OnabotulinumtoxinA wear-off in chronic migraine, observational cohort study

Zidan, Awss; Roe, Cheryl; Burke, D. C.; Mejico, Luis J.

doi:10.1016/j.jocn.2019.07.043

Cited by 15 publications

(9 citation statements)

References 9 publications

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“…Response to OnaB-A is not uniform between 12-week injections but rather has a 'U' shape response with clear induction, peak-effect, and 'wear-off' phases [70]. Wear-off of OnaB-A is a common clinical phenomenon, presenting a challenge in management.…”

Section: Wearing Off Effect Of Botulinum Toxinmentioning

confidence: 99%

OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy

Ray

Hutton

Matharu

2021

JCM

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The efficacy of onabotulinumtoxinA (OnaB-A) as a preventative treatment for chronic migraine, emerging fortuitously from clinical observation is now supported by class one evidence and over two decades of real-world clinical data. There is still limited ability to predict a clinically meaningful response to OnaB-A for individual patients, however. This review summarises briefly the proposed mechanism of OnaB-A in chronic migraine, the literature of predictors of clinical response, and recent developments in the field.

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Section: Wearing Off Effect Of Botulinum Toxinmentioning

confidence: 99%

OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy

Ray

Hutton

Matharu

2021

JCM

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“…However, at its approved intramuscular dosing regimen of 12‐week intervals, 25 there is evidence that some patients experience a wearing‐off effect. Across several studies, 23%‐63% of patients reported a wearing‐off of efficacy as early as 4 weeks prior to next treatment 26‐28 . Therefore, wearing‐off has become a concern for patients and practitioners for the quarterly dosing of monoclonal antibodies targeting the CGRP pathway.…”

Section: Discussionmentioning

confidence: 99%

“…Across several studies, 23%-63% of patients reported a wearing-off of efficacy as early as 4 weeks prior to next treatment. [26][27][28] Therefore, wearing-off has become a concern for patients and practitioners for the quarterly dosing of monoclonal antibodies targeting the CGRP pathway. It has been suggested that 12 weeks represents a mean duration of response to onabotulinumtoxinA, with some patients expected to have a shorter duration of response.…”

Section: Monthly Fremanezumabmentioning

confidence: 99%

No “Wearing‐Off Effect” Seen in Quarterly or Monthly Dosing of Fremanezumab: Subanalysis of a Randomized Long‐Term Study

et al. 2020

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Objective.-To evaluate whether quarterly or monthly administration of fremanezumab for migraine prevention exhibits a pattern of decreased efficacy toward the end of the dosing interval (wearing-off effect). Background.-The main goals of migraine preventive treatment are to reduce the frequency, severity, and duration of migraine attacks, and migraine-associated disability. Wearing-off refers to the phenomenon whereby clinical symptoms return or worsen before the next dose of a drug is due and has been reported previously with migraine preventive medications. Design and Methods.-This was a long-term, 12-month, multicenter, randomized, double-blind, parallel-group phase 3 study (NCT02638103) that included chronic (CM) and episodic migraine (EM) patients who rolled over from the 12-week phase 3 HALO CM (NCT02621931) and EM trials (NCT02629861), as well as an additional subset of 312 new patients. Patients with CM or EM received fremanezumab either monthly or quarterly. In this post hoc analysis, for selected months, the difference in the average number of migraine days between weeks 1-2 and weeks 3-4, between weeks 1-3 and week 4, and between weeks 1-2 and weeks 11-12 were calculated. Results.-A total of 1890 patients (CM, 1110; EM, 780) were enrolled. At months 3, 6, 9, and 15, there were no substantial differences in mean weekly migraine days between weeks 1-2 and weeks 3-4 or between weeks 1-3 and week 4 with quarterly or monthly fremanezumab in the CM or EM subgroups. There were no substantial increases in mean weekly migraine days between weeks 1-2 and weeks 11-12 during the first quarter of treatment (months 1-3) or the second quarter of treatment (months 4-6) with quarterly or monthly fremanezumab in the CM or EM subgroups. Across both dosing subgroups in CM and EM patients, the mean weekly number of migraine days decreased substantially (30%-42%) during the first 2 weeks; decreases in weekly migraine days remained steady during the last 2 weeks of the first quarter, with a similar maintenance of response during the second quarter. Conclusions.-This analysis of data from a long-term, phase 3 study showed that patients receiving quarterly fremanezumab or monthly fremanezumab did not experience a wearing-off effect toward the end of the dosing interval.

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“…3. Patients were not allowed to undergo Botox injections (10,11) Acupuncture and Transcutaneous Electrical Nerve Stimulation for at least 3 months.…”

Section: Inclusion / Exclusion Criteriamentioning

confidence: 99%

Application of thermal microcautery in migraine management

Papageorgiou¹,

Kovas²,

Power³

et al. 2019

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Thermal microcautery is a novel minimally invasive intervention for migraine. We present a case series of twenty-one patients who underwent this technique. Nineteen patients reported improvement in migraine management. Of these four patients went on to complete remission and a further eleven patients reported over 50% improvement. In addition, the majority of patients noted reductions in intensity and duration of headache with a better response to medication. The efficacy of thermal microcautery generates a new hypothesis that attempts to explain how a neuromodulation technique may be helpful in the management of migraine.

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OnabotulinumtoxinA wear-off in chronic migraine, observational cohort study

Cited by 15 publications

References 9 publications

OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy

OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy

No “Wearing‐Off Effect” Seen in Quarterly or Monthly Dosing of Fremanezumab: Subanalysis of a Randomized Long‐Term Study

Application of thermal microcautery in migraine management

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