Redefining migraine prevention: early treatment with anti-CGRP monoclonal antibodies enhances response in the real world

被引：26

作者：

Caronna, Edoardo ^{[1
,2
]}

Gallardo, Victor Jose ^{[2
]}

Egeo, Gabriella ^{[3
]}

Vazquez, Manuel Millan ^{[4
]}

Castellanos, Candela Nieves ^{[5
]}

Membrilla, Javier A. ^{[6
,7
]}

Vaghi, Gloria ^{[8
,9
]}

Rodriguez-Montolio, Joana ^{[10
,11
]}

Fabra, Neus Fabregat ^{[12
]}

Sanchez-Caballero, Francisco ^{[13
]}

Sanchez, Alex Jaimes ^{[14
]}

Munoz-Vendrell, Albert ^{[15
]}

Oliveira, Renato ^{[16
]}

Garate, Gabriel ^{[17
]}

Gonzalez-Osorio, Yesica ^{[18
]}

Guisado-Alonso, Daniel ^{[19
]}

Ornello, Raffaele ^{[20
]}

Thunstedt, Cem ^{[21
]}

Fernandez-Lazaro, Iris ^{[22
]}

Torres-Ferrus, Marta ^{[1
,2
]}

Alpuente, Alicia ^{[1
,2
]}

Torelli, Paola ^{[23
]}

Aurilia, Cinzia ^{[3
]}

Pere, Raquel Lamas ^{[4
]}

Castrillo, Maria Jose Ruiz ^{[6
]}

De Icco, Roberto ^{[8
,9
]}

Sances, Grazia ^{[9
]}

Broadhurst, Sarah ^{[24
]}

Ong, Hui Ching ^{[24
]}

Garcia, Andrea Gomez ^{[14
]}

Campoy, Sergio ^{[15
,25
]}

Sanahuja, Jordi ^{[26
]}

Cabral, Goncalo ^{[27
]}

Blasco, Isabel Beltran ^{[28
]}

Waliszewska-Prosol, Marta ^{[29
]}

Pereira, Liliana ^{[30
]}

Layos-Romero, Almudena ^{[31
]}

Luzeiro, Isabel ^{[32
,33
]}

Dorado, Laura ^{[34
]}

Escudero, Maria Rocio Alvarez ^{[35
]}

May, Arne ^{[36
]}

Lopez-Bravo, Alba ^{[11
,37
]}

Martins, Isabel Pavao ^{[38
,39
]}

Sundal, Christina ^{[40
,41
,42
,43
]}

Irimia, Pablo ^{[44
]}

Ros, Alberto Lozano ^{[45
]}

Gago-Veiga, Ana Beatriz ^{[22
]}

Juanes, Fernando Velasco ^{[46
]}

Ruscheweyh, Ruth ^{[21
]}

Sacco, Simona ^{[20
]}

机构：

[1] Vall dHebron Hosp, Neurol Dept, Headache Clin, Barcelona, Spain

[2] Vall dHebron Res Inst, Headache & Neurol Pain Res Grp, Barcelona, Spain

[3] Headache & Pain Unit, Italian Migraine Registry IGRAINE Study Grp, IRCCS San Raffaele, Rome, Italy

[4] Hosp Univ Virgen Rocio, Unidad Cefaleas, Seville, Spain

[5] Hosp Univ & Politecn La Fe, Dept Neurol, Headache Unit, Valencia, Spain

[6] La Paz Univ Hosp, Dept Neurol, Headache Unit, Madrid, Spain

[7] Autonomous Univ Madrid, La Paz Inst Hlth Res IdiPAZ, Madrid, Spain

[8] Univ Pavia, Dept Brain & Behav Sci, Pavia, Italy

[9] IRCCS Mondino Fdn, Headache Sci & Neurorehabil Ctr, Pavia, Italy

[10] Hosp Clin Univ Lozano Blesa, Dept Neurol, Zaragoza, Spain

[11] Aragon Inst Hlth Res IIS Aragon, Zaragoza, Spain

[12] Hosp Clin Barcelona, Neurol Dept, Headache Unit, Barcelona, Spain

[13] Hosp Virgen Macarena, Seville, Spain

[14] Hosp Univ Fdn Jimenez Diaz, Headache Unit, Madrid, Spain

[15] Univ Barcelona, Hosp Univ Bellvitge IDIBELL, IDIBELL, Resp Dept, Lhospitalet De Llobregat, Barcelona, Spain

[16] Hosp Luz, Hosp Luz Headache Ctr, Neurol Dept, Lisbon, Portugal

[17] Univ Hosp Marques Valdecilla, Univ Cantabria, Neurol Dept, Santander, Spain

[18] Hosp Clin Univ Valladolid, Dept Neurol, Headache Unit, Valladolid, Spain

[19] Hosp Del Mar, Dept Neurol, Barcelona, Spain

[20] Univ Aquila, Dept Appl Clin Sci & Biotechnol, Laquila, Italy

[21] LMU Univ Hosp, Dept Neurol, LMU Munich, Munich, Germany

[22] Hosp Univ La Princesa, Dept Neurol, Headache Unit, Madrid, Spain

[23] Univ Parma, Dept Med & Surg, Neurol Unit, Neurol Unit,Italian Migraine Registry IGRAINE Stu, Parma, Italy

[24] Walton Ctr NHS Fdn Trust, Liverpool, England

[25] Hosp Viladecans IDIBELL, Neurol Dept, Viladecans, Barcelona, Spain

[26] Hosp Universitari Arnau Vilanova IRBLleida, Dept Neurol, Headache Unit, Lleida, Spain

[27] Hosp Egas Moniz, Ctr Hosp Lisboa Ocidental, Dept Rheumatol, Lisbon, Portugal

[28] Hosp Gen Univ Dr Balmis, Neurol Dept, Headache Clin, ISABIAL, Alicante, Spain

[29] Wroclaw Med Univ, Dept Neurol, Wroclaw, Poland

[30] Hosp Garcia Orta, Dept Neurol, Almada, Portugal

[31] Hosp Gen Univ Albacete, Neurol Dept, Headache Unit, Albacete, Spain

[32] Hosp & Univ Ctr Coimbra, Headache Outpatient Unit, Coimbra, Portugal

[33] ESTeSC, Coimbra Hlth School, Coimbra, Portugal

[34] Germans Trias i Pujol Univ Hosp, Dept Neurosci, Badalona, Spain

[35] Univ Hosp Cent Asturias, Dept Neurol, Headache Unit, Oviedo, Spain

[36] Univ Clin Hamburg, Hamburg, Germany

[37] Hosp Reina Sofia, Dept Neurol, Headache Unit, Tudela, Spain

[38] Univ Lisbon, North Lisbon Univ Hosp Ctr, Hosp Sta Maria, Neurol Dept,Headache Outpatient Clin, Lisbon, Portugal

[39] Campus Neurol, Lisbon, Portugal

[40] Norwegian Univ Sci & Technol, Dept Neuromed & Movement Sci, Trondheim, Norway

[41] Norwegian Headache Res Ctr, NorHEAD, Oslo, Norway

[42] Neuroclin Norway, Lillestrom, Norway

[43] Univ Gothenburg, Inst Neurosci & Physiol, Dept Clin Neurosci & Rehabil, Sahlgrenska Acad, Gothenburg, Sweden

[44] Clin Univ Navarra, Dept Neurol, Pamplona, Spain

[45] Gregorio Maranon Gen Univ Hosp HGUGM, Genom Unit, Madrid, Spain

[46] Hosp Univ Cruces, Biocruces Bizkaia Hlth Res Inst, Dept Neurol, Bilbao, Spain

[47] Pompeu Fabra Univ, Hosp Del Mar, Res Inst, Neurosci Res Program, Barcelona, Spain

[48] Univ Catolica Portuguesa, Ctr Interdisciplinary Res Hlth CIIS, Lisbon, Portugal

[49] Univ San Raffaele, Rome, Italy

来源：

JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY | 2024年 / 95卷 / 10期

关键词：

migraine; health policy & practice; HEADACHE;

D O I：

10.1136/jnnp-2023-333295

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background Anti-CGRP monoclonal antibodies (anti-CGRP MAbs) are approved and available treatments for migraine prevention. Patients do not respond alike and many countries have reimbursement policies, which hinder treatments to those who might respond. This study aimed to investigate clinical factors associated with good and excellent response to anti-CGRP MAbs at 6 months. Methods European multicentre, prospective, real-world study, including high-frequency episodic or chronic migraine (CM) patients treated since March 2018 with anti-CGRP MAbs. We defined good and excellent responses as >= 50% and >= 75% reduction in monthly headache days (MHD) at 6 months, respectively. Generalised mixed-effect regression models (GLMMs) were used to identify variables independently associated with treatment response. Results Of the 5818 included patients, 82.3% were females and the median age was 48.0 (40.0-55.0) years. At baseline, the median of MHD was 20.0 (14.0-28.0) days/months and 72.2% had a diagnosis of CM. At 6 months (n=4963), 56.5% (2804/4963) were good responders and 26.7% (1324/4963) were excellent responders. In the GLMM model, older age (1.08 (95% CI 1.02 to 1.15), p=0.016), the presence of unilateral pain (1.39 (95% CI 1.21 to 1.60), p<0.001), the absence of depression (0.840 (95% CI 0.731 to 0.966), p=0.014), less monthly migraine days (0.923 (95% CI 0.862 to 0.989), p=0.023) and lower Migraine Disability Assessment at baseline (0.874 (95% CI 0.819 to 0.932), p<0.001) were predictors of good response (AUC of 0.648 (95% CI 0.616 to 0.680)). These variables were also significant predictors of excellent response (AUC of 0.691 (95% CI 0.651 to 0.731)). Sex was not significant in the GLMM models. Conclusions This is the largest real-world study of migraine patients treated with anti-CGRP MAbs. It provides evidence that higher migraine frequency and greater disability at baseline reduce the likelihood of responding to anti-CGRP MAbs, informing physicians and policy-makers on the need for an earlier treatment in order to offer the best chance of treatment success.

引用

页码：927 / 937

页数：11

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