A longitudinal clinical and MRI evaluation of the treatment with erenumab
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BRIEF COMMUNICATION
A longitudinal clinical and MRI evaluation of the treatment with erenumab Alberto Coccia 1 & Caterina Lapucci 1 & Monica Bandettini di Poggio 1 & Matteo Grazzini 1 & Matilde Inglese 1 & Cinzia Finocchi 1
# The Author(s) 2020
Keywords Migraine . MoA . CGRP
Migraine is a very common neurologic disease second only to stroke for number of disability-adjusted life-years and, for the global disease burden [1]. Nowadays, there are several available preventive, abortive, and behavioral therapies for migraine, with different mechanisms of action (MoA). It has been demonstrated that a neuropeptide (the CGRP— the calcitonin gene–related peptide), along its receptor, located in both central and peripheral neurons can influence neuronal modulation of pain and vascular activity. The role in the pathophysiology of migraine is supported by the localization of the peptide receptors in the dorsal root and trigeminal ganglions. Its involvement in the pathophysiological processes underlying migraine led to the development of CGRP antagonists (the “gepants”) and four different antibodies targeting the CGRP receptor (erenumab) or the CGRP itself (eptinezumab, fremanezumab, and galcanezumab). Erenumab, a fully human monoclonal antibody directed against the calcitonin gene–related peptide receptor, was consequently approved for the prevention of episodic or chronic migraine. The STRIVE Study (A Phase 3, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and Safety of AMG 334 in Migraine Prevention) demonstrated that the treatment with erenumab at a monthly dose of 70 mg or 140 mg provides a significant reduction in the frequency of migraine days [2].
* Alberto Coccia [email protected] 1
Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Largo Paolo Daneo 3, 16132 Genoa, Italy
The aim of our study is to perform a longitudinal evaluation of the effect of the treatment with erenumab in migraine patients from a clinical and neuroradiological point of view. Thus, we recruited 22 migraine patients (17 (77%) female and 5 (23%) male) (mean age: 52 years (± 9.8 SD)), who started treatment with erenumab at the dose of 70 mg from May 2019 to December 2020. In 12 (55%), the dose was successively increased to 140 mg. Follow-up clinical evaluations were scheduled at 3 months and 1 year. At each visit, data about migraine evolution were collected, evaluating monthly number of migraine days, concomitant and acute medications, and Migraine Disability Assessment (MIDAS) questionnaire. Three-tesla MRI (Prisma, Siemens) was performed in 9 patients at the baseline and scheduled at 3-month and 1-year FU. For each patient and timepoint, MRI protocol included the following sequences: 3D FLAIR (TR: 5000 ms; TE 393 ms; voxel size 0.4 × 0.4 × 1 mm3), 3D-MPRAGE (TR: 2300 ms; TE: 3 ms; 1 mm isotropic voxels), T2 space (TR: 3200 ms; TE 564 ms; 1 mm isotropic voxels), PSIR (TR: 5000 ms; TE: 11 ms; voxe
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