Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients
Por:
Muñoz-Vendrell A, Campoy S, Caronna E, Alpuente A, Torres-Ferrus M, Nieves Castellanos C, Olivier M, Campdelacreu J, Prat J, Camiña Muñiz J, Molina Martínez FJ, Mínguez-Olaondo A, Ruibal Salgado M, Santos Lasaosa S, Navarro Pérez MP, Morollón N, López Bravo A, Cano Sánchez LM, García-Sánchez SM, García-Ull J, Rubio-Flores L, Gonzalez-Martinez A, Quintas S, Echavarría Íñiguez A, Gil Luque S, Castro-Sánchez MV, Adell Ortega V, García Alhama J, Berrocal N, Belvís R, Díaz-Insa S, Pozo-Rosich P and Huerta-Villanueva M
Publicada:
2 jun 2023
Ahead of Print:
2 jun 2023
Resumen:
Background Anti-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.
Methods In 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.
Results A 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 10.17.3 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%).
Conclusions Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice.
Filiaciones:
Muñoz-Vendrell A:
Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain.
Campoy S:
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
Caronna E:
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
Alpuente A:
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
Torres-Ferrus M:
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
Nieves Castellanos C:
Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari I Politécnic La Fe, Valencia, Spain
Olivier M:
Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari I Politécnic La Fe, Valencia, Spain
Campdelacreu J:
Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
Prat J:
Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain
Camiña Muñiz J:
Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari Son Espases, Palma, Spain
Consulta Monográfica de Cefaleas. Clínica Rotger Quirónsalud, Palma, Spain
Molina Martínez FJ:
Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari Son Espases, Palma, Spain
Mínguez-Olaondo A:
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
Ruibal Salgado M:
Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain
Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain
Santos Lasaosa S:
Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain
Navarro Pérez MP:
Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain
Morollón N:
Unidad de Cefaleas Y Neuralgias. Servicio de Neurología. Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
López Bravo A:
Unidad de Cefaleas. Sección de Neurología, Hospital Reina Sofía. Instituto de Investigación Sanitaria de Aragón (IIS-A), Tudela, Spain
Cano Sánchez LM:
Servicio de Neurología. Hospital Sant Joan Despí. Consorci Sanitari Integral, Sant Joan Despí, Spain
García-Sánchez SM:
Servicio de Neurología. Hospital Sant Joan Despí. Consorci Sanitari Integral, Sant Joan Despí, Spain
García-Ull J:
Unidad de Cefaleas. Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
Rubio-Flores L:
Servicio de Neurología. Hospital Universitario General de Villalba, Madrid, Spain
Gonzalez-Martinez A:
Headache Unit, Neurology Department, Hospital Universitario de La Princesa E Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
Quintas S:
Headache Unit, Neurology Department, Hospital Universitario de La Princesa E Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
Echavarría Íñiguez A:
Unidad de Cefaleas, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Gil Luque S:
Servicio de Neurología. Hospital Universitario de Burgos, Burgos, Spain
Castro-Sánchez MV:
Servicio de Neurología. Hospital Carlos Haya de Málaga, Málaga, Spain
Adell Ortega V:
Servei de Neurologia. Consorci Sanitari de L'Alt Penedès-Garraf, Barcelona, Spain
García Alhama J:
Servei de Neurologia. Consorci Sanitari de L'Alt Penedès-Garraf, Barcelona, Spain
Berrocal N:
Parc Sanitari Sant Joan de Déu. Servicio de Neurología. Sant Boi de Llobregat, Barcelona, Spain
Belvís R:
Unidad de Cefaleas Y Neuralgias. Servicio de Neurología. Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
Díaz-Insa S:
Unidad de Cefaleas. Servicio de Neurología, Hospital Universitari I Politécnic La Fe, Valencia, Spain
Pozo-Rosich P:
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
Huerta-Villanueva M:
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
Green Published, gold
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