PDF(Pubmed)
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.
BACKGROUND: No registration, retrospective analysis.
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.
BACKGROUND: No registration, retrospective analysis.
摘要：
背景：合并药物过度使用（MO）或药物过度使用头痛（MOH）的偏头痛患者的治疗是临床实践中的主要问题。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，尽管最近对此概念提出了质疑。此外,戒毒后复发是一个常见的问题。这项现实世界的研究分析了在没有预先排毒的情况下，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。
方法：对291例患者（发作性偏头痛（EM）伴MO（EM-MO；n=35），无MO的EM(EM-noMO；n=77)，慢性偏头痛（CM）伴MOH（CM-MOH；n=109），无MOH的CM(CM-noMOH;n=70)。所有患者开始使用erenumab治疗（n=173），Fremanezumab（n=70）或galcanezumab（n=48）没有预先排毒。数据可用于长达12个月的治疗。每月头痛天数(MHD)的响应者比率，分析每月偏头痛天数(MMD)和每月急性药物摄入量(AMD).
结果：所有组显示MHD显著降低，与基线相比，最后观察时间点的MMD和AMD。在CM和MOH患者中，60.6%（66/109）不再符合MO或MOH的定义，另有13.8%（15/109）只有EM-MO。在EM队列中，89%(31/35)的MO患者在治疗期间失去MO。CM-MOH和CM-noMOH的MHD和AMD30％应答率相当（MHD：CM-MOH：56.0％与CM-NOMOH:41.4%,p=0.058，AMD：CM-MOH：66.1%vs.CM-NOMOH:52.9%,p=0.077)。MMD反应率没有显着差异（Bonferroni调整后）（CM-MOH：62.4％与CM-NOMOH:47.1%,p=0.045,α=0.017)。成功开始治疗后，15.4%的初始CM-MOH患者在随访结束时复发并符合CM-MOH的标准。对治疗的反应没有抗体特异性差异。
结论：我们的数据证实了CGRP抗体治疗在真实世界环境中额外MOH或MO的偏头痛患者中的有效性。初始成功治疗后的低复发率支持MOH或MO患者早期开始CGRP抗体治疗。
背景：无需注册，回顾性分析。
方法：对291例患者（发作性偏头痛（EM）伴MO（EM-MO；n=35），无MO的EM(EM-noMO；n=77)，慢性偏头痛（CM）伴MOH（CM-MOH；n=109），无MOH的CM(CM-noMOH;n=70)。所有患者开始使用erenumab治疗（n=173），Fremanezumab（n=70）或galcanezumab（n=48）没有预先排毒。数据可用于长达12个月的治疗。每月头痛天数(MHD)的响应者比率，分析每月偏头痛天数(MMD)和每月急性药物摄入量(AMD).
结果：所有组显示MHD显著降低，与基线相比，最后观察时间点的MMD和AMD。在CM和MOH患者中，60.6%（66/109）不再符合MO或MOH的定义，另有13.8%（15/109）只有EM-MO。在EM队列中，89%(31/35)的MO患者在治疗期间失去MO。CM-MOH和CM-noMOH的MHD和AMD30％应答率相当（MHD：CM-MOH：56.0％与CM-NOMOH:41.4%,p=0.058，AMD：CM-MOH：66.1%vs.CM-NOMOH:52.9%,p=0.077)。MMD反应率没有显着差异（Bonferroni调整后）（CM-MOH：62.4％与CM-NOMOH:47.1%,p=0.045,α=0.017)。成功开始治疗后，15.4%的初始CM-MOH患者在随访结束时复发并符合CM-MOH的标准。对治疗的反应没有抗体特异性差异。
结论：我们的数据证实了CGRP抗体治疗在真实世界环境中额外MOH或MO的偏头痛患者中的有效性。初始成功治疗后的低复发率支持MOH或MO患者早期开始CGRP抗体治疗。
背景：无需注册，回顾性分析。
