medication classes, while 44.0% failed three or more classes of medication. Dr. Pozo-Rosich noted that participants were taking a number of different oral preventatives across different medication classes, including flunarizine, beta blockers, topiramate, and amitriptyline, but data are not yet available on which participants had received certain combinations of oral medications.
“[T]hese people have already taken some type of prevention, so they’re not naive patients,” she said. “They’re usually more or less well treated in the sense of having had a contact with specialists or a general neurologist, someone that actually tries to do some prevention.”
The researchers examined change from MMDs at baseline and at 12 weeks as a primary outcome, with 50% or greater MMD reduction, change in mean monthly headache days, and change in acute medication use days as secondary outcomes. Regarding the different acute medications used, Dr. Pozo-Rosich said the main three types were analgesics, nonsteroid anti-inflammatory drugs, and triptans, with participants excluded from the trial if they were taking opioids.
The results showed participants in the atogepant group had significantly fewer mean MMDs compared with the placebo group at 12 weeks compared with baseline (–4.20 vs. –1.85 days; P < .0001). Researchers also found statistically significant improvement in the atogepant group for 50% or greater reduction in MMD, change in mean monthly headache days, and change in acute medication use days across 12 weeks of treatment compared with the placebo group. While the specific data analyses for secondary outcomes were not conducted in the initial analysis, Dr. Pozo-Rosich said the numbers “correlate with the primary outcome” as seen in other migraine trials.
Compared with the placebo group, participants in the atogepant group had higher rates of constipation (10.3% vs. 2.5%), COVID-19 (9.6% vs. 8.3%), and nausea (7.1% vs. 3.2%), while the placebo group had a higher rate of nasopharyngitis (5.1% vs. 7.6%).*
Migraine is a prevalent and undertreated disease, and patients around the world with migraine are in need of treatment options that are both safe and effective, Dr. Pozo-Rosich said in an interview. “[E]ven in these hard-to-treat or difficult-to-treat migraine patients, you have a drug that works, and is safe, and well tolerated and effective,” she said.
That’s “kind of good news for all of us,” she said. Patients “need this type of good news and solution,” she explained, because they may not tolerate or have access to injectable medications. Atogepant would also give clinicians have another option to offer patients with difficult-to-treat migraine cases, she noted. “It makes life easier for many physicians and many patients for many different reasons,” she said.
Dr. Pozo-Rosich said the likely next step in the research is to conduct the main analysis as well as post hoc analyses with accumulated data from pathology trials “to understand patterns of response, understand the sustainability of the response, [and] adherence to the treatment in the long term.”
‘Exciting that it works well’ in difficult-to-treat patients
Commenting on the study, Alan M. Rapoport, MD, clinical professor of neurology at University of California, Los Angeles, and past president of the International Headache Society, agreed that better options in migraine treatment and prevention are needed.
“We needed something that was going to be better than what we had before,” he said.
Dr. Rapoport noted the study was well designed with strongly positive results. “It looks like it’s an effective drug, and it looks really good in that it’s effective for people that have failed all these preventives that have very little hope for the future,” he said.
He specifically praised the inclusion of older participants in the population. “You never see a study on 80-year-olds,” he said, “but I like that, because they felt it would be safe. There are 80-year-old patients – fewer of them than 40-year-old patients – but there are 80-year-old patients who still have migraine, so I’m really glad they put older patients in it,” he said.
For atogepant, he noted that “some patients won’t get the side effects, and some patients will tolerate the side effects because it’s working really well.” While the study was not a head-to-head comparison against other oral migraine preventatives, he pointed out the high rate of constipation among participants in the trial setting may be a warning sign of future issues, as seen with other CGRP receptor agonists.
“I can tell you that with erenumab, the monoclonal antibody that was injected in the double-blind studies, they didn’t find any significant increase in constipation,” he explained. However, some clinicians using erenumab in the real world have reported up to 20% of their patients are constipated. “It’s not good that they’re reporting 10% are constipated” in the study, he said.
Overall, “all you can really say is it does work well,” Dr. Rapoport said. “It’s exciting that it works well in such difficult-to-treat patients, and it does come with some side effects.”
Dr. Pozo-Rosich reports serving as a consultant and developing education materials for AbbVie, Eli Lilly, Novartis, Teva Pharmaceuticals, and Pfizer. Dr. Rapoport is the editor-in-chief of Neurology Reviews; he reports being a consultant for AbbVie, the developer of atogepant. The ELEVATE trial is supported by AbbVie.
*Correction, 5/4/23: An earlier version of this article misstated the percentage of COVID-positive patients in the study population.
BOSTON – , according to findings from a study presented at the 2023 annual meeting of the American Academy of Neurology.
Initial results from the double-blind ELEVATE trial showed the oral atogepant group had significantly fewer mean monthly migraine days (MMD) compared with a placebo group. There was also a significant difference in the number of participants who achieved 50% or greater reduction in the number of mean MMDs and a significant reduction in acute medication use days compared with the placebo group, according to Patricia Pozo-Rosich, MD, PhD, a headache specialist in the neurology department and director of the headache and craniofacial pain clinical unit and the Migraine Adaptive Brain Center at the Vall d’Hebron University Hospital in Barcelona, and colleagues.
The oral calcitonin gene-related peptide (CGRP) receptor antagonist is currently approved in the United States by the Food and Drug Administration as a preventative for both episodic and chronic migraine.
Results from ELEVATE
Overall, ELEVATE’s initial efficacy analysis population consisted of 309 adults aged between 18 and 80 years from North America and Europe with episodic migraine who had 4-14 MMDs and had treatment failure with at least two classes of conventional oral medication. After a 28-day screening period, participants received either 60 mg of oral atogepant once per day (154 participants) or a placebo (155 participants). In the efficacy analysis population, 56.0% of participants had failed two oral migraine preventative medication classes, while 44.0% failed three or more classes of medication. Dr. Pozo-Rosich noted that participants were taking a number of different oral preventatives across different medication classes, including flunarizine, beta blockers, topiramate, and amitriptyline, but data are not yet available on which participants had received certain combinations of oral medications.
“[T]hese people have already taken some type of prevention, so they’re not naive patients,” she said. “They’re usually more or less well treated in the sense of having had a contact with specialists or a general neurologist, someone that actually tries to do some prevention.”
The researchers examined change from MMDs at baseline and at 12 weeks as a primary outcome, with 50% or greater MMD reduction, change in mean monthly headache days, and change in acute medication use days as secondary outcomes. Regarding the different acute medications used, Dr. Pozo-Rosich said the main three types were analgesics, nonsteroid anti-inflammatory drugs, and triptans, with participants excluded from the trial if they were taking opioids.
The results showed participants in the atogepant group had significantly fewer mean MMDs compared with the placebo group at 12 weeks compared with baseline (–4.20 vs. –1.85 days; P < .0001). Researchers also found statistically significant improvement in the atogepant group for 50% or greater reduction in MMD, change in mean monthly headache days, and change in acute medication use days across 12 weeks of treatment compared with the placebo group. While the specific data analyses for secondary outcomes were not conducted in the initial analysis, Dr. Pozo-Rosich said the numbers “correlate with the primary outcome” as seen in other migraine trials.
Compared with the placebo group, participants in the atogepant group had higher rates of constipation (10.3% vs. 2.5%), COVID-19 (9.6% vs. 8.3%), and nausea (7.1% vs. 3.2%), while the placebo group had a higher rate of nasopharyngitis (5.1% vs. 7.6%).*
Migraine is a prevalent and undertreated disease, and patients around the world with migraine are in need of treatment options that are both safe and effective, Dr. Pozo-Rosich said in an interview. “[E]ven in these hard-to-treat or difficult-to-treat migraine patients, you have a drug that works, and is safe, and well tolerated and effective,” she said.
That’s “kind of good news for all of us,” she said. Patients “need this type of good news and solution,” she explained, because they may not tolerate or have access to injectable medications. Atogepant would also give clinicians have another option to offer patients with difficult-to-treat migraine cases, she noted. “It makes life easier for many physicians and many patients for many different reasons,” she said.
Dr. Pozo-Rosich said the likely next step in the research is to conduct the main analysis as well as post hoc analyses with accumulated data from pathology trials “to understand patterns of response, understand the sustainability of the response, [and] adherence to the treatment in the long term.”
‘Exciting that it works well’ in difficult-to-treat patients
Commenting on the study, Alan M. Rapoport, MD, clinical professor of neurology at University of California, Los Angeles, and past president of the International Headache Society, agreed that better options in migraine treatment and prevention are needed.
“We needed something that was going to be better than what we had before,” he said.
Dr. Rapoport noted the study was well designed with strongly positive results. “It looks like it’s an effective drug, and it looks really good in that it’s effective for people that have failed all these preventives that have very little hope for the future,” he said.
He specifically praised the inclusion of older participants in the population. “You never see a study on 80-year-olds,” he said, “but I like that, because they felt it would be safe. There are 80-year-old patients – fewer of them than 40-year-old patients – but there are 80-year-old patients who still have migraine, so I’m really glad they put older patients in it,” he said.
For atogepant, he noted that “some patients won’t get the side effects, and some patients will tolerate the side effects because it’s working really well.” While the study was not a head-to-head comparison against other oral migraine preventatives, he pointed out the high rate of constipation among participants in the trial setting may be a warning sign of future issues, as seen with other CGRP receptor agonists.
“I can tell you that with erenumab, the monoclonal antibody that was injected in the double-blind studies, they didn’t find any significant increase in constipation,” he explained. However, some clinicians using erenumab in the real world have reported up to 20% of their patients are constipated. “It’s not good that they’re reporting 10% are constipated” in the study, he said.
Overall, “all you can really say is it does work well,” Dr. Rapoport said. “It’s exciting that it works well in such difficult-to-treat patients, and it does come with some side effects.”
Dr. Pozo-Rosich reports serving as a consultant and developing education materials for AbbVie, Eli Lilly, Novartis, Teva Pharmaceuticals, and Pfizer. Dr. Rapoport is the editor-in-chief of Neurology Reviews; he reports being a consultant for AbbVie, the developer of atogepant. The ELEVATE trial is supported by AbbVie.
*Correction, 5/4/23: An earlier version of this article misstated the percentage of COVID-positive patients in the study population.
BOSTON – , according to findings from a study presented at the 2023 annual meeting of the American Academy of Neurology.
Initial results from the double-blind ELEVATE trial showed the oral atogepant group had significantly fewer mean monthly migraine days (MMD) compared with a placebo group. There was also a significant difference in the number of participants who achieved 50% or greater reduction in the number of mean MMDs and a significant reduction in acute medication use days compared with the placebo group, according to Patricia Pozo-Rosich, MD, PhD, a headache specialist in the neurology department and director of the headache and craniofacial pain clinical unit and the Migraine Adaptive Brain Center at the Vall d’Hebron University Hospital in Barcelona, and colleagues.
The oral calcitonin gene-related peptide (CGRP) receptor antagonist is currently approved in the United States by the Food and Drug Administration as a preventative for both episodic and chronic migraine.
Results from ELEVATE
Overall, ELEVATE’s initial efficacy analysis population consisted of 309 adults aged between 18 and 80 years from North America and Europe with episodic migraine who had 4-14 MMDs and had treatment failure with at least two classes of conventional oral medication. After a 28-day screening period, participants received either 60 mg of oral atogepant once per day (154 participants) or a placebo (155 participants). In the efficacy analysis population, 56.0% of participants had failed two oral migraine preventative medication classes, while 44.0% failed three or more classes of medication. Dr. Pozo-Rosich noted that participants were taking a number of different oral preventatives across different medication classes, including flunarizine, beta blockers, topiramate, and amitriptyline, but data are not yet available on which participants had received certain combinations of oral medications.
“[T]hese people have already taken some type of prevention, so they’re not naive patients,” she said. “They’re usually more or less well treated in the sense of having had a contact with specialists or a general neurologist, someone that actually tries to do some prevention.”
The researchers examined change from MMDs at baseline and at 12 weeks as a primary outcome, with 50% or greater MMD reduction, change in mean monthly headache days, and change in acute medication use days as secondary outcomes. Regarding the different acute medications used, Dr. Pozo-Rosich said the main three types were analgesics, nonsteroid anti-inflammatory drugs, and triptans, with participants excluded from the trial if they were taking opioids.
The results showed participants in the atogepant group had significantly fewer mean MMDs compared with the placebo group at 12 weeks compared with baseline (–4.20 vs. –1.85 days; P < .0001). Researchers also found statistically significant improvement in the atogepant group for 50% or greater reduction in MMD, change in mean monthly headache days, and change in acute medication use days across 12 weeks of treatment compared with the placebo group. While the specific data analyses for secondary outcomes were not conducted in the initial analysis, Dr. Pozo-Rosich said the numbers “correlate with the primary outcome” as seen in other migraine trials.
Compared with the placebo group, participants in the atogepant group had higher rates of constipation (10.3% vs. 2.5%), COVID-19 (9.6% vs. 8.3%), and nausea (7.1% vs. 3.2%), while the placebo group had a higher rate of nasopharyngitis (5.1% vs. 7.6%).*
Migraine is a prevalent and undertreated disease, and patients around the world with migraine are in need of treatment options that are both safe and effective, Dr. Pozo-Rosich said in an interview. “[E]ven in these hard-to-treat or difficult-to-treat migraine patients, you have a drug that works, and is safe, and well tolerated and effective,” she said.
That’s “kind of good news for all of us,” she said. Patients “need this type of good news and solution,” she explained, because they may not tolerate or have access to injectable medications. Atogepant would also give clinicians have another option to offer patients with difficult-to-treat migraine cases, she noted. “It makes life easier for many physicians and many patients for many different reasons,” she said.
Dr. Pozo-Rosich said the likely next step in the research is to conduct the main analysis as well as post hoc analyses with accumulated data from pathology trials “to understand patterns of response, understand the sustainability of the response, [and] adherence to the treatment in the long term.”
‘Exciting that it works well’ in difficult-to-treat patients
Commenting on the study, Alan M. Rapoport, MD, clinical professor of neurology at University of California, Los Angeles, and past president of the International Headache Society, agreed that better options in migraine treatment and prevention are needed.
“We needed something that was going to be better than what we had before,” he said.
Dr. Rapoport noted the study was well designed with strongly positive results. “It looks like it’s an effective drug, and it looks really good in that it’s effective for people that have failed all these preventives that have very little hope for the future,” he said.
He specifically praised the inclusion of older participants in the population. “You never see a study on 80-year-olds,” he said, “but I like that, because they felt it would be safe. There are 80-year-old patients – fewer of them than 40-year-old patients – but there are 80-year-old patients who still have migraine, so I’m really glad they put older patients in it,” he said.
For atogepant, he noted that “some patients won’t get the side effects, and some patients will tolerate the side effects because it’s working really well.” While the study was not a head-to-head comparison against other oral migraine preventatives, he pointed out the high rate of constipation among participants in the trial setting may be a warning sign of future issues, as seen with other CGRP receptor agonists.
“I can tell you that with erenumab, the monoclonal antibody that was injected in the double-blind studies, they didn’t find any significant increase in constipation,” he explained. However, some clinicians using erenumab in the real world have reported up to 20% of their patients are constipated. “It’s not good that they’re reporting 10% are constipated” in the study, he said.
Overall, “all you can really say is it does work well,” Dr. Rapoport said. “It’s exciting that it works well in such difficult-to-treat patients, and it does come with some side effects.”
Dr. Pozo-Rosich reports serving as a consultant and developing education materials for AbbVie, Eli Lilly, Novartis, Teva Pharmaceuticals, and Pfizer. Dr. Rapoport is the editor-in-chief of Neurology Reviews; he reports being a consultant for AbbVie, the developer of atogepant. The ELEVATE trial is supported by AbbVie.
*Correction, 5/4/23: An earlier version of this article misstated the percentage of COVID-positive patients in the study population.
FROM AAN 2023
High prevalence of migraine among women with endometriosis
Key clinical point: Women with endometriosis seemed prone to migraine, with menstrual-related migraine being the most common type and dysmenorrhea and dysuria being more frequent when endometriosis and migraine coexisted.
Major finding: Overall, 53.4% of women had migraine, of which 64.3% had migraine related to menstruation and 35.7% had non-menstrual migraine. Typical endometriosis-related pain symptoms such as dysmenorrhea (94.3% vs 82.0%; P = .03) and dysuria (27.1% vs 9.8%; P < .01) occurred significantly more frequently in patients with vs without migraine.
Study details: This was a prospective, nested case-control study including 131 women with endometriosis with or without migraine.
Disclosures: This study was supported by a grant from Ministero della Salute, Italy. The authors declared no conflicts of interest.
Source: Pasquini B, Seravalli V, et al. Endometriosis and the diagnosis of different forms of migraine: an association with dysmenorrhea. Reprod Biomed Online. 2023 (Apr 6). Doi: 10.1016/j.rbmo.2023.03.020
Key clinical point: Women with endometriosis seemed prone to migraine, with menstrual-related migraine being the most common type and dysmenorrhea and dysuria being more frequent when endometriosis and migraine coexisted.
Major finding: Overall, 53.4% of women had migraine, of which 64.3% had migraine related to menstruation and 35.7% had non-menstrual migraine. Typical endometriosis-related pain symptoms such as dysmenorrhea (94.3% vs 82.0%; P = .03) and dysuria (27.1% vs 9.8%; P < .01) occurred significantly more frequently in patients with vs without migraine.
Study details: This was a prospective, nested case-control study including 131 women with endometriosis with or without migraine.
Disclosures: This study was supported by a grant from Ministero della Salute, Italy. The authors declared no conflicts of interest.
Source: Pasquini B, Seravalli V, et al. Endometriosis and the diagnosis of different forms of migraine: an association with dysmenorrhea. Reprod Biomed Online. 2023 (Apr 6). Doi: 10.1016/j.rbmo.2023.03.020
Key clinical point: Women with endometriosis seemed prone to migraine, with menstrual-related migraine being the most common type and dysmenorrhea and dysuria being more frequent when endometriosis and migraine coexisted.
Major finding: Overall, 53.4% of women had migraine, of which 64.3% had migraine related to menstruation and 35.7% had non-menstrual migraine. Typical endometriosis-related pain symptoms such as dysmenorrhea (94.3% vs 82.0%; P = .03) and dysuria (27.1% vs 9.8%; P < .01) occurred significantly more frequently in patients with vs without migraine.
Study details: This was a prospective, nested case-control study including 131 women with endometriosis with or without migraine.
Disclosures: This study was supported by a grant from Ministero della Salute, Italy. The authors declared no conflicts of interest.
Source: Pasquini B, Seravalli V, et al. Endometriosis and the diagnosis of different forms of migraine: an association with dysmenorrhea. Reprod Biomed Online. 2023 (Apr 6). Doi: 10.1016/j.rbmo.2023.03.020
High prevalence of migraine among women with endometriosis
Key clinical point: Women with endometriosis seemed prone to migraine, with menstrual-related migraine being the most common type and dysmenorrhea and dysuria being more frequent when endometriosis and migraine coexisted.
Major finding: Overall, 53.4% of women had migraine, of which 64.3% had migraine related to menstruation and 35.7% had non-menstrual migraine. Typical endometriosis-related pain symptoms such as dysmenorrhea (94.3% vs 82.0%; P = .03) and dysuria (27.1% vs 9.8%; P < .01) occurred significantly more frequently in patients with vs without migraine.
Study details: This was a prospective, nested case-control study including 131 women with endometriosis with or without migraine.
Disclosures: This study was supported by a grant from Ministero della Salute, Italy. The authors declared no conflicts of interest.
Source: Pasquini B, Seravalli V, et al. Endometriosis and the diagnosis of different forms of migraine: an association with dysmenorrhea. Reprod Biomed Online. 2023 (Apr 6). Doi: 10.1016/j.rbmo.2023.03.020
Key clinical point: Women with endometriosis seemed prone to migraine, with menstrual-related migraine being the most common type and dysmenorrhea and dysuria being more frequent when endometriosis and migraine coexisted.
Major finding: Overall, 53.4% of women had migraine, of which 64.3% had migraine related to menstruation and 35.7% had non-menstrual migraine. Typical endometriosis-related pain symptoms such as dysmenorrhea (94.3% vs 82.0%; P = .03) and dysuria (27.1% vs 9.8%; P < .01) occurred significantly more frequently in patients with vs without migraine.
Study details: This was a prospective, nested case-control study including 131 women with endometriosis with or without migraine.
Disclosures: This study was supported by a grant from Ministero della Salute, Italy. The authors declared no conflicts of interest.
Source: Pasquini B, Seravalli V, et al. Endometriosis and the diagnosis of different forms of migraine: an association with dysmenorrhea. Reprod Biomed Online. 2023 (Apr 6). Doi: 10.1016/j.rbmo.2023.03.020
Key clinical point: Women with endometriosis seemed prone to migraine, with menstrual-related migraine being the most common type and dysmenorrhea and dysuria being more frequent when endometriosis and migraine coexisted.
Major finding: Overall, 53.4% of women had migraine, of which 64.3% had migraine related to menstruation and 35.7% had non-menstrual migraine. Typical endometriosis-related pain symptoms such as dysmenorrhea (94.3% vs 82.0%; P = .03) and dysuria (27.1% vs 9.8%; P < .01) occurred significantly more frequently in patients with vs without migraine.
Study details: This was a prospective, nested case-control study including 131 women with endometriosis with or without migraine.
Disclosures: This study was supported by a grant from Ministero della Salute, Italy. The authors declared no conflicts of interest.
Source: Pasquini B, Seravalli V, et al. Endometriosis and the diagnosis of different forms of migraine: an association with dysmenorrhea. Reprod Biomed Online. 2023 (Apr 6). Doi: 10.1016/j.rbmo.2023.03.020
Does migraine worsen prognosis of ischemic stroke?
Key clinical point: Migraine diagnosis was not significantly correlated with a higher frequency of an absence of ischemic penumbra, its volume, or the prognosis of ischemic stroke.
Major finding: There was no significant association between migraine diagnosis and the absence of ischemic penumbra (P = .649), stroke volume (P = .995), or prognosis of ischemic stroke.
Study details: Findings are from a prospective cohort study including 221 patients with ischemic stroke who were hospitalized within 72 hours of the onset of symptoms, of which 59 had migraine.
Disclosures: The study was financed in part by the Coordenaçao de Aperfeiçoamento de Pessoal de Nível Superior-Brasil. The authors declared no conflicts of interest.
Source: Oliveira FAA et al. Assessing the influence of migraine on ischemic penumbra and on the prognosis of ischemic stroke: A prospective cohort study. Headache. 2023;63:549-558 (Mar 29). Doi: 10.1111/head.14492
Key clinical point: Migraine diagnosis was not significantly correlated with a higher frequency of an absence of ischemic penumbra, its volume, or the prognosis of ischemic stroke.
Major finding: There was no significant association between migraine diagnosis and the absence of ischemic penumbra (P = .649), stroke volume (P = .995), or prognosis of ischemic stroke.
Study details: Findings are from a prospective cohort study including 221 patients with ischemic stroke who were hospitalized within 72 hours of the onset of symptoms, of which 59 had migraine.
Disclosures: The study was financed in part by the Coordenaçao de Aperfeiçoamento de Pessoal de Nível Superior-Brasil. The authors declared no conflicts of interest.
Source: Oliveira FAA et al. Assessing the influence of migraine on ischemic penumbra and on the prognosis of ischemic stroke: A prospective cohort study. Headache. 2023;63:549-558 (Mar 29). Doi: 10.1111/head.14492
Key clinical point: Migraine diagnosis was not significantly correlated with a higher frequency of an absence of ischemic penumbra, its volume, or the prognosis of ischemic stroke.
Major finding: There was no significant association between migraine diagnosis and the absence of ischemic penumbra (P = .649), stroke volume (P = .995), or prognosis of ischemic stroke.
Study details: Findings are from a prospective cohort study including 221 patients with ischemic stroke who were hospitalized within 72 hours of the onset of symptoms, of which 59 had migraine.
Disclosures: The study was financed in part by the Coordenaçao de Aperfeiçoamento de Pessoal de Nível Superior-Brasil. The authors declared no conflicts of interest.
Source: Oliveira FAA et al. Assessing the influence of migraine on ischemic penumbra and on the prognosis of ischemic stroke: A prospective cohort study. Headache. 2023;63:549-558 (Mar 29). Doi: 10.1111/head.14492
Fremanezumab shows early and sustained efficacy in patients with multiple migraine treatment failures
Key clinical point: Fremanezumab demonstrated early and sustained efficacy with an optimal safety profile in patients with high disability and high-frequency episodic migraine (HFEM) or chronic migraine (CM) with multiple preventive failures and diverse comorbidities.
Major finding: At 21-24 weeks, fremanezumab significantly reduced monthly migraine days in patients with HFEM (−6.9 ± 3.6; P < .001) and monthly headache days in patients with CM (−14.2 ± 7.6; P < .001) along with significant reductions in monthly analgesic medications and Numerical Rating Scale scores in both patients with HFEM and CM (P < .001), with benefits sustaining throughout treatment period and adverse events being rare.
Study details: This multicenter, prospective real-life study included 148 patients with migraine (HFEM, n = 52; CM, n = 96) who were treated with fremanezumab for ≥24 weeks.
Disclosures: The study was partially supported by the Italian Ministry of Health Institutional Funding Ricerca Corrente San Raffaele Roma, Italy. Some authors declared receiving research support, travel grants, or honoraria for advisory board participation, speaking, or clinical investigation studies from various sources.
Source: Barbanti P et al for the FRIEND-Study Group. Early and sustained efficacy of fremanezumab over 24-weeks in migraine patients with multiple preventive treatment failures: The multicenter, prospective, real-life FRIEND2 study. J Headache Pain. 2023;24:30 (Mar 23). Doi: 10.1186/s10194-023-01561-w
Key clinical point: Fremanezumab demonstrated early and sustained efficacy with an optimal safety profile in patients with high disability and high-frequency episodic migraine (HFEM) or chronic migraine (CM) with multiple preventive failures and diverse comorbidities.
Major finding: At 21-24 weeks, fremanezumab significantly reduced monthly migraine days in patients with HFEM (−6.9 ± 3.6; P < .001) and monthly headache days in patients with CM (−14.2 ± 7.6; P < .001) along with significant reductions in monthly analgesic medications and Numerical Rating Scale scores in both patients with HFEM and CM (P < .001), with benefits sustaining throughout treatment period and adverse events being rare.
Study details: This multicenter, prospective real-life study included 148 patients with migraine (HFEM, n = 52; CM, n = 96) who were treated with fremanezumab for ≥24 weeks.
Disclosures: The study was partially supported by the Italian Ministry of Health Institutional Funding Ricerca Corrente San Raffaele Roma, Italy. Some authors declared receiving research support, travel grants, or honoraria for advisory board participation, speaking, or clinical investigation studies from various sources.
Source: Barbanti P et al for the FRIEND-Study Group. Early and sustained efficacy of fremanezumab over 24-weeks in migraine patients with multiple preventive treatment failures: The multicenter, prospective, real-life FRIEND2 study. J Headache Pain. 2023;24:30 (Mar 23). Doi: 10.1186/s10194-023-01561-w
Key clinical point: Fremanezumab demonstrated early and sustained efficacy with an optimal safety profile in patients with high disability and high-frequency episodic migraine (HFEM) or chronic migraine (CM) with multiple preventive failures and diverse comorbidities.
Major finding: At 21-24 weeks, fremanezumab significantly reduced monthly migraine days in patients with HFEM (−6.9 ± 3.6; P < .001) and monthly headache days in patients with CM (−14.2 ± 7.6; P < .001) along with significant reductions in monthly analgesic medications and Numerical Rating Scale scores in both patients with HFEM and CM (P < .001), with benefits sustaining throughout treatment period and adverse events being rare.
Study details: This multicenter, prospective real-life study included 148 patients with migraine (HFEM, n = 52; CM, n = 96) who were treated with fremanezumab for ≥24 weeks.
Disclosures: The study was partially supported by the Italian Ministry of Health Institutional Funding Ricerca Corrente San Raffaele Roma, Italy. Some authors declared receiving research support, travel grants, or honoraria for advisory board participation, speaking, or clinical investigation studies from various sources.
Source: Barbanti P et al for the FRIEND-Study Group. Early and sustained efficacy of fremanezumab over 24-weeks in migraine patients with multiple preventive treatment failures: The multicenter, prospective, real-life FRIEND2 study. J Headache Pain. 2023;24:30 (Mar 23). Doi: 10.1186/s10194-023-01561-w
Increased prevalence of migraine with and without aura in IBD
Key clinical point: The odds of having migraine with or without aura is higher among patients with migraine with vs without inflammatory bowel disease (IBD); however, patients with migraine and IBD are less likely to have chronic migraine or receive treatment for migraine.
Major finding: Patients with migraine with vs without IBD were more likely to have migraine with (odds ratio [OR] 2.20; P < .001) and without (OR 2.79; P < .001) aura, but were less likely to have chronic migraine (OR 0.23; P < .001) or receive treatment for migraine (OR 0.23-0.55; P ≤ .037).
Study details: Findings are from a retrospective cohort study including 675 patients with migraine, of which 280 patients had IBD.
Disclosures: This study did not receive any funding. The authors declared no potential conflicts of interest.
Source: Sileno SM et al. Comparison of migraine characteristics in patients with and without inflammatory bowel disease: A retrospective cohort study. J Prim Care Community Health. 2023 (Mar 23). Doi: 10.1177/21501319231164307
Key clinical point: The odds of having migraine with or without aura is higher among patients with migraine with vs without inflammatory bowel disease (IBD); however, patients with migraine and IBD are less likely to have chronic migraine or receive treatment for migraine.
Major finding: Patients with migraine with vs without IBD were more likely to have migraine with (odds ratio [OR] 2.20; P < .001) and without (OR 2.79; P < .001) aura, but were less likely to have chronic migraine (OR 0.23; P < .001) or receive treatment for migraine (OR 0.23-0.55; P ≤ .037).
Study details: Findings are from a retrospective cohort study including 675 patients with migraine, of which 280 patients had IBD.
Disclosures: This study did not receive any funding. The authors declared no potential conflicts of interest.
Source: Sileno SM et al. Comparison of migraine characteristics in patients with and without inflammatory bowel disease: A retrospective cohort study. J Prim Care Community Health. 2023 (Mar 23). Doi: 10.1177/21501319231164307
Key clinical point: The odds of having migraine with or without aura is higher among patients with migraine with vs without inflammatory bowel disease (IBD); however, patients with migraine and IBD are less likely to have chronic migraine or receive treatment for migraine.
Major finding: Patients with migraine with vs without IBD were more likely to have migraine with (odds ratio [OR] 2.20; P < .001) and without (OR 2.79; P < .001) aura, but were less likely to have chronic migraine (OR 0.23; P < .001) or receive treatment for migraine (OR 0.23-0.55; P ≤ .037).
Study details: Findings are from a retrospective cohort study including 675 patients with migraine, of which 280 patients had IBD.
Disclosures: This study did not receive any funding. The authors declared no potential conflicts of interest.
Source: Sileno SM et al. Comparison of migraine characteristics in patients with and without inflammatory bowel disease: A retrospective cohort study. J Prim Care Community Health. 2023 (Mar 23). Doi: 10.1177/21501319231164307
Migraine raises risk for subsequent primary open angle glaucoma
Key clinical point: Patients with migraine are at a higher risk of developing subsequent primary open angle glaucoma (POAG), with the risk being even higher among patients with chronic and severe migraine.
Major finding: Over 9 years of follow-up, the incidence rates of POAG were 3.249 and 2.408 per 1000 person-years in patients with and without migraine, respectively. Compared with individuals without migraine, patients with migraine and severe migraine had 1.19 (adjusted HR [aHR] 1.188; 95% CI 1.140-1.239) and 1.29 (aHR 1.285; 95% CI 1.166-1.415) times higher risk for POAG, respectively.
Study details: Findings are from a retrospective cohort study including 2,716,562 individuals aged ≥40 years, of which 87,809 had migraine.
Disclosures: The study was funded by Catholic Medical Center Research Foundation, New Hampshire. The authors declared no competing interests.
Source: Ohn K et al. Presence and severity of migraine is associated with development of primary open angle glaucoma: A population-based longitudinal cohort study. PLoS One. 2023;18(3):e0283495 (Mar 24). Doi: 10.1371/journal.pone.0283495
Key clinical point: Patients with migraine are at a higher risk of developing subsequent primary open angle glaucoma (POAG), with the risk being even higher among patients with chronic and severe migraine.
Major finding: Over 9 years of follow-up, the incidence rates of POAG were 3.249 and 2.408 per 1000 person-years in patients with and without migraine, respectively. Compared with individuals without migraine, patients with migraine and severe migraine had 1.19 (adjusted HR [aHR] 1.188; 95% CI 1.140-1.239) and 1.29 (aHR 1.285; 95% CI 1.166-1.415) times higher risk for POAG, respectively.
Study details: Findings are from a retrospective cohort study including 2,716,562 individuals aged ≥40 years, of which 87,809 had migraine.
Disclosures: The study was funded by Catholic Medical Center Research Foundation, New Hampshire. The authors declared no competing interests.
Source: Ohn K et al. Presence and severity of migraine is associated with development of primary open angle glaucoma: A population-based longitudinal cohort study. PLoS One. 2023;18(3):e0283495 (Mar 24). Doi: 10.1371/journal.pone.0283495
Key clinical point: Patients with migraine are at a higher risk of developing subsequent primary open angle glaucoma (POAG), with the risk being even higher among patients with chronic and severe migraine.
Major finding: Over 9 years of follow-up, the incidence rates of POAG were 3.249 and 2.408 per 1000 person-years in patients with and without migraine, respectively. Compared with individuals without migraine, patients with migraine and severe migraine had 1.19 (adjusted HR [aHR] 1.188; 95% CI 1.140-1.239) and 1.29 (aHR 1.285; 95% CI 1.166-1.415) times higher risk for POAG, respectively.
Study details: Findings are from a retrospective cohort study including 2,716,562 individuals aged ≥40 years, of which 87,809 had migraine.
Disclosures: The study was funded by Catholic Medical Center Research Foundation, New Hampshire. The authors declared no competing interests.
Source: Ohn K et al. Presence and severity of migraine is associated with development of primary open angle glaucoma: A population-based longitudinal cohort study. PLoS One. 2023;18(3):e0283495 (Mar 24). Doi: 10.1371/journal.pone.0283495
Ultrasound-guided stellate ganglion blockade is safe and effective in chronic migraine
Key clinical point: Ultrasound-guided stellate ganglion blockade (SGB) is a safe and effective treatment option for patients with chronic migraine (CM); however, comorbid anxiety, or depression negatively predict SGB efficacy.
Major finding: The effective rates of ultrasound-guided SGB treatment were 90.7%, 82.5%, and 71.1% at 1-, 2-, and 3-month follow-ups, respectively, with the number of SGB being significantly greater in patients who did vs did not respond to SGB at the 3-month follow-up (P = .02) and comorbid anxiety or depression being a negative predictor of poor response to SGB (B −0.25; P = .01). Overall, the SGB-associated adverse event rate was 9.3%, with all adverse events being transient.
Study details: The data come from a retrospective, single-center study including 97 patients with CM who received ≥1 ultrasound-guided SGB treatment with a time interval of 1-7 days.
Disclosures: The study funded by The Capital’s Funds for Health Improvement and Research, China. The authors declared no conflicts of interest.
Source: Yu B et al. Effectiveness, safety, and predictors of response to ultrasound-guided stellate ganglion blockades for the treatment of patients with chronic migraine: A retrospective and observational study. Pain Pract. 2023 (Mar 16). Doi: 10.1111/papr.13224
Key clinical point: Ultrasound-guided stellate ganglion blockade (SGB) is a safe and effective treatment option for patients with chronic migraine (CM); however, comorbid anxiety, or depression negatively predict SGB efficacy.
Major finding: The effective rates of ultrasound-guided SGB treatment were 90.7%, 82.5%, and 71.1% at 1-, 2-, and 3-month follow-ups, respectively, with the number of SGB being significantly greater in patients who did vs did not respond to SGB at the 3-month follow-up (P = .02) and comorbid anxiety or depression being a negative predictor of poor response to SGB (B −0.25; P = .01). Overall, the SGB-associated adverse event rate was 9.3%, with all adverse events being transient.
Study details: The data come from a retrospective, single-center study including 97 patients with CM who received ≥1 ultrasound-guided SGB treatment with a time interval of 1-7 days.
Disclosures: The study funded by The Capital’s Funds for Health Improvement and Research, China. The authors declared no conflicts of interest.
Source: Yu B et al. Effectiveness, safety, and predictors of response to ultrasound-guided stellate ganglion blockades for the treatment of patients with chronic migraine: A retrospective and observational study. Pain Pract. 2023 (Mar 16). Doi: 10.1111/papr.13224
Key clinical point: Ultrasound-guided stellate ganglion blockade (SGB) is a safe and effective treatment option for patients with chronic migraine (CM); however, comorbid anxiety, or depression negatively predict SGB efficacy.
Major finding: The effective rates of ultrasound-guided SGB treatment were 90.7%, 82.5%, and 71.1% at 1-, 2-, and 3-month follow-ups, respectively, with the number of SGB being significantly greater in patients who did vs did not respond to SGB at the 3-month follow-up (P = .02) and comorbid anxiety or depression being a negative predictor of poor response to SGB (B −0.25; P = .01). Overall, the SGB-associated adverse event rate was 9.3%, with all adverse events being transient.
Study details: The data come from a retrospective, single-center study including 97 patients with CM who received ≥1 ultrasound-guided SGB treatment with a time interval of 1-7 days.
Disclosures: The study funded by The Capital’s Funds for Health Improvement and Research, China. The authors declared no conflicts of interest.
Source: Yu B et al. Effectiveness, safety, and predictors of response to ultrasound-guided stellate ganglion blockades for the treatment of patients with chronic migraine: A retrospective and observational study. Pain Pract. 2023 (Mar 16). Doi: 10.1111/papr.13224