J Talbot1, R Stuckey2, L Crawford2, S Weatherby2, S Mullin3,4. 1. Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK. Jamie.talbot1@nhs.net. 2. Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK. 3. Peninsula Medical School, University of Plymouth, Plymouth, UK. 4. UCL Queen Square Institute of Neurology, University College London, London, UK.
Abstract
BACKGROUND: The CGRP antagonists offer a novel therapeutic approach in migraine. Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA. METHODS: We offered erenumab to 98 patients with a prior unsatisfactory response to onabotulinumtoxinA. Eighty of 98 had trialled greater occipital nerve injections (82%), 32/98 peripheral neurostimulation (33%) and 18/98 intravenous dihydroergotamine (18%). Thirty eight of 98 (39%) met the definition of triptan overuse and 43/98 (44%) analgesic overuse. All patients met the EHF criteria for 'resistant migraine'. Outcome measures (recorded monthly) included days with headache limiting activities of daily living ("red"), not limiting ("amber"), headache free ("green"), and requiring triptans or other analgesics. Quality of life scores - headache impact test 6 (HIT-6), patient health questionnaire 9 (PHQ-9) and pain disability index (PDI) - were also measured. RESULTS: Mean number of red days improved by - 6.4 days (SE 0.67, 95%CI - 7.7 to - 5.1, p=0.001) at 3 months; - 6.8 days (SE 0.96, 95%CI - 8.80 to - 4.9, p=0.001) at 6 months and - 6.5 days (SE 0.86, 95%CI - 8.3 to - 4.8, p=0.001) at 9 months. Repeated measures ANOVA confirmed improvements in the number of red (p=0.001), green (p=0.001), triptan (p=0.001) and painkiller days (p=0.001) as well as scores of the HIT-6 (p=0.001), PHQ-9 (p=0.001), and PDI (p=0.001) across the duration of study. CONCLUSION: We observed improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment.
BACKGROUND: The CGRP antagonists offer a novel therapeutic approach in migraine. Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA. METHODS: We offered erenumab to 98 patients with a prior unsatisfactory response to onabotulinumtoxinA. Eighty of 98 had trialled greater occipital nerve injections (82%), 32/98 peripheral neurostimulation (33%) and 18/98 intravenous dihydroergotamine (18%). Thirty eight of 98 (39%) met the definition of triptan overuse and 43/98 (44%) analgesic overuse. All patients met the EHF criteria for 'resistant migraine'. Outcome measures (recorded monthly) included days with headache limiting activities of daily living ("red"), not limiting ("amber"), headache free ("green"), and requiring triptans or other analgesics. Quality of life scores - headache impact test 6 (HIT-6), patient health questionnaire 9 (PHQ-9) and pain disability index (PDI) - were also measured. RESULTS: Mean number of red days improved by - 6.4 days (SE 0.67, 95%CI - 7.7 to - 5.1, p=0.001) at 3 months; - 6.8 days (SE 0.96, 95%CI - 8.80 to - 4.9, p=0.001) at 6 months and - 6.5 days (SE 0.86, 95%CI - 8.3 to - 4.8, p=0.001) at 9 months. Repeated measures ANOVA confirmed improvements in the number of red (p=0.001), green (p=0.001), triptan (p=0.001) and painkiller days (p=0.001) as well as scores of the HIT-6 (p=0.001), PHQ-9 (p=0.001), and PDI (p=0.001) across the duration of study. CONCLUSION: We observed improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migrainepatients following erenumab treatment.
Authors: Stephen D Silberstein; David W Dodick; Marcelo E Bigal; Paul P Yeung; Peter J Goadsby; Tricia Blankenbiller; Melissa Grozinski-Wolff; Ronghua Yang; Yuju Ma; Ernesto Aycardi Journal: N Engl J Med Date: 2017-11-30 Impact factor: 91.245
Authors: Marcelo E Bigal; Lars Edvinsson; Alan M Rapoport; Richard B Lipton; Egilius L H Spierings; Hans-Christoph Diener; Rami Burstein; Pippa S Loupe; Yuju Ma; Ronghua Yang; Stephen D Silberstein Journal: Lancet Neurol Date: 2015-09-30 Impact factor: 44.182
Authors: Virginia L Stauffer; David W Dodick; Qi Zhang; Jeffrey N Carter; Jessica Ailani; Robert R Conley Journal: JAMA Neurol Date: 2018-09-01 Impact factor: 18.302
Authors: David W Dodick; Stephen D Silberstein; Marcelo E Bigal; Paul P Yeung; Peter J Goadsby; Tricia Blankenbiller; Melissa Grozinski-Wolff; Ronghua Yang; Yuju Ma; Ernesto Aycardi Journal: JAMA Date: 2018-05-15 Impact factor: 56.272
Authors: Stewart Tepper; Messoud Ashina; Uwe Reuter; Jan L Brandes; David Doležil; Stephen Silberstein; Paul Winner; Dean Leonardi; Daniel Mikol; Robert Lenz Journal: Lancet Neurol Date: 2017-04-28 Impact factor: 44.182
Authors: David W Dodick; Messoud Ashina; Jan Lewis Brandes; David Kudrow; Michel Lanteri-Minet; Vera Osipova; Kerry Palmer; Hernan Picard; Daniel D Mikol; Robert A Lenz Journal: Cephalalgia Date: 2018-02-22 Impact factor: 6.292
Authors: Messoud Ashina; David Dodick; Peter J Goadsby; Uwe Reuter; Stephen Silberstein; Feng Zhang; Julia R Gage; Sunfa Cheng; Daniel D Mikol; Robert A Lenz Journal: Neurology Date: 2017-08-23 Impact factor: 9.910
Authors: Marcelo E Bigal; David W Dodick; Abouch V Krymchantowski; Juliana H VanderPluym; Stewart J Tepper; Ernesto Aycardi; Pippa S Loupe; Yuju Ma; Peter J Goadsby Journal: Neurology Date: 2016-06-08 Impact factor: 9.910
Authors: Holland C Detke; Peter J Goadsby; Shufang Wang; Deborah I Friedman; Katherine J Selzler; Sheena K Aurora Journal: Neurology Date: 2018-11-16 Impact factor: 9.910
Authors: Bianca Raffaelli; Rea Kalantzis; Jasper Mecklenburg; Lucas Hendrik Overeem; Lars Neeb; Astrid Gendolla; Uwe Reuter Journal: Front Neurol Date: 2020-05-28 Impact factor: 4.003
Authors: Robert Belvís; Pablo Irimia; Patricia Pozo-Rosich; Carmen González-Oria; Antonio Cano; Javier Viguera; Belén Sánchez; Francisco Molina; Isabel Beltrán; Agustín Oterino; Elisa Cuadrado; Angel Gómez-Camello; Miguel Alberte-Woodward; Carmen Jurado; Teresa Oms; David Ezpeleta; Javier Díaz de Terán; Noemí Morollón; Germán Latorre; Marta Torres-Ferrús; Alicia Alpuente; Raquel Lamas; Carlos Toledano; Rogelio Leira; Sonia Santos; Margarita Sánchez Del Río Journal: J Headache Pain Date: 2021-07-17 Impact factor: 7.277