Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1 Coppito, 67100 L'Aquila, Italy.
Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, 41125 Modena, Italy.
Int J Environ Res Public Health. 2022 Sep 2;19(17):10975. doi: 10.3390/ijerph191710975.
The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineurs treated with onabotulinumtoxinA and followed-up for, at least, 9 months was performed. Excellent responders were defined either as patients with a ≥75% decrease in monthly headache days (percent-based excellent responders) or as patients with <4 monthly headache days (frequency-based excellent responders). The characteristics of excellent responders at the baseline were compared with the ones of patients with a <30% decrease in monthly headache days. Percent-based excellent responders represented about 10% of the sample, whilst frequency-based excellent responders were about 5% of the sample. Compared with non-responders, percent-based excellent responders had a higher prevalence of medication overuse and a higher excellent response rate even after the 1st and the 2nd injection. Females were less like to be frequency-based excellent responders. Chronic migraine sufferers without medication overuse and of female sex may find fewer benefits with onabotulinumtoxinA. Additionally, the excellent response status is identifiable after the first cycle.
在慢性偏头痛中，识别最能从现有预防治疗中获益的患者非常重要。我们根据不同的定义，在一项多中心的欧洲研究中探讨了接受肉毒毒素 A 治疗的慢性偏头痛患者中优秀应答者的比例，并探讨了这种反应的预测因素。对接受肉毒毒素 A 治疗并至少随访 9 个月的慢性偏头痛患者进行了汇总分析。优秀应答者的定义为每月头痛天数减少≥75%（基于百分比的优秀应答者）或每月头痛天数<4 天（基于频率的优秀应答者）。将基线时优秀应答者的特征与每月头痛天数减少<30%的患者进行比较。基于百分比的优秀应答者约占样本的 10%，而基于频率的优秀应答者约占样本的 5%。与无应答者相比，基于百分比的优秀应答者药物过度使用的发生率更高，即使在第 1 次和第 2 次注射后，优秀应答率也更高。女性更不可能成为基于频率的优秀应答者。无药物过度使用且为女性的慢性偏头痛患者可能从肉毒毒素 A 中获益较少。此外，在第一个周期后就可以确定优秀应答状态。
