De Luca Ciro, Baldacci Filippo, Mazzucchi Sonia, Lombardo Irene, Curto Letizia, Ulivi Martina, Chico Lucia, Papa Michele, Siciliano Gabriele, Gori Sara
Laboratory of Morphology of Neuronal Network, Department of Public Medicine, University of Campania "Luigi Vanvitelli", 80138 Napoli, Italy.
Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
J Clin Med. 2021 Oct 4;10(19):4586. doi: 10.3390/jcm10194586.
Patients with high-frequency resistant migraine and medication-overuse headache are still the main clinical challenge in tertiary headache centers. The approval of targeted antibodies against the calcitonin gene-related peptide (CGRP) and its receptor represents a powerful instrument. In this study, we observed how biological and clinical features of resistant migraineurs responded to erenumab, fremanezumab, or galcanezumab. We found a reduction in advanced oxidation protein products (AOPP) as a biomarker of improved redox state after six months of treatment. We also found that treatment efficacy was precocious and maintained with high individual responder rates. In particular, seven out of ten patients achieved a reduction of 50% from the baseline at three months, which was maintained at six months, while about one out of our patients experienced a 75% reduction in headache frequency from the first month of treatment. The migraine disability assessment (MIDAS) and the associated fatigue, anxiety, and sleep quality also significantly improved. The allodynia symptom dropped from moderate/severe to mild/absent as a sign of central sensitization reduction. Our study confirmed the safety and efficacy of CGRP inhibition in real-life, high-challenging patients. Additional evidence is needed to understand the role of oxidative stress as a migraine biomarker.
高频耐药性偏头痛和药物过度使用性头痛患者仍是三级头痛中心的主要临床挑战。抗降钙素基因相关肽（CGRP）及其受体的靶向抗体获批是一种有力手段。在本研究中，我们观察了耐药性偏头痛患者的生物学和临床特征对erenumab、fremanezumab或galcanezumab的反应。我们发现，治疗六个月后，作为氧化还原状态改善生物标志物的晚期氧化蛋白产物（AOPP）有所减少。我们还发现治疗效果出现较早且得以维持，个体缓解率较高。特别是，十分之七的患者在三个月时头痛频率较基线降低了50%，并在六个月时维持这一水平，而约十分之一的患者在治疗第一个月头痛频率就降低了75%。偏头痛残疾评估（MIDAS）以及相关的疲劳、焦虑和睡眠质量也显著改善。异常性疼痛症状从中度/重度降至轻度/消失，这是中枢敏化减轻的迹象。我们的研究证实了CGRP抑制在现实生活中高挑战性患者中的安全性和有效性。还需要更多证据来了解氧化应激作为偏头痛生物标志物的作用。
