Exploring new strategy in erenumab therapy for migraine patients
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BRIEF COMMUNICATION
Exploring new strategy in erenumab therapy for migraine patients Fabio Frediani 1 & Giacomo D’Arrigo 1 & Alberto Galli 1 & Riccardo Altavilla 1 & Paola Di Fiore 1
# Fondazione Società Italiana di Neurologia 2020
Migraine prevention therapy has always been a real complex challenge, due to the lack of specific and targeted drugs. With the previous old therapies, like calcium-antagonists, betablockers, or antiepileptics, many migraine patients experienced side effects, leading in most cases to discontinuation of therapy because of their lack of specificity. The new therapies with human monoclonal antibodies blocking CGRP activity disclose a new era for treatment because of three fundamental aspects: efficacy, tolerability, and compliance of the patients. Erenumab is one of these new drugs and it is the only one acting selectively and potently binding the CGRP receptor. Its effectiveness is well documented in migraine therapy [1]. However, we have to face some significant questions [2]: how long should the treatment be continued? What is the best treatment scheme for the patient? How should therapy be stopped? For erenumab we know from RCTs that the therapy is effective when it is continued for 3 or 6 months, but we do not know what happens when it is suspended. Trying to answer these questions, at our center we decided to adopt a single scheme for all patients who started this therapy. Each patient was treated with a cycle of 6 injections of erenumab 70 mg; after the first 12 weeks (T12), a clinical evaluation was made regarding whether to continue with 70 or increase to 140 mg. At 24 weeks the data of migraine days and painkillers consumption in the last 4 weeks were compared with those of the baseline. After the 6th administration (T20), the patient did not take other doses for the next 12 weeks. We treated 43 patients (mean age 49 years, range 21–73, SD ± 11.4; 86% female); 1 dropped out for side effect and 3 for ineffectiveness. For the remaining 39 patients, the trend was analyzed at 4 (T24), 8 (T28), and 12 (T32) weeks after the last administration.
* Fabio Frediani [email protected] 1
Headache Center, Neurology & Stroke Unit, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
Considering migraine days (Fig. 1), a mean reduction of 52.8% (SD ± 23.4%) was observed at the end of the cycle (T24), reduced to 47.9% (SD ± 26.0%, p = 0.2112, n.s.) after 8 weeks (T28), and to 36.4% (SD ± 23.2%, p = 0.0018) at 12 weeks after the last administration (T32), with a significant difference versus the decrease at T24 (Wilcoxon two-tail test). By dividing migraine patients in chronic (n 23) and episodic (n 16), a longer therapeutic effect was observed in episodic migraine patients. In these, the percentage of reduction was 49.5% (SD ± 24.7%) at T24, 46.4% (SD ± 31.2%, p = 0.8494, n.s.) at T28, and 28.3% (SD ± 25.8%, p = 0.05, n.s.) at T32; in the chronic cases the reduction was respectively 54.8% (SD ± 23.5%), 48.6% (SD ± 23.3%, p = 0.1646, n.s.), and 40.0% (SD ± 2
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