Factors associated with favorable outcome in botulinum toxin A treatment for chronic migraine: A clinic-based prospective study

Lee, Mi Ji; Lee, Chungbin; Choi, Hanna; Chung, Chin‐Sang

doi:10.1016/j.jns.2016.01.054

Cited by 34 publications

(37 citation statements)

References 29 publications

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“…At month 12 of treatment, a clinically significant excellent response was associated with earlier onset age of migraine, less years of evolution of migraine, presence of anxiety, and MWA. Our results are in line with those that found that the presence of symptoms such as allodynia or aura which are correlated with central mechanisms, a shorter disease duration and being younger subjects are factors of excellent response to preventive treatment with OnabotulinumtoxinA.…”

Section: Discussionsupporting

confidence: 93%

“…In regards to our cohort, the characteristics of our population, migraine, and type of intervention are comparable to other real‐life studies assessing predictors of response performed in tertiary headache centers, this is the patients which are eligible for treatment with OnabotulinumtoxinA. So, the results that we have seen might be generalizable in other cohorts.…”

Section: Discussionsupporting

confidence: 68%

“…The time of the evolution of migraine has been elucidated as one of the most important factors for a better treatment outcome. 21,32 Our results also highlight the importance of starting treatment with OnabotulinumtoxinA earlier in the course of the disease in young patients even when the diagnosis is high-frequency EM 25 since this population is equally disabled. 33 However, this is not always easy due to the delay in diagnosis or in reaching specialized headache units.…”

Section: Discussionmentioning

confidence: 57%

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Short and Mid‐Term Predictors of Response to OnabotulinumtoxinA: Real‐Life Experience Observational Study

et al. 2020

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Objective To identify clinical predictors of excellent response to OnabotulinumtoxinA in patients with chronic migraine (CM) at 6 and 12 months of follow‐up. Background Clinical predictors of response to OnabotulinumtoxinA are scarce and have not been clearly reproduced and analyzed in detail. So far, predictors of response to OnabotulinumtoxinA assess response in general or good response, but not an excellent response. Methods Cohort study of patients attended in a specialized Headache Clinic in treatment with OnabotulinumtoxinA were classified according to their improvement in frequency: no‐response (<25%) and excellent response (≥75%). A comparative analysis was carried out at 6 and 12 months identifying clinical predictors of excellent response to OnabotulinumtoxinA at each timepoint. Results Data were collected from 221 patients. After 6 and also 12 months, we observed a statistically significant mean reduction in frequency and analgesic intake. At month 6, independent variables associated with excellent response (OR[95%CI]) were daily headache frequency (0.32[0.14‐0.74]; P = .005), medication overuse (MO) (2.28[1.19‐4.37]; P = .013), and a higher ratio of migraine days/month (MDM) (1.20[1.10‐1.45]; P = .018) at baseline. At month 12, independent predictors of excellent response were patients with less than 30 years of migraine evolution (0.43[0.23‐0.82]; P = .011), presence of anxiety (0.44[0.23‐0.85]; P = .018), and aura (0.48[0.25‐0.92]; P = .037). Excellent responders showed a higher improvement rate in pain intensity at 6 and 12 months. Conclusions Patients with daily frequency and MO show a clinical improvement in short‐term. Patients with comorbidities who start treatment earlier in the course of the disease need a longer duration of treatment. The profile of response to treatment with OnabotulinumtoxinA determines its minimum treatment duration and the timepoint of a meaningful response.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 57%

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Short and Mid‐Term Predictors of Response to OnabotulinumtoxinA: Real‐Life Experience Observational Study

et al. 2020

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“…Onabotulinumtoxin A (BT-A) is a safe and effective preventive treatment for CM, as shown in the Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials [8][9][10][11][12]. Several real-life studies confirmed its safety and efficacy in clinical practice [13][14][15][16][17][18][19][20][21][22] and showed that a shorter disease duration, some characteristics of headache (ocular, imploding), allodynia, and the absence of medication overuse and depressive symptoms are predictors of clinical response [23][24][25][26][27][28][29][30][31][32][33]. However, it is common experience to observe fluctuations in the clinical response to BT-A as to other preventive treatments.…”

Section: Introductionmentioning

confidence: 97%

Sustained response to onabotulinumtoxin A in patients with chronic migraine: real-life data

et al. 2020

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Background: Treatment with onabotulinumtoxin A (BT-A) is safe and effective for chronic migraine (CM). Several studies assessed possible predictors of response to treatment with BT-A, but there is little knowledge on the frequency and predictors of sustained response. The aim of this study was to evaluate sustained response to BT-A in patients with CM. Main body: In this prospective open-label study, 115 patients with CM and treated with BT-A were consecutively enrolled in two Italian headache centers and followed up for 15 months. Anytime responders were defined as those patients who achieved a ≥ 50% reduction in headache days during any three-month treatment cycle compared with the 3 months prior to initiation of BT-A treatment. Sustained responders were defined as those who achieved a ≥ 50% reduction in headache days within the third treatment cycle and maintained response until the end of follow-up. Non-responders were defined as those patients who never achieved a ≥ 50% reduction in headache days during the follow-up. Headache characteristics prior to BT-A treatment were assessed in order to evaluate their ability in predicting treatment response. The 115 enrolled patients (84.3% female; median age 50 years) had a median migraine duration of 30 years (interquartile range 22-38). At the end of follow-up, 66 patients (57.4%) were classified as anytime responders. Among the 51 patients who achieved a clinical response within the third month of treatment, 33 (64.7%) were sustained responders. Patients with sustained response had a lower CM duration (median 31 vs 65 months; P = 0.030) and a lower number of headache days (median 25 vs 30; P = 0.013) at baseline compared with nonresponders. Conclusions: About two thirds of patients who gain ≥50% response to BT-A within the third cycle of treatment maintain this positive response over time. More recent onset of CM and more headache-free days at baseline are associated with sustained response. We suggest not to delay preventive treatment of CM with BT-A, in order to increase the likelihood to achieve sustained clinical response.

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“…Beta-blockers (metoprolol, propranolol), calcium channel blockers (flunarizine), antiepileptic drugs (valproic acid, topiramate) or antidepressants (amitriptyline, venlafaxine) are recommended for migraine prevention [19]. Lately Botulinum toxin A (BoNTA) has proven to be effective and it improves the quality of life in chronic migraine treatment [28][29][30][31]. An important disadvantage of BoNTA is its route of administration: intramuscular injection in the muscles of the face and neck [28,30].…”

Section: Migrainementioning

confidence: 99%

Migraine, Neurogenic Inflammation, Drug Development - Pharmacochemical Aspects

Lukács

Tajti

Fülöp

et al. 2017

CMC

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Abstract:Background: Migraine is a primary headache disorder. Despite numerous studies conducted with the aim to understand the pathophysiology of migraine, several aspects are still unclear. The trigeminovascular system plays a key role. Neurogenic inflammation is presumed to be an important factor in migraine pathophysiology, mediated by the activation of primary neurons, leading to the release of various pro-inflammatory neuropeptides and neurotransmitters such as Calcitonin Gene-Related Peptide (CGRP), substance P (SP), and vasoactive intestinal peptide (VIP). Nitric oxide (NO), Pituitary adenylate cyclase-activating polypeptide (PACAP) and Glutamate (Glu) also play an important role in the modulation of inflammatory mechanisms. Objective: To review the literature focusing on novel therapeutic targets in migraine, related to neurogenic inflammation. Method: A systematic literature search in the database of PUBMED was conducted regarding therapeutic strategies in migraine, focusing on substances and cytokines released during neurogenic inflammation, published in January 2017. Results: Ongoing phase III clinical studies with monoclonal antibodies against CGRP and CGRP receptors offer promising novel aspects for migraine treatment. Preclinical and clinical studies targeting SP and nitric oxide synthase (NOS) were all terminated with no significant result compared to placebo. New promising therapeutic goal could be PACAP and its receptor (PAC 1 ), and kynurenic acid (KYNA) analogues. Conclusion: Current migraine treatment offers pain relief only for a small proportion of migraine patients and might not be adequate for patients with cardiovascular comorbidity due to side effects. Better understanding of migraine pathophysiology might, therefore, lead to novel therapeutic lines both in migraine attack treatment and prophylaxis.

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Factors associated with favorable outcome in botulinum toxin A treatment for chronic migraine: A clinic-based prospective study

Cited by 34 publications

References 29 publications

Short and Mid‐Term Predictors of Response to OnabotulinumtoxinA: Real‐Life Experience Observational Study

Short and Mid‐Term Predictors of Response to OnabotulinumtoxinA: Real‐Life Experience Observational Study

Sustained response to onabotulinumtoxin A in patients with chronic migraine: real-life data

Migraine, Neurogenic Inflammation, Drug Development - Pharmacochemical Aspects

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