Trajectory of blood pressure after initiating anti-calcitonin gene-related peptide treatment of migraine: a target trial emulation from the veterans health administration

The Journal of Headache and Pain

Research

Melissa Skanderson¹  Sarah E. Anthony²  Jason J. Sico³  Brenda T. Fenton⁴  Kaicheng Wang⁵  Alexander B. Guirguis⁶  Vinh X. Dao⁷ 

[1] Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA;Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA;Department of Neurology, Yale School of Medicine, New Haven, CT, USA;Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA;Headache Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA;Department of Neurology, Yale School of Medicine, New Haven, CT, USA;Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA;Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA;Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA;Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA;Yale Center for Analytical Sciences, Yale School of Public Health, 300 George St STE 511, 06511, New Haven, CT, USA;Pharmacy Benefits Management Services, VA Connecticut Healthcare System, West Haven, CT, USA;Headache Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA;Pharmacy Benefits Management Services, VA Minneapolis Health Care System, Minneapolis, MN, USA;Headache Center of Excellence, VA Minneapolis Health Care System, Minneapolis, MN, USA;

关键词: Anti-CGRP;    Blood pressure;    Hypertension;    Migraine;   

DOI  :  10.1186/s10194-023-01640-y

 received in 2023-06-15, accepted in 2023-07-25,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCalcitonin gene-related peptide (CGRP) is involved in migraine pathophysiology and blood pressure regulation. Although clinical trials have established the cardio-cerebrovascular safety profile of anti-CGRP treatment, limited high-quality real-world evidence exists on its long-term effects on blood pressure (BP). To address this gap, we examined the safety of anti-CGRP treatment on BP in patients with migraine headache in the Veterans Health Administration (VHA).MethodsWe emulated a target trial of patients who initiated anti-CGRP treatment or topiramate for migraine prevention between May 17th, 2018 and February 28th, 2023. We calculated stabilized inverse probability weights to balance between groups and then used weighted linear mixed-effect models to estimate the systolic and diastolic BP changes over the study period. For patients without hypertension at baseline, we estimated the cumulative incidence of hypertension using Kaplan–Meier curve. We also used weight mixed-effect Poisson model to estimate the number of antihypertension medications for patients with hypertension at baseline.ResultsThis analysis included 69,589 patients and 554,437 blood pressure readings. of these, 18,880 patients received anti-CGRP treatment, and they were more likely to be women, have a chronic migraine diagnosis and higher healthcare utilization than those received topiramate. Among patients without hypertension at baseline, we found no significant differences in systolic BP changes over the four-year follow-up between anti-CGRP (slope [standard error, SE] = 0.48[0.06]) and topiramate treated patients (slope[SE] = 0.39[0.04]). The incidence of hypertension was similar for anti-CGRP and topiramate group (4.4 vs 4.3 per 100 person-years). Among patients with hypertension at baseline who initiated anti-CGRP treatment, we found a small but persistent effect on exacerbating hypertension during the first four years of treatment, as evidenced by a significant annual 3.7% increase in the number of antihypertensive medications prescribed (RR = 1.037, 95%CI 1.025–1.048).ConclusionsOur findings suggest that anti-CGRP treatment is safe regarding blood pressure in patients without hypertension. However, for those with baseline hypertension, anti-CGRP treatment resulted in a small but persistent increase in the number of antihypertensives, indicating an exacerbation of hypertension. Future studies are needed to evaluate the cardio-cerebrovascular safety of anti-CGRP treatment beyond the first four years.

【 授权许可】

CC BY   
© Springer-Verlag Italia S.r.l., part of Springer Nature 2023

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