Mohammad K Mojadidi1, Preetham Kumar2, Ahmed N Mahmoud3, Islam Y Elgendy4, Hilary Shapiro2, Brian West5, Andrew C Charles6, Heinrich P Mattle7, Sherman Sorensen8, Bernhard Meier9, Stephen D Silberstein10, Jonathan M Tobis2. 1. Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA. Electronic address: mkmojadidi@gmail.com. 2. Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA. 3. Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. 4. Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar. 5. Division of Cardiology, Sharp Rees-Stealy Medical Group, San Diego, California, USA. 6. Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. 7. Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland. 8. Sorensen Cardiovascular Group, Salt Lake City, Utah, USA. 9. Department of Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland. 10. Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND: Although observational studies have shown percutaneous patent foramen ovale (PFO) closure to be a safe means of reducing the frequency and duration of migraine, randomized clinical trials have not met their primary efficacy endpoints. OBJECTIVES: The authors report the results of a pooled analysis of individual participant data from the 2 randomized trials using the Amplatzer PFO Occluder to assess the efficacy and safety of percutaneous device closure as a therapy for episodic migraine with or without aura. METHODS: The authors analyzed individual patient-level data from 2 randomized migraine trials (the PRIMA [Percutaneous Closure of Patent Foramen Ovale in Migraine With Aura] and PREMIUM [Prospective Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects with Migraine and PFO Using the Amplatzer PFO Occluder Compared to Medical Management] studies). Efficacy endpoints were mean reduction in monthly migraine days, responder rate (defined as ≥50% reduction in monthly migraine attacks), mean reduction in monthly migraine attacks, and percentage of patients who experienced complete cessation of migraine. The safety endpoint was major procedure- and device-related adverse events. RESULTS: Among 337 subjects, 176 were randomized by blocks to device closure and 161 to medical treatment only. At 12-month follow-up, the analysis met 3 of the 4 efficacy endpoints: mean reduction of monthly migraine days (-3.1 days vs. -1.9 days; p = 0.02), mean reduction of monthly migraine attacks (-2.0 vs. -1.4; p = 0.01), and number of subjects who experienced complete cessation of migraine (14 [9%] vs. 1 [0.7%]; p < 0.001). For the safety analysis, 9 procedure-related and 4 device-related adverse events occurred in 245 subjects who eventually received devices. All events were transient and resolved. CONCLUSIONS: This pooled analysis of patient-level data demonstrates that PFO closure was safe and significantly reduced the mean number of monthly migraine days and monthly migraine attacks, and resulted in a greater number of subjects who experienced complete migraine cessation.
BACKGROUND: Although observational studies have shown percutaneous patent foramen ovale (PFO) closure to be a safe means of reducing the frequency and duration of migraine, randomized clinical trials have not met their primary efficacy endpoints. OBJECTIVES: The authors report the results of a pooled analysis of individual participant data from the 2 randomized trials using the Amplatzer PFO Occluder to assess the efficacy and safety of percutaneous device closure as a therapy for episodic migraine with or without aura. METHODS: The authors analyzed individual patient-level data from 2 randomized migraine trials (the PRIMA [Percutaneous Closure of Patent Foramen Ovale in Migraine With Aura] and PREMIUM [Prospective Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects with Migraine and PFO Using the Amplatzer PFO Occluder Compared to Medical Management] studies). Efficacy endpoints were mean reduction in monthly migraine days, responder rate (defined as ≥50% reduction in monthly migraine attacks), mean reduction in monthly migraine attacks, and percentage of patients who experienced complete cessation of migraine. The safety endpoint was major procedure- and device-related adverse events. RESULTS: Among 337 subjects, 176 were randomized by blocks to device closure and 161 to medical treatment only. At 12-month follow-up, the analysis met 3 of the 4 efficacy endpoints: mean reduction of monthly migraine days (-3.1 days vs. -1.9 days; p = 0.02), mean reduction of monthly migraine attacks (-2.0 vs. -1.4; p = 0.01), and number of subjects who experienced complete cessation of migraine (14 [9%] vs. 1 [0.7%]; p < 0.001). For the safety analysis, 9 procedure-related and 4 device-related adverse events occurred in 245 subjects who eventually received devices. All events were transient and resolved. CONCLUSIONS: This pooled analysis of patient-level data demonstrates that PFO closure was safe and significantly reduced the mean number of monthly migraine days and monthly migraine attacks, and resulted in a greater number of subjects who experienced complete migraine cessation.
Authors: Joshua Y P Yeo; Claire X Y Goh; Ying Kiat Tan; Bryan T S Sim; Beverly L X Chan; Nicholas L Syn; Yinghao Lim; Amanda C Y Chan; Vijay K Sharma; Jonathan J Y Ong; Leonard L L Yeo; Ching-Hui Sia; Benjamin Y Q Tan Journal: Front Neurol Date: 2022-08-18 Impact factor: 4.086