Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients

The Journal of Headache and Pain

Research

Marta Torres-Ferrus¹  Patricia Pozo-Rosich¹  Edoardo Caronna¹  Alicia Alpuente¹  Sonia Quintas²  Alicia Gonzalez-Martinez²  Ane Mínguez-Olaondo³  Marta Ruibal Salgado⁴  Jaume Campdelacreu⁵  Albert Muñoz-Vendrell⁵  Joan Prat⁵  Mariano Huerta-Villanueva⁶  Sergio Campoy⁶  Nuria Berrocal-Izquierdo⁷  Jessica García Alhama⁸  Vanesa Adell Ortega⁸  María Victoria Castro-Sánchez⁹  Sonia María García-Sánchez^1,10  Luis Miguel Cano Sánchez^1,10  Laura Rubio-Flores^1,11  Sendoa Gil Luque^1,12  Robert Belvís^1,13  Noemí Morollón^1,13  Ana Echavarría Íñiguez^1,14  Alba López Bravo^1,15  María Pilar Navarro Pérez^1,16  Sonia Santos Lasaosa^1,16  Jésica García-Ull^1,17  Candela Nieves Castellanos^1,18  Marina Olivier^1,18  Samuel Díaz-Insa^1,18  Francisco José Molina Martínez^1,19  Javier Camiña Muñiz^2,20 

[1] Headache Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain;Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain;Headache Unit, Neurology Department, Hospital Universitario de La Princesa E Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain;Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain;ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain;Department of Medicine, Faculty of Health Sciences, University of Deusto, Bilbao, Spain;Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain;Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain;Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain;Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain;Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain;Neurology Department, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain;Parc Sanitari Sant Joan de Déu. Servicio de Neurología. Sant Boi de Llobregat, Barcelona, Spain;Servei de Neurologia. Consorci Sanitari de L’Alt Penedès-Garraf, Barcelona, Spain;Servicio de Neurología. Hospital Carlos Haya de Málaga, Málaga, Spain;Servicio de Neurología. Hospital Sant Joan Despí. Consorci Sanitari Integral, Sant Joan Despí, Spain;Servicio de Neurología. Hospital Universitario General de Villalba, Madrid, Spain;Servicio de Neurología. Hospital Universitario de Burgos, Burgos, Spain;Unidad de Cefaleas Y Neuralgias. Servicio de Neurología. Hospital de La Santa Creu I Sant Pau, Barcelona, Spain;Unidad de Cefaleas, Hospital Clínico Universitario de Valladolid, Valladolid, Spain;Unidad de Cefaleas. Sección de Neurología, Hospital Reina Sofía. Instituto de Investigación Sanitaria de Aragón (IIS-A), Tudela, Spain;Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain;Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain;Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari I Politécnic La Fe, Valencia, Spain;Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari Son Espases, Palma, Spain;Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari Son Espases, Palma, Spain;Consulta Monográfica de Cefaleas. Clínica Rotger Quirónsalud, Palma, Spain;

关键词: Calcitonin gene-related peptide;    Monoclonal antibodies;    Migraine;    65 years old;    Real-world;   

DOI  :  10.1186/s10194-023-01585-2

 received in 2023-02-09, accepted in 2023-04-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAnti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life.MethodsIn this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies.ResultsA total of 162 patients were included, median age 68 years (range 65–87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%).ConclusionsAnti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice.Graphical Abstract

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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