Ultrasound-guided stellate ganglion block: An effective treatment strategy for migraine

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Key clinical point: Real-time ultrasound-guided stellate ganglion block (SGB) can effectively ameliorate migraine pain and disability without causing any serious complications, thus improving the quality of life of patients.

Major finding: After 3 months of SGB administration, the numerical rating scale score decreased from 7.0 to 2.0 (P < .01), Migraine Disability Assessment Scale total score from 14.0 to 7.0 (P < .001), and analgesic use frequency from 6.2 ± 2.8 to 1.9 ± 1.8. No serious complications were observed.

Study details: The study enrolled 81 patients aged >18 years with migraine who received SGB on the affected side with 0.15% ropivacaine weekly 4 times.

Disclosures: The study was sponsored by a grant from the Shanghai Municipal Health Commission. The authors reported no conflicts of interest.

Source: Hou J et al. Real-time ultrasound-guided stellate ganglion block for migraine: an observational study. BMC Anesthesiol. 2022;22:78 (Mar 24). Doi: 10.1186/s12871-022-01622-8

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Key clinical point: Real-time ultrasound-guided stellate ganglion block (SGB) can effectively ameliorate migraine pain and disability without causing any serious complications, thus improving the quality of life of patients.

Major finding: After 3 months of SGB administration, the numerical rating scale score decreased from 7.0 to 2.0 (P < .01), Migraine Disability Assessment Scale total score from 14.0 to 7.0 (P < .001), and analgesic use frequency from 6.2 ± 2.8 to 1.9 ± 1.8. No serious complications were observed.

Study details: The study enrolled 81 patients aged >18 years with migraine who received SGB on the affected side with 0.15% ropivacaine weekly 4 times.

Disclosures: The study was sponsored by a grant from the Shanghai Municipal Health Commission. The authors reported no conflicts of interest.

Source: Hou J et al. Real-time ultrasound-guided stellate ganglion block for migraine: an observational study. BMC Anesthesiol. 2022;22:78 (Mar 24). Doi: 10.1186/s12871-022-01622-8

Key clinical point: Real-time ultrasound-guided stellate ganglion block (SGB) can effectively ameliorate migraine pain and disability without causing any serious complications, thus improving the quality of life of patients.

Major finding: After 3 months of SGB administration, the numerical rating scale score decreased from 7.0 to 2.0 (P < .01), Migraine Disability Assessment Scale total score from 14.0 to 7.0 (P < .001), and analgesic use frequency from 6.2 ± 2.8 to 1.9 ± 1.8. No serious complications were observed.

Study details: The study enrolled 81 patients aged >18 years with migraine who received SGB on the affected side with 0.15% ropivacaine weekly 4 times.

Disclosures: The study was sponsored by a grant from the Shanghai Municipal Health Commission. The authors reported no conflicts of interest.

Source: Hou J et al. Real-time ultrasound-guided stellate ganglion block for migraine: an observational study. BMC Anesthesiol. 2022;22:78 (Mar 24). Doi: 10.1186/s12871-022-01622-8

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Effect of CGRP-receptor mAb therapy resumption after a drug holiday on migraine frequency

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Key clinical point: Migraine frequency decreases significantly in most patients with migraine on resuming preventive treatment with the same calcitonin gene-related peptide-receptor (CGRP-[R]) monoclonal antibody (mAb) after a 3-month drug holiday.

Major finding: After 9-12 weeks of therapy resumption, monthly migraine days reduced significantly (−4.5 days, P < .001) and attained a level comparable with that in the 4-week period before therapy discontinuation (P > .999).

Study details: Findings are from a longitudinal cohort study including 39 patients with episodic or chronic migraine who restarted treatment with erenumab (n = 16) or galcanezumab/fremanezumab (n = 23) after a 3-month drug holiday following the first treatment cycle with the same CGRP(-R) mAb.

Disclosures: This study did not receive any financial support. Some authors declared serving on the advisory board of or receiving consulting, speaker, or personal fees from various sources.

Source: Raffaelli B et al. Resumption of migraine preventive treatment with CGRP(-receptor) antibodies after a 3-month drug holiday: A real-world experience. J Headache Pain. 2022;23:40 (Mar 30). Doi:  10.1186/s10194-022-01417-9

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Key clinical point: Migraine frequency decreases significantly in most patients with migraine on resuming preventive treatment with the same calcitonin gene-related peptide-receptor (CGRP-[R]) monoclonal antibody (mAb) after a 3-month drug holiday.

Major finding: After 9-12 weeks of therapy resumption, monthly migraine days reduced significantly (−4.5 days, P < .001) and attained a level comparable with that in the 4-week period before therapy discontinuation (P > .999).

Study details: Findings are from a longitudinal cohort study including 39 patients with episodic or chronic migraine who restarted treatment with erenumab (n = 16) or galcanezumab/fremanezumab (n = 23) after a 3-month drug holiday following the first treatment cycle with the same CGRP(-R) mAb.

Disclosures: This study did not receive any financial support. Some authors declared serving on the advisory board of or receiving consulting, speaker, or personal fees from various sources.

Source: Raffaelli B et al. Resumption of migraine preventive treatment with CGRP(-receptor) antibodies after a 3-month drug holiday: A real-world experience. J Headache Pain. 2022;23:40 (Mar 30). Doi:  10.1186/s10194-022-01417-9

Key clinical point: Migraine frequency decreases significantly in most patients with migraine on resuming preventive treatment with the same calcitonin gene-related peptide-receptor (CGRP-[R]) monoclonal antibody (mAb) after a 3-month drug holiday.

Major finding: After 9-12 weeks of therapy resumption, monthly migraine days reduced significantly (−4.5 days, P < .001) and attained a level comparable with that in the 4-week period before therapy discontinuation (P > .999).

Study details: Findings are from a longitudinal cohort study including 39 patients with episodic or chronic migraine who restarted treatment with erenumab (n = 16) or galcanezumab/fremanezumab (n = 23) after a 3-month drug holiday following the first treatment cycle with the same CGRP(-R) mAb.

Disclosures: This study did not receive any financial support. Some authors declared serving on the advisory board of or receiving consulting, speaker, or personal fees from various sources.

Source: Raffaelli B et al. Resumption of migraine preventive treatment with CGRP(-receptor) antibodies after a 3-month drug holiday: A real-world experience. J Headache Pain. 2022;23:40 (Mar 30). Doi:  10.1186/s10194-022-01417-9

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Chronic migraine: Topiramate performs better when combined with greater occipital nerve block

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Key clinical point: Topiramate in combination with monthly injections of greater occipital nerve block (GONB) is better at decreasing monthly migraine days (MMD) in chronic migraine (CM) than topiramate monotherapy at month 3 and is equally well tolerated.

Major finding: At month 3, greater reductions in MMD were observed in patients receiving topiramate and GONB with lidocaine+methylprednisolone (−9.6 vs. −7.3 days; P = .003) and topiramate and GONB with only lidocaine (−10.1 vs. −7.3 days; P < .001) compared with patients receiving topiramate monotherapy. Tolerability between the groups was comparable.

Study details: Findings are from a parallel group, three-arm study including 125 adult patients with CM who were randomly assigned to receive topiramate alone (n = 41), topiramate and GONB with lidocaine+methylprednisolone in month 1 followed by monthly lidocaine injections (n = 44), or topiramate and GONB with monthly lidocaine injections (n = 40) for 3 months.

Disclosures: The study received no financial support. The authors declared no conflicts of interest.

Source: Chowdhury D et al. Efficacy and tolerability of combination treatment of topiramate and greater occipital nerve block versus topiramate monotherapy for the preventive treatment of chronic migraine: A randomized controlled trial. Cephalalgia. 2022 (Mar 8). Doi: 10.1177/03331024221082077

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Key clinical point: Topiramate in combination with monthly injections of greater occipital nerve block (GONB) is better at decreasing monthly migraine days (MMD) in chronic migraine (CM) than topiramate monotherapy at month 3 and is equally well tolerated.

Major finding: At month 3, greater reductions in MMD were observed in patients receiving topiramate and GONB with lidocaine+methylprednisolone (−9.6 vs. −7.3 days; P = .003) and topiramate and GONB with only lidocaine (−10.1 vs. −7.3 days; P < .001) compared with patients receiving topiramate monotherapy. Tolerability between the groups was comparable.

Study details: Findings are from a parallel group, three-arm study including 125 adult patients with CM who were randomly assigned to receive topiramate alone (n = 41), topiramate and GONB with lidocaine+methylprednisolone in month 1 followed by monthly lidocaine injections (n = 44), or topiramate and GONB with monthly lidocaine injections (n = 40) for 3 months.

Disclosures: The study received no financial support. The authors declared no conflicts of interest.

Source: Chowdhury D et al. Efficacy and tolerability of combination treatment of topiramate and greater occipital nerve block versus topiramate monotherapy for the preventive treatment of chronic migraine: A randomized controlled trial. Cephalalgia. 2022 (Mar 8). Doi: 10.1177/03331024221082077

Key clinical point: Topiramate in combination with monthly injections of greater occipital nerve block (GONB) is better at decreasing monthly migraine days (MMD) in chronic migraine (CM) than topiramate monotherapy at month 3 and is equally well tolerated.

Major finding: At month 3, greater reductions in MMD were observed in patients receiving topiramate and GONB with lidocaine+methylprednisolone (−9.6 vs. −7.3 days; P = .003) and topiramate and GONB with only lidocaine (−10.1 vs. −7.3 days; P < .001) compared with patients receiving topiramate monotherapy. Tolerability between the groups was comparable.

Study details: Findings are from a parallel group, three-arm study including 125 adult patients with CM who were randomly assigned to receive topiramate alone (n = 41), topiramate and GONB with lidocaine+methylprednisolone in month 1 followed by monthly lidocaine injections (n = 44), or topiramate and GONB with monthly lidocaine injections (n = 40) for 3 months.

Disclosures: The study received no financial support. The authors declared no conflicts of interest.

Source: Chowdhury D et al. Efficacy and tolerability of combination treatment of topiramate and greater occipital nerve block versus topiramate monotherapy for the preventive treatment of chronic migraine: A randomized controlled trial. Cephalalgia. 2022 (Mar 8). Doi: 10.1177/03331024221082077

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External trigeminal nerve stimulation: A nonpharmacological alternative for the acute treatment of migraine attacks

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Key clinical point: External trigeminal nerve stimulation (e-TNS) for 2 consecutive hours is an effective, safe, nonpharmacological, and noninvasive acute treatment option for a migraine attack with or without aura.

Major finding: A significantly higher percentage of patients experienced pain freedom (25.5% vs. 18.3%; P < .05) and showed resolution of the most bothersome migraine symptoms (56.4% vs. 42.3%; P < .01) with e-TNS vs. sham treatment, effectuating a therapeutic gain of 7.2% and 14.1%, respectively.

Study details: The intention-to-treat population in this multicenter, prospective, phase 3 study, TEAM, consisted of 538 adult patients with episodic migraine with or without aura who were randomly assigned to receive active (n = 259) or sham (n = 279) stimulation for 2 hours.

Disclosures: The study was sponsored by Cefaly Technology, Belgium. Some authors reported receiving consulting fees, advisory board honoraria, or research grants from various sources. MAL Johnson is the Global Director of Medical Affairs for Cefaly.

Source: Kuruvilla DE et al. Phase 3 randomized, double-blind, sham-controlled Trial of e-TNS for the Acute treatment of Migraine (TEAM). Sci Rep. 2022;12:5110 (Mar 24). Doi: 10.1038/s41598-022-09071-6

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Key clinical point: External trigeminal nerve stimulation (e-TNS) for 2 consecutive hours is an effective, safe, nonpharmacological, and noninvasive acute treatment option for a migraine attack with or without aura.

Major finding: A significantly higher percentage of patients experienced pain freedom (25.5% vs. 18.3%; P < .05) and showed resolution of the most bothersome migraine symptoms (56.4% vs. 42.3%; P < .01) with e-TNS vs. sham treatment, effectuating a therapeutic gain of 7.2% and 14.1%, respectively.

Study details: The intention-to-treat population in this multicenter, prospective, phase 3 study, TEAM, consisted of 538 adult patients with episodic migraine with or without aura who were randomly assigned to receive active (n = 259) or sham (n = 279) stimulation for 2 hours.

Disclosures: The study was sponsored by Cefaly Technology, Belgium. Some authors reported receiving consulting fees, advisory board honoraria, or research grants from various sources. MAL Johnson is the Global Director of Medical Affairs for Cefaly.

Source: Kuruvilla DE et al. Phase 3 randomized, double-blind, sham-controlled Trial of e-TNS for the Acute treatment of Migraine (TEAM). Sci Rep. 2022;12:5110 (Mar 24). Doi: 10.1038/s41598-022-09071-6

Key clinical point: External trigeminal nerve stimulation (e-TNS) for 2 consecutive hours is an effective, safe, nonpharmacological, and noninvasive acute treatment option for a migraine attack with or without aura.

Major finding: A significantly higher percentage of patients experienced pain freedom (25.5% vs. 18.3%; P < .05) and showed resolution of the most bothersome migraine symptoms (56.4% vs. 42.3%; P < .01) with e-TNS vs. sham treatment, effectuating a therapeutic gain of 7.2% and 14.1%, respectively.

Study details: The intention-to-treat population in this multicenter, prospective, phase 3 study, TEAM, consisted of 538 adult patients with episodic migraine with or without aura who were randomly assigned to receive active (n = 259) or sham (n = 279) stimulation for 2 hours.

Disclosures: The study was sponsored by Cefaly Technology, Belgium. Some authors reported receiving consulting fees, advisory board honoraria, or research grants from various sources. MAL Johnson is the Global Director of Medical Affairs for Cefaly.

Source: Kuruvilla DE et al. Phase 3 randomized, double-blind, sham-controlled Trial of e-TNS for the Acute treatment of Migraine (TEAM). Sci Rep. 2022;12:5110 (Mar 24). Doi: 10.1038/s41598-022-09071-6

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Fremanezumab effective in difficult-to-treat migraine with associated neurological dysfunction

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Key clinical point: Fremanezumab lowers the pain and neurological symptom days in patients with episodic migraine (EM) or chronic migraine (CM) with associated neurological dysfunction and inadequate response to 2-4 prior classes of prophylactic medications.

Major finding: Quarterly and monthly fremanezumab vs. placebo significantly reduced monthly mean days with neurological symptoms (least square mean difference −1.7 days and −1.8 days vs. −0.5 days; both P ≤ .01) and monthly migraine days (P < .0001) over 12 weeks.

Study details: This post hoc analysis included 837 patients with difficult-to-treat EM or CM from the phase 3b FOCUS study who received quarterly fremanezumab, monthly fremanezumab, or placebo over 12 weeks and were categorized into patients with (n = 493) and without (n = 344) associated neurological dysfunction.

Disclosures: This study was funded by Teva Branded Pharmaceutical Products R&D, Inc., USA. Some authors declared serving as consultants, speakers, or principal clinical trial investigators for or receiving personal fees from various sources, including Teva, and other authors are employees or stockholders of Teva.

Source: Lampl C et al. Efficacy and quality-of-life improvements with fremanezumab treatment in patients with difficult-to-treat migraine with associated neurological dysfunction. Eur J Neurol. 2022 (Mar 18). Doi: 10.1111/ene.15328

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Key clinical point: Fremanezumab lowers the pain and neurological symptom days in patients with episodic migraine (EM) or chronic migraine (CM) with associated neurological dysfunction and inadequate response to 2-4 prior classes of prophylactic medications.

Major finding: Quarterly and monthly fremanezumab vs. placebo significantly reduced monthly mean days with neurological symptoms (least square mean difference −1.7 days and −1.8 days vs. −0.5 days; both P ≤ .01) and monthly migraine days (P < .0001) over 12 weeks.

Study details: This post hoc analysis included 837 patients with difficult-to-treat EM or CM from the phase 3b FOCUS study who received quarterly fremanezumab, monthly fremanezumab, or placebo over 12 weeks and were categorized into patients with (n = 493) and without (n = 344) associated neurological dysfunction.

Disclosures: This study was funded by Teva Branded Pharmaceutical Products R&D, Inc., USA. Some authors declared serving as consultants, speakers, or principal clinical trial investigators for or receiving personal fees from various sources, including Teva, and other authors are employees or stockholders of Teva.

Source: Lampl C et al. Efficacy and quality-of-life improvements with fremanezumab treatment in patients with difficult-to-treat migraine with associated neurological dysfunction. Eur J Neurol. 2022 (Mar 18). Doi: 10.1111/ene.15328

Key clinical point: Fremanezumab lowers the pain and neurological symptom days in patients with episodic migraine (EM) or chronic migraine (CM) with associated neurological dysfunction and inadequate response to 2-4 prior classes of prophylactic medications.

Major finding: Quarterly and monthly fremanezumab vs. placebo significantly reduced monthly mean days with neurological symptoms (least square mean difference −1.7 days and −1.8 days vs. −0.5 days; both P ≤ .01) and monthly migraine days (P < .0001) over 12 weeks.

Study details: This post hoc analysis included 837 patients with difficult-to-treat EM or CM from the phase 3b FOCUS study who received quarterly fremanezumab, monthly fremanezumab, or placebo over 12 weeks and were categorized into patients with (n = 493) and without (n = 344) associated neurological dysfunction.

Disclosures: This study was funded by Teva Branded Pharmaceutical Products R&D, Inc., USA. Some authors declared serving as consultants, speakers, or principal clinical trial investigators for or receiving personal fees from various sources, including Teva, and other authors are employees or stockholders of Teva.

Source: Lampl C et al. Efficacy and quality-of-life improvements with fremanezumab treatment in patients with difficult-to-treat migraine with associated neurological dysfunction. Eur J Neurol. 2022 (Mar 18). Doi: 10.1111/ene.15328

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Eptinezumab can prevent self-reported migraine with aura

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Key clinical point: Consistent with the overall study population results, eptinezumab therapy demonstrated favorable efficacy and safety in patients with episodic migraine (EM) or chronic migraine (CM) and self-reported aura from the PROMISE studies.

Major finding: Over weeks 1-12, monthly migraine days decreased with 100 mg and 300 mg eptinezumab vs. placebo in patients with EM (100 mg, −3.9 days; 300 mg, −4.2 days vs. −3.3 days) and CM (100 mg, −7.1 days; 300 mg, −7.6 days vs. −5.9 days) with aura. Treatment-emergent adverse event rates were similar across treatment groups.

Study details: Of 1741 patients with EM/CM from the PROMISE-1 and PROMISE-2 trials, this post hoc analysis included 877 patients who self-reported migraine with aura at screening and received eptinezumab (n = 583) or placebo (n = 294).

Disclosures: Lundbeck Seattle BioPharmaceuticals, Inc., USA, funded the study. Some authors declared serving as consultants, speakers, advisors, or as a primary trial investigator for and receiving personal fees and research support from various sources, including Lundbeck. Some authors are current or former employees of Lundbeck or its subsidiary company.

Source: Ashina M et al. Efficacy and safety of eptinezumab in patients with migraine and self-reported aura: Post hoc analysis of PROMISE-1 and PROMISE-2. Cephalalgia. 2022 (Mar 18). Doi: 10.1177/03331024221077646

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Key clinical point: Consistent with the overall study population results, eptinezumab therapy demonstrated favorable efficacy and safety in patients with episodic migraine (EM) or chronic migraine (CM) and self-reported aura from the PROMISE studies.

Major finding: Over weeks 1-12, monthly migraine days decreased with 100 mg and 300 mg eptinezumab vs. placebo in patients with EM (100 mg, −3.9 days; 300 mg, −4.2 days vs. −3.3 days) and CM (100 mg, −7.1 days; 300 mg, −7.6 days vs. −5.9 days) with aura. Treatment-emergent adverse event rates were similar across treatment groups.

Study details: Of 1741 patients with EM/CM from the PROMISE-1 and PROMISE-2 trials, this post hoc analysis included 877 patients who self-reported migraine with aura at screening and received eptinezumab (n = 583) or placebo (n = 294).

Disclosures: Lundbeck Seattle BioPharmaceuticals, Inc., USA, funded the study. Some authors declared serving as consultants, speakers, advisors, or as a primary trial investigator for and receiving personal fees and research support from various sources, including Lundbeck. Some authors are current or former employees of Lundbeck or its subsidiary company.

Source: Ashina M et al. Efficacy and safety of eptinezumab in patients with migraine and self-reported aura: Post hoc analysis of PROMISE-1 and PROMISE-2. Cephalalgia. 2022 (Mar 18). Doi: 10.1177/03331024221077646

Key clinical point: Consistent with the overall study population results, eptinezumab therapy demonstrated favorable efficacy and safety in patients with episodic migraine (EM) or chronic migraine (CM) and self-reported aura from the PROMISE studies.

Major finding: Over weeks 1-12, monthly migraine days decreased with 100 mg and 300 mg eptinezumab vs. placebo in patients with EM (100 mg, −3.9 days; 300 mg, −4.2 days vs. −3.3 days) and CM (100 mg, −7.1 days; 300 mg, −7.6 days vs. −5.9 days) with aura. Treatment-emergent adverse event rates were similar across treatment groups.

Study details: Of 1741 patients with EM/CM from the PROMISE-1 and PROMISE-2 trials, this post hoc analysis included 877 patients who self-reported migraine with aura at screening and received eptinezumab (n = 583) or placebo (n = 294).

Disclosures: Lundbeck Seattle BioPharmaceuticals, Inc., USA, funded the study. Some authors declared serving as consultants, speakers, advisors, or as a primary trial investigator for and receiving personal fees and research support from various sources, including Lundbeck. Some authors are current or former employees of Lundbeck or its subsidiary company.

Source: Ashina M et al. Efficacy and safety of eptinezumab in patients with migraine and self-reported aura: Post hoc analysis of PROMISE-1 and PROMISE-2. Cephalalgia. 2022 (Mar 18). Doi: 10.1177/03331024221077646

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Galcanezumab shows long-term efficacy and safety in chronic migraine

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Key clinical point: Galcanezumab is an effective and safe long-term treatment option for chronic migraine.

Major finding: At month 12, patients in the placebo, 120 mg galcanezumab, and 240 mg galcanezumab groups showed a mean change of −8.5, −9.0, and −8.0 days in monthly migraine days from the beginning of the double-blind period, respectively (all within-group P < .001). No new safety concerns emerged with extended treatment.

Study details: Findings are from the 9-month open-label extension of the REGAIN trial including 1022 patients with chronic migraine who completed the preceding 3-month double-blind treatment (501, 259, and 262 patients assigned to the placebo, 120 mg galcanezumab, and 240 mg galcanezumab groups, respectively) and received a 240-mg galcanezumab loading dose, followed by 120 mg in the next month and flexible dosing thereafter.

Disclosures: This study was sponsored by Eli Lilly and Company. Some authors declared receiving speaker, consultant, or advisory board member honoraria from various sources, including Eli Lilly. Two authors reported being full-time employees and minor stockholders of Eli Lilly.

Source: Pozo-Rosich P et al. Long-term treatment with galcanezumab in patients with chronic migraine: results from the open-label extension of the REGAIN study. Curr Med Res Opin. 2022 (Apr 8). Doi:   10.1080/03007995.2022.2059975

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Key clinical point: Galcanezumab is an effective and safe long-term treatment option for chronic migraine.

Major finding: At month 12, patients in the placebo, 120 mg galcanezumab, and 240 mg galcanezumab groups showed a mean change of −8.5, −9.0, and −8.0 days in monthly migraine days from the beginning of the double-blind period, respectively (all within-group P < .001). No new safety concerns emerged with extended treatment.

Study details: Findings are from the 9-month open-label extension of the REGAIN trial including 1022 patients with chronic migraine who completed the preceding 3-month double-blind treatment (501, 259, and 262 patients assigned to the placebo, 120 mg galcanezumab, and 240 mg galcanezumab groups, respectively) and received a 240-mg galcanezumab loading dose, followed by 120 mg in the next month and flexible dosing thereafter.

Disclosures: This study was sponsored by Eli Lilly and Company. Some authors declared receiving speaker, consultant, or advisory board member honoraria from various sources, including Eli Lilly. Two authors reported being full-time employees and minor stockholders of Eli Lilly.

Source: Pozo-Rosich P et al. Long-term treatment with galcanezumab in patients with chronic migraine: results from the open-label extension of the REGAIN study. Curr Med Res Opin. 2022 (Apr 8). Doi:   10.1080/03007995.2022.2059975

Key clinical point: Galcanezumab is an effective and safe long-term treatment option for chronic migraine.

Major finding: At month 12, patients in the placebo, 120 mg galcanezumab, and 240 mg galcanezumab groups showed a mean change of −8.5, −9.0, and −8.0 days in monthly migraine days from the beginning of the double-blind period, respectively (all within-group P < .001). No new safety concerns emerged with extended treatment.

Study details: Findings are from the 9-month open-label extension of the REGAIN trial including 1022 patients with chronic migraine who completed the preceding 3-month double-blind treatment (501, 259, and 262 patients assigned to the placebo, 120 mg galcanezumab, and 240 mg galcanezumab groups, respectively) and received a 240-mg galcanezumab loading dose, followed by 120 mg in the next month and flexible dosing thereafter.

Disclosures: This study was sponsored by Eli Lilly and Company. Some authors declared receiving speaker, consultant, or advisory board member honoraria from various sources, including Eli Lilly. Two authors reported being full-time employees and minor stockholders of Eli Lilly.

Source: Pozo-Rosich P et al. Long-term treatment with galcanezumab in patients with chronic migraine: results from the open-label extension of the REGAIN study. Curr Med Res Opin. 2022 (Apr 8). Doi:   10.1080/03007995.2022.2059975

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Prenatal estimated fetal weight standards better at diagnosing SGA fetuses than other biometric methods

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Key clinical point: Prenatal standard estimated fetal weight (EFW) z-scores can predict small-for-gestational-age (SGA) fetuses with greater accuracy than abdominal circumference (AC) z-scores and postnatal reference standards.

Major finding: The INTERGROWTH-21st project-derived EFW z-scores showed higher accuracy in identifying fetuses with a birthweight of <10th and <3rd percentiles than AC z-scores (both P < .05) and postnatal standards (both P < .05). The Hadlock group-derived EFW z-scores performed better in identifying fetuses <10th percentiles (P < .05) and similarly in identifying fetuses <3rd percentile (P = .344) than AC z-scores, whereas they were more accurate than postnatal standards with both birth-weight percentiles (both P < .05).

Study details: This retrospective study included 406 singleton pregnant women at an increased risk for fetal growth restriction who underwent ultrasound examinations between 24 and 36 weeks of gestation.

Disclosures: The study received no financial support. No conflicts of interest were reported.

Source: Visentin S et al. A prenatal standard for fetal weight improves the prenatal diagnosis of small for gestational age fetuses in pregnancies at increased risk. BMC Pregnancy Childbirth. 2022;22:254 (Mar 26). Doi: 10.1186/s12884-022-04545-x

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Key clinical point: Prenatal standard estimated fetal weight (EFW) z-scores can predict small-for-gestational-age (SGA) fetuses with greater accuracy than abdominal circumference (AC) z-scores and postnatal reference standards.

Major finding: The INTERGROWTH-21st project-derived EFW z-scores showed higher accuracy in identifying fetuses with a birthweight of <10th and <3rd percentiles than AC z-scores (both P < .05) and postnatal standards (both P < .05). The Hadlock group-derived EFW z-scores performed better in identifying fetuses <10th percentiles (P < .05) and similarly in identifying fetuses <3rd percentile (P = .344) than AC z-scores, whereas they were more accurate than postnatal standards with both birth-weight percentiles (both P < .05).

Study details: This retrospective study included 406 singleton pregnant women at an increased risk for fetal growth restriction who underwent ultrasound examinations between 24 and 36 weeks of gestation.

Disclosures: The study received no financial support. No conflicts of interest were reported.

Source: Visentin S et al. A prenatal standard for fetal weight improves the prenatal diagnosis of small for gestational age fetuses in pregnancies at increased risk. BMC Pregnancy Childbirth. 2022;22:254 (Mar 26). Doi: 10.1186/s12884-022-04545-x

Key clinical point: Prenatal standard estimated fetal weight (EFW) z-scores can predict small-for-gestational-age (SGA) fetuses with greater accuracy than abdominal circumference (AC) z-scores and postnatal reference standards.

Major finding: The INTERGROWTH-21st project-derived EFW z-scores showed higher accuracy in identifying fetuses with a birthweight of <10th and <3rd percentiles than AC z-scores (both P < .05) and postnatal standards (both P < .05). The Hadlock group-derived EFW z-scores performed better in identifying fetuses <10th percentiles (P < .05) and similarly in identifying fetuses <3rd percentile (P = .344) than AC z-scores, whereas they were more accurate than postnatal standards with both birth-weight percentiles (both P < .05).

Study details: This retrospective study included 406 singleton pregnant women at an increased risk for fetal growth restriction who underwent ultrasound examinations between 24 and 36 weeks of gestation.

Disclosures: The study received no financial support. No conflicts of interest were reported.

Source: Visentin S et al. A prenatal standard for fetal weight improves the prenatal diagnosis of small for gestational age fetuses in pregnancies at increased risk. BMC Pregnancy Childbirth. 2022;22:254 (Mar 26). Doi: 10.1186/s12884-022-04545-x

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Ultrasonography and MRI can prenatally diagnose placenta accreta spectrum with comparable accuracy

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Key clinical point: Accuracy of ultrasonography for the prenatal diagnosis of placenta accreta spectrum (PAS) disorder is comparable with that of magnetic resonance imaging (MRI).

Major finding: Ultrasonography and MRI showed similar sensitivity (0.90; 95% CI 0.86-0.93 vs. 0.89; 95% CI 0.85-0.92), specificity (0.83; 95% CI 0.79-0.86 vs. 0.87; 95% CI 0.83-0.89), and diagnostic odds ratio (39.5; 95% CI 19.6-79.7 vs. 37.4; 95% CI 17.0-82.3) for PAS diagnosis, with no significant difference between their pooled diagnostic sensitivity (P = .808) and specificity (P = .413).

Study details: This is a meta-analysis of 18 studies including 861 pregnancies at a potential risk for PAS, of which 339 were diagnosed with PAS.

Disclosures: The study was sponsored by the Natural Science Foundation of Science and Technology Commission of Shanghai Municipality. The authors declared no conflicts of interest.

Source: Hong S et al. Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: A systematic review and meta-analysis. Insights Imaging. 2022;13:50 (Mar 22). Doi: 10.1186/s13244-022-01192-w

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Key clinical point: Accuracy of ultrasonography for the prenatal diagnosis of placenta accreta spectrum (PAS) disorder is comparable with that of magnetic resonance imaging (MRI).

Major finding: Ultrasonography and MRI showed similar sensitivity (0.90; 95% CI 0.86-0.93 vs. 0.89; 95% CI 0.85-0.92), specificity (0.83; 95% CI 0.79-0.86 vs. 0.87; 95% CI 0.83-0.89), and diagnostic odds ratio (39.5; 95% CI 19.6-79.7 vs. 37.4; 95% CI 17.0-82.3) for PAS diagnosis, with no significant difference between their pooled diagnostic sensitivity (P = .808) and specificity (P = .413).

Study details: This is a meta-analysis of 18 studies including 861 pregnancies at a potential risk for PAS, of which 339 were diagnosed with PAS.

Disclosures: The study was sponsored by the Natural Science Foundation of Science and Technology Commission of Shanghai Municipality. The authors declared no conflicts of interest.

Source: Hong S et al. Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: A systematic review and meta-analysis. Insights Imaging. 2022;13:50 (Mar 22). Doi: 10.1186/s13244-022-01192-w

Key clinical point: Accuracy of ultrasonography for the prenatal diagnosis of placenta accreta spectrum (PAS) disorder is comparable with that of magnetic resonance imaging (MRI).

Major finding: Ultrasonography and MRI showed similar sensitivity (0.90; 95% CI 0.86-0.93 vs. 0.89; 95% CI 0.85-0.92), specificity (0.83; 95% CI 0.79-0.86 vs. 0.87; 95% CI 0.83-0.89), and diagnostic odds ratio (39.5; 95% CI 19.6-79.7 vs. 37.4; 95% CI 17.0-82.3) for PAS diagnosis, with no significant difference between their pooled diagnostic sensitivity (P = .808) and specificity (P = .413).

Study details: This is a meta-analysis of 18 studies including 861 pregnancies at a potential risk for PAS, of which 339 were diagnosed with PAS.

Disclosures: The study was sponsored by the Natural Science Foundation of Science and Technology Commission of Shanghai Municipality. The authors declared no conflicts of interest.

Source: Hong S et al. Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: A systematic review and meta-analysis. Insights Imaging. 2022;13:50 (Mar 22). Doi: 10.1186/s13244-022-01192-w

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Routine prenatal fetal RHD screening after 11 weeks of pregnancy yields encouraging results

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Key clinical point: Noninvasive prenatal fetal rhesus D (RHD) screening after 11 weeks of gestation offers high accuracy and reliability in routine clinical practice.

Major finding: Fetal RHD testing had a 100% sensitivity (95% CI 95.3%-100.0%) and a 100% specificity (95% CI 91.6%-100.0%), with the negative and positive predictive values being 100.0%. No false-negative or false-positive screening results were reported.

Study details: This was a single-center study wherein fetal RHD testing (real-time polymerase chain reaction targeting RHD exons 5 and 7) was performed using blood samples from 205 RHD-negative pregnant women at 11 weeks of gestation and test performance was evaluated using cord blood samples obtained from 62% (n = 127) of women.

Disclosures: The study was sponsored by the Scientific Fund of Hematology. The authors reported no conflicts of interest.

Source: Blomme S et al. Routine noninvasive prenatal screening for fetal Rh D in maternal plasma—A 2-year experience from a single center in Belgium. Transfusion. 2022 (Mar 30). Doi: 10.1111/trf.16868

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Key clinical point: Noninvasive prenatal fetal rhesus D (RHD) screening after 11 weeks of gestation offers high accuracy and reliability in routine clinical practice.

Major finding: Fetal RHD testing had a 100% sensitivity (95% CI 95.3%-100.0%) and a 100% specificity (95% CI 91.6%-100.0%), with the negative and positive predictive values being 100.0%. No false-negative or false-positive screening results were reported.

Study details: This was a single-center study wherein fetal RHD testing (real-time polymerase chain reaction targeting RHD exons 5 and 7) was performed using blood samples from 205 RHD-negative pregnant women at 11 weeks of gestation and test performance was evaluated using cord blood samples obtained from 62% (n = 127) of women.

Disclosures: The study was sponsored by the Scientific Fund of Hematology. The authors reported no conflicts of interest.

Source: Blomme S et al. Routine noninvasive prenatal screening for fetal Rh D in maternal plasma—A 2-year experience from a single center in Belgium. Transfusion. 2022 (Mar 30). Doi: 10.1111/trf.16868

Key clinical point: Noninvasive prenatal fetal rhesus D (RHD) screening after 11 weeks of gestation offers high accuracy and reliability in routine clinical practice.

Major finding: Fetal RHD testing had a 100% sensitivity (95% CI 95.3%-100.0%) and a 100% specificity (95% CI 91.6%-100.0%), with the negative and positive predictive values being 100.0%. No false-negative or false-positive screening results were reported.

Study details: This was a single-center study wherein fetal RHD testing (real-time polymerase chain reaction targeting RHD exons 5 and 7) was performed using blood samples from 205 RHD-negative pregnant women at 11 weeks of gestation and test performance was evaluated using cord blood samples obtained from 62% (n = 127) of women.

Disclosures: The study was sponsored by the Scientific Fund of Hematology. The authors reported no conflicts of interest.

Source: Blomme S et al. Routine noninvasive prenatal screening for fetal Rh D in maternal plasma—A 2-year experience from a single center in Belgium. Transfusion. 2022 (Mar 30). Doi: 10.1111/trf.16868

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