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. 2024 Jul;45(7):3305-3312.
doi: 10.1007/s10072-024-07380-4. Epub 2024 Feb 10.

Monoclonal antibodies targeting the calcitonin gene-related peptide pathway improve the effectiveness of acute medication-a real-world study

Chiara Rosignoli  1 , Valeria Caponnetto  2 , Agnese Onofri  1 , Vittorio Trozzi  1 , Lorenzo Tartaglione  3 , Marcello Silvestro  3 , Antonio Russo  3 , Simona Sacco  1 , Raffaele Ornello  4
Affiliations

Monoclonal antibodies targeting the calcitonin gene-related peptide pathway improve the effectiveness of acute medication-a real-world study

Chiara Rosignoli et al. Neurol Sci. 2024 Jul.

Abstract

Background: One of the aims of migraine prevention is to improve response to acute migraine treatments. The aim of the present study was to assess whether monoclonal antibodies targeting the CGRP pathway (CGRP-mAbs) can improve the perceived efficacy of acute treatments.

Methods: We included and followed up patients with chronic or episodic migraine from the Headache Centers of Avezzano-L'Aquila and Naples treated with CGRP-mAbs from March 2021 to December 2022. All patients filled out the Migraine Treatment Optimization Questionnaire (MTOQ), the Headache Impact Test (HIT-6), and the Migraine Impact and Disability Assessment Scale (MIDAS) at baseline and 3-6 months after the start of treatment with CGRP-mAbs.

Results: Sixty-five patients (81.3%) completed the 6-month follow-up. Most patients were female (55, 84.6%), with a median age of 46 years (IQR 39-56). Median MTOQ score increased from 8 (interquartile range [IQR] 4-13) at baseline to 15 (IQR 11-17) at 3 months (p < 0.001) and 16 (IQR 13-17) at the 6-month follow-up (p < 0.001). Median migraine days over 90-day periods decreased from 40 (IQR 24-60) to 24 (IQR 15-30) at 3 months (p < 0.001) and to 20 (IQR 12-24) at 6 months (p < 0.001). Median monthly intake of acute medication decreased from 55 doses (IQR 29-80.5) to 24 doses (IQR 15-40) at 3 months and 18 doses (IQR 11-30) at 6 months (p < 0.001).

Conclusions: We showed that 6 months of preventive treatment with CGRP-mAbs led to a significantly better effectiveness of acute treatments, paralleled by decreased monthly migraine days and acute treatment intake.

Keywords: Acute medication; Calcitonin gene-related peptide; Migraine; Migraine treatment.

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Conflict of interest statement

V.C. has received honoraria for participation in advisory boards sponsored by Novartis and speaker honoraria sponsored by Teva. M.S. has received speaker honoraria from Novartis, Teva, and Lilly. A.R. has received speaker honoraria from Allergan, Lilly, Novartis, Biogen, and Teva and serves as an associate editor of Frontiers in Neurology (Headache Medicine and Facial Pain session). S.S. reports personal fees as speaker or advisor by Abbott, Allergan-Abbvie, AstraZeneca, Boehringer, Eli Lilly, Lundbeck, Novartis, Novo Nordisk, Pfizer, Teva; research grants by Novartis, Uriach; president-elect European Stroke Organisation, second vice president of the European Headache Federation, specialty chief editor in Headache and Neurogenic Pain for Frontiers in Neurology, associate editor for the Journal of Headache and Pain, assistant editor for Stroke. RO reports personal fees from Novartis, Teva, Lilly, and Pfizer and non-financial support from AbbVie/Allergan, Lilly, Novartis, and Teva. The other authors have nothing to declare.

Figures

Fig. 1
Fig. 1
Flowchart of patients’ inclusion
Fig. 2
Fig. 2
Box plot of change in Migraine Treatment Optimization Questionnaire-19 in the 65 patients with a 6-month follow-up. All changes from baseline to 3 months and 6 months have a p < 0.001 (Wilcoxon test)
Fig. 3
Fig. 3
Box plots of monthly migraine days (A), medication intake (B), Migraine Impact and Disability Assessment Scale (C), and Headache Impact Test-6 scores (D) at baseline, 3 months, and 6 months. All comparisons have p < 0.001 compared with baseline
Fig. 4
Fig. 4
Correlations between changes in Migraine Treatment Optimization Questionnaire scores and changes in migraine days, acute medication intakes, Migraine Impact and Disability Assessment Scale, and Headache Impact Test-6 scores at 3 months and 6 months. HIT-6 Headache Impact Test-6, MIDAS Migraine Impact and Disability Assessment Scale
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