Candesartan in migraine prevention: results from a retrospective real-world study
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Candesartan in migraine prevention: results from a retrospective real‑world study Roberta Messina1,2,5 · Carlo P. Lastarria Perez5,6 · Massimo Filippi1,2,3,4 · Peter J. Goadsby5 Received: 7 May 2020 / Revised: 7 June 2020 / Accepted: 10 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Randomized studies have reported a positive effect of candesartan, an angiotensin II receptor antagonist, in migraine prevention. The aim of our study was to explore patient subjective efficacy of candesartan in a real-world sample of migraine patients and try to identify predictors of candesartan response. We audited the clinical records of 253 patients who attended the King’s College Hospital, London, from February 2015 to December 2017, looking specifically at their response to candesartan. Univariate and multivariate logistic regression models were used to identify predictors of headache benefit. Odds ratios (OR) with confidence intervals (CI) 95% were calculated. Eighty-one patients (chronic migraine, n = 68) were included in the final analysis. Thirty-eight patients reported a positive response to candesartan, while 43 patients did not have a meaningful therapeutic effect. The median dose of candesartan was 8 mg and the median treatment period was 6 months. In a univariate logistic regression model, the presence of daily headache was associated with reduced odds of headache benefit (OR 0.39, 95% CI 0.16–0.96, p = 0.04). In multivariate logistic regression model, younger age (OR 0.92, 95% CI 0.87–0.98, p = 0.006) and longer disease duration (OR 1.06, 95% CI 1.01–1.12, p = 0.03) were associated with a good response to candesartan, while the presence of daily headache was associated with reduced odds of headache benefit (OR 0.16, 95% CI 0.04–0.71, p = 0.01). Having failed up to nine preventives in patients did not predict a treatment failure with candesartan as well. Candesartan yields clinical benefits in difficult-to-treat migraine patients, irrespective of previous failed preventives. Keywords Migraine · Candesartan · Prevention · Treatment response · Challenging migraine patients
Introduction A range of therapies are currently available for migraine prevention, with most, excepting calcitonin gene-related peptide (CGRP) pathway monoclonal antibodies, having
* Roberta Messina [email protected] 1
Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
2
Neurology Unit, Milan, Italy
3
Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
4
Vita-Salute San Raffaele University, Milan, Italy
5
NIHR‑Wellcome Trust King’s Clinical Research Facility, King’s College London, London, UK
6
Department of Neurology, AUNA, Clinica Valle Sur, Arequipa, Peru
ill-defined mechanisms [1, 2]. Predictors of response to a particular treatment have not been identified for any preventive or sub-type of migraine. Candesartan, an angiot
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