[真实世界中的偏头痛负担：临床和经济方面]

[Real-world migraine burden: clinical and economic aspects].

作者信息

Naprienko M V, Smekalkina L V, Safonov M I, Filatova E G, Latysheva N V, Ekusheva E V, Artemenko A R, Osipova V V, Baiushkina L I

机构信息

Alexander Vein Headache Clinic, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia.

I.M. Sechenov First Moscow State Medical University, Moscow, Russia.

出版信息

Zh Nevrol Psikhiatr Im S S Korsakova. 2019;119(1):31-37. doi: 10.17116/jnevro201911901131.

DOI:10.17116/jnevro201911901131

PMID:30778028

Abstract

AIM

To evaluate the rationale for different approaches to preventive chronic migraine (CM) treatment by comparing clinical outcomes and financial burden of the disease in the real-world practice.

MATERIAL AND METHODS

Sixty-six patients with CM were enrolled at the Alexander Vein Headache Clinic (60 women and 6 men, aged 28-51). All patients were divided into 3 groups: group 1 (n=22) received oral preventative treatment with topiramate, up to 100 mg daily, for three months; group 2 (n=20) received 12 acupuncture sessions (3 sessions a week); group 3 (n=24) received 155-195 units of botulinum toxin type A (botox, BTA). The follow-up period in all groups was 3 months. Efficacy was evaluated by clinical examination, the Headache Impact Test (HIT-6) and questionnaires to assess subjective patient satisfaction and treatment tolerability.

RESULTS

BTA demonstrated the highest efficacy in this study. Compared to the oral preventative treatment and acupuncture, BTA reduced the frequency of headache faster and more significantly facilitating CM transformation into episodic migraine (headache frequency was 16.1±0.1; 18.0±0.02; and 13.9±0.3 in groups 1, 2 and 3, respectively, after one month of treatment). BTA also improved the quality of life faster and more significantly and was better tolerated (good - 51%, 75% and 85% in groups 1, 2 and 3, respectively; satisfactory - 35%, 25% and 15% in groups 1, 2 and 3, respectively; bad 14% in the oral prevention group). In the BTA group, the majority of patients demonstrated earlier treatment satisfaction. Despite higher (compared to topiramate) direct costs in the BTA group (RUB 29 931.51 and RUB 32 085.87, respectively), the predicted cost of a headache-free day was the smallest and totaled RUB 652.15 (compared to RUB 692.86 and RUB 1017.60 in the topiramate and acupuncture groups, respectively).

CONCLUSION

The data on the efficacy and costs of different CM prevention strategies would facilitate optimal treatment choice for neurologists and patients.

摘要

目的

通过比较现实世界中慢性偏头痛（CM）治疗的临床结果和疾病的经济负担，评估不同预防性治疗方法的合理性。

材料与方法

66例CM患者在亚历山大静脉头痛诊所入组（60名女性和6名男性，年龄28 - 51岁）。所有患者分为3组：第1组（n = 22）接受口服托吡酯预防性治疗，每日剂量高达100mg，持续3个月；第2组（n = 20）接受12次针灸治疗（每周3次）；第3组（n = 24）接受155 - 195单位A型肉毒毒素（保妥适，BTA）治疗。所有组的随访期均为3个月。通过临床检查、头痛影响测试（HIT - 6）以及评估患者主观满意度和治疗耐受性的问卷来评估疗效。

结果

在本研究中，BTA显示出最高的疗效。与口服预防性治疗和针灸相比，BTA更快且更显著地降低了头痛频率，促使CM转变为发作性偏头痛（治疗1个月后，第1、2和3组的头痛频率分别为16.1±0.1、18.0±0.02和13.9±0.3）。BTA还更快且更显著地改善了生活质量，并且耐受性更好（第1、2和3组中，耐受性良好的分别为51%、75%和85%；满意的分别为35%、25%和15%；口服预防组中耐受性差的为14%）。在BTA组中，大多数患者更早表现出对治疗的满意度。尽管BTA组的直接成本（分别为29931.51卢布和32085.87卢布）高于托吡酯组，但无头痛日的预测成本最低，总计652.15卢布（相比之下，托吡酯组和针灸组分别为692.86卢布和1017.60卢布）。