偏头痛和共病药物过度使用或药物过度使用性头痛中 CGRP 抗体治疗的持续有效性 - 一项回顾性真实世界分析。

Persistent effectiveness of CGRP antibody therapy in migraine and comorbid medication overuse or medication overuse headache - a retrospective real-world analysis.

机构信息

Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany.

Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Universitätsstraße 105, Bochum, 44789, Germany.

出版信息

J Headache Pain. 2024 Jul 4;25(1):109. doi: 10.1186/s10194-024-01813-3.

DOI:10.1186/s10194-024-01813-3

PMID:38965463

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11225246/

Abstract

BACKGROUND

Management of patients with migraine who have concomitant medication overuse (MO) or medication overuse headache (MOH) is a major problem in clinical practice. Detoxification of acute analgesics before or during initiation of prophylactic therapy has long been recommended although this concept has recently been questioned. Additionally, relapse after detoxification is a common problem. This real-world study analyses the initial and sustained effectiveness of prophylactic migraine therapy with CGRP (receptor) antibodies without prior detoxification in patients with comorbid MO or MOH for up to one year.

METHODS

A retrospective real-world analysis was performed on 291 patients (episodic migraine (EM) with MO (EM-MO; n = 35), EM without MO (EM-noMO; n = 77), chronic migraine (CM) with MOH (CM-MOH; n = 109), CM without MOH (CM-noMOH; n = 70). All patients began treatment with either erenumab (n = 173), fremanezumab (n = 70) or galcanezumab (n = 48) without prior detoxification. Data were available for up to 12 months of treatment. Responder rates for monthly headache days (MHD), monthly migraine days (MMD) and monthly acute medication intake (AMD) were analysed.

RESULTS

All groups showed a significant reduction in MHD, MMD and AMD at the last observed time point compared to baseline. In patients with CM and MOH, 60.6% (66/109) no longer fulfilled the definition of MO or MOH and a further 13.8% (15/109) had only EM-MO. In the EM cohort, 89% (31/35) of MO patients lost their MO during therapy. MHD and AMD 30% responder rates were comparable for CM-MOH and CM-noMOH (MHD: CM-MOH: 56.0% vs. CM-noMOH: 41.4%, p = 0.058, AMD: CM-MOH: 66.1% vs. CM-noMOH: 52.9%, p = 0.077). MMD responder rate did not differ significantly (after Bonferroni adjustment) (CM-MOH: 62.4% vs. CM-noMOH: 47.1%, p = 0.045, α = 0.017). After successful initiation of therapy, 15.4% of the initial CM-MOH patients relapsed and met the criterion for CM-MOH at the end of follow-up. There were no antibody specific differences in response to therapy.

CONCLUSIONS

Our data confirms the effectiveness of CGRP antibody treatment in migraine patients with additional MOH or MO in a real-world setting. Low relapse rates after initial successful therapy support an early start of CGRP antibody treatment in patients with MOH or MO.

TRIAL REGISTRATION

No registration, retrospective analysis.

摘要

背景

伴有药物过度使用（MO）或药物过度使用性头痛（MOH）的偏头痛患者的管理是临床实践中的一个主要问题。长期以来，人们一直建议在开始预防性治疗之前或期间对急性镇痛药进行解毒，尽管这一概念最近受到了质疑。此外，解毒后复发是一个常见的问题。这项真实世界的研究分析了在伴有 MO 或 MOH 的患者中，在没有预先解毒的情况下，使用 CGRP（受体）抗体进行预防性偏头痛治疗的初始和持续有效性，最长可达一年。

方法

对 291 例患者（伴有 MO 的发作性偏头痛（EM-MO；n=35）、无 MO 的 EM（EM-noMO；n=77）、伴有 MOH 的慢性偏头痛（CM-MOH；n=109）、无 MOH 的 CM（CM-noMOH；n=70）进行了回顾性真实世界分析。所有患者均在无预先解毒的情况下开始接受依那西普（n=173）、佛来美昔布（n=70）或加奈昔布（n=48）治疗。数据可用于治疗长达 12 个月。分析每月头痛天数（MHD）、每月偏头痛天数（MMD）和每月急性药物摄入（AMD）的应答率。

结果

与基线相比，所有组在最后一次观察到的时间点的 MHD、MMD 和 AMD 均显著降低。在伴有 CM 和 MOH 的患者中，60.6%（66/109）不再符合 MO 或 MOH 的定义，另有 13.8%（15/109）仅有 EM-MO。在 EM 队列中，89%（31/35）的 MO 患者在治疗期间失去了 MO。CM-MOH 和 CM-noMOH 的 MHD 和 AMD 30%应答率相当（MHD：CM-MOH：56.0% vs. CM-noMOH：41.4%，p=0.058，AMD：CM-MOH：66.1% vs. CM-noMOH：52.9%，p=0.077）。MMD 应答率无显著差异（经 Bonferroni 校正后）（CM-MOH：62.4% vs. CM-noMOH：47.1%，p=0.045，α=0.017）。在成功启动治疗后，15.4%的初始 CM-MOH 患者复发，并在随访结束时符合 CM-MOH 的标准。对治疗的反应没有抗体特异性差异。