Advances in pharmacotherapy for the prophylactic treatment of resistant and refractory migraine

Fitzek, Mira Pauline; Raffaelli, Bianca; Reuter, Uwe

doi:10.1080/14656566.2022.2088281

Cited by 3 publications

(3 citation statements)

References 89 publications

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“…Chronic migraine is associated with impaired quality of life, severe disability, and a considerable socio-economic burden ( 2 , 3 ). Preventive treatment of chronic migraine is a challenging task and includes specific anticonvulsants, antihypertensives, and antidepressants ( 2 , 4 ). Fremanezumab, a monoclonal antibody (mAb) against the calcitonin gene-related peptide (CGRP) ligand, is one of the four approved anti-CGRP mAb, that has been approved for prevention of chronic migraine ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Real-world efficacy and tolerability of fremanezumab in adults with chronic migraine: a 3-month, single-center, prospective, observational study

et al. 2023

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BackgroundFollowing the promising pre-marketing placebo-controlled randomized clinical trials of fremanezumab, post-marketing studies are necessary to verify efficacy and tolerability in various real-world settings. The present study assessed real-world efficacy and safety of fremanezumab.MethodsA 3-month, single-center, prospective, observation study of adults with chronic migraine who were treated with monthly subcutaneous injections of 225 mg fremanezumab in Denmark. The primary outcome was defined as proportion of patients who achieved ≥30% reduction in monthly migraine days (MMDs) from baseline to weeks 9–12. Among secondary outcomes were ≥50 and ≥75% responder rates and the proportion of patients reporting adverse events.ResultsA total of 91 patients with chronic migraine were enrolled and received at least one dose of fremanezumab of whom 89 patients (98%) completed the 3-months treatment period. At baseline, the mean (SD) number of monthly headache days was 24.3 ± 5.8 and mean number of MMDs was 18.5 ± 7.4. The number of patients who achieved ≥30% reduction in MMDs from baseline to weeks 9–12 was 58 (65%), while 45 (51%) and 21 (24%) had ≥50 and 75% reduction in MMD, respectively. Twenty-one patients (23%) reported adverse event, in which the most common were constipation (4.4%), fatigue (4.4%) and dizziness (3.3%). No serious adverse events were reported.ConclusionIn adult chronic migraine patients with previous failure of conventional oral migraine preventives, fremanezumab was found to be effective and well-tolerated.

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Section: Introductionmentioning

confidence: 99%

Real-world efficacy and tolerability of fremanezumab in adults with chronic migraine: a 3-month, single-center, prospective, observational study

et al. 2023

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“…The term refers to the subgroup of episodic or chronic migraine patients whose symptoms do not respond to established preventive treatments. These patients experience poor quality of life, they often struggle to keep full-time employments and need frequent access to healthcare systems for symptoms management [1,2]. The main variable used to define this patients' subgroup is the number of treatments failed with thresholds that vary between 2-4 classes of treatments [1].…”

Section: Introductionmentioning

confidence: 99%

“…These patients experience poor quality of life, they often struggle to keep full-time employments and need frequent access to healthcare systems for symptoms management [1,2]. The main variable used to define this patients' subgroup is the number of treatments failed with thresholds that vary between 2-4 classes of treatments [1]. A recent expert consensus on this topic suggested the use of the term "resistant" for patients who failed at least three classes of migraine preventatives and suffer from at least eight debilitating headache days per month for at least three consecutive months without improvement and the term "refractory" those who failed all of the available preventatives and suffer from at least eight debilitating headache days per month for at least six consecutive months [3].…”

Section: Introductionmentioning

confidence: 99%

Two-year effectiveness of erenumab in resistant chronic migraine: a prospective real-world analysis

et al. 2022

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Background Controlled and real-world evidence have demonstrated the efficacy of calcitonin gene related peptide (CGRP) monoclonal antibodies (MABs) in migraine. However, data on the over-one-year sustained effectiveness of CGRP MABs in resistant chronic migraine (CM) is sparse. Methods This is a two-year real-world prospective analysis of an ongoing single centre audit conducted in patients with resistant CM. Patients received monthly erenumab for six months before assessing its effectiveness. Responders were considered those who achieved at least 30% reduction in monthly migraine days (MMD) by month 6, compared to baseline. Secondary outcomes were also analysed, including changes of the Headache Impact Test version 6 (HIT-6). Results One hundred sixty-four patients [135 (82.3%) females; mean age 46 SD 14) years] were included in the audit and 160 patients analysed. Patients had failed a mean of 8.4 preventive treatments at baseline. At month 6, 76 patients (48%) were 30% responders to erenumab, 50 patients (31%) were 50% responders and 25 (15%) were 75% responders. The mean reduction in MMD at month 6 was 7.5 days compared to baseline (P < 0.001). At month 12 and month 18, 61 patients (38%) and 52 patients (33%) remained 30% responders respectively. At month 24, 36 patients (23%) remained 30% responders, 25 patients (16%) and 13 patients (8%) were respectively 50% and 75% responders. Compared to 95% of patients at baseline, at months 6, 12 and 24, 46%, 29% and 16% of responders respectively had severe disability. At least one adverse event at month 6, 12, 18 and 24 was reported by 49%, 19%, 11% and 3% of patients. By month 6, 13% of patients discontinued the treatment because of side effects, often constipation. Conclusions Long-term sustained effectiveness of erenumab was reported only by a minority of resistant CM patients. Although more research in resistant migraine is needed, Erenumab can provide long-term meaningful reduction in migraine load and migraine-related disability in some patients.

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Ibero-American consensus statement on migraine treatment

Láinez,

Pradilla,

Irimia

et al. 2025

Neurology Perspectives

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Advances in pharmacotherapy for the prophylactic treatment of resistant and refractory migraine

Cited by 3 publications

References 89 publications

Real-world efficacy and tolerability of fremanezumab in adults with chronic migraine: a 3-month, single-center, prospective, observational study

Real-world efficacy and tolerability of fremanezumab in adults with chronic migraine: a 3-month, single-center, prospective, observational study

Two-year effectiveness of erenumab in resistant chronic migraine: a prospective real-world analysis

Ibero-American consensus statement on migraine treatment

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