Abstract：
OBJECTIVE: We assessed whether the effectiveness of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway changes according to the duration of chronic migraine (CM) over 12 months.
BACKGROUND: In most patients, CM is a progressive disease starting with episodic migraine. Longer CM duration might be associated with more difficult treatment, probably because the mechanisms underlying chronicization are strengthened. Therefore, early treatment of CM could lead to better outcomes compared with later treatment.
METHODS: This cohort study included individuals with CM treated with anti-CGRP mAbs in two tertiary headache centers from April 2019 to May 2023. The primary outcome included a change in monthly migraine days (MMDs) from baseline to the third trimester of treatment, 10-12 months. Secondary outcomes established whether response to anti-CGRP mAbs has a more rapid onset in individuals with shorter CM duration compared with longer duration; they included change in MMDs, monthly headache days (MHDs), and days and number of intakes of acute medication during each trimester compared to baseline. Additional outcomes included persisting MMDs, MHDs, and days and number of intakes of acute medication during each trimester of treatment. Patients were compared across tertiles of the overall CM duration.
RESULTS: The study included 335 individuals with CM, with a median (interquartile range [IQR]) age of 48 (39-57) years; 270 (80.6%) were women. Patients in the highest tertile of CM duration (aged 18-60 years) were older than patients in the lower duration tertiles (0-7 years and 8-18 years, respectively), with a median (IQR) age of 56 (48-64) years compared with 42 (31-50) years, and 48 (39-56)years, respectively (p = 0.025); however, this difference was likely due to a correlation between age and disease duration. The change in MMDs from baseline to the last trimester of treatment (10-12 months) was comparable across tertiles of CM duration (median [IQR] -12 [-18 to -5] days, -12 [-17 to -6] days, and -12 [-18 to -4] days; p = 0.946). No difference emerged in secondary outcomes, suggesting a similar time to onset of anti-CGRP mAbs effect across all tertiles of CM duration.
CONCLUSIONS: Our data showed that anti-CGRP mAbs are effective and have a rapid onset of action in CM regardless of disease duration.
BACKGROUND: In most patients, CM is a progressive disease starting with episodic migraine. Longer CM duration might be associated with more difficult treatment, probably because the mechanisms underlying chronicization are strengthened. Therefore, early treatment of CM could lead to better outcomes compared with later treatment.
METHODS: This cohort study included individuals with CM treated with anti-CGRP mAbs in two tertiary headache centers from April 2019 to May 2023. The primary outcome included a change in monthly migraine days (MMDs) from baseline to the third trimester of treatment, 10-12 months. Secondary outcomes established whether response to anti-CGRP mAbs has a more rapid onset in individuals with shorter CM duration compared with longer duration; they included change in MMDs, monthly headache days (MHDs), and days and number of intakes of acute medication during each trimester compared to baseline. Additional outcomes included persisting MMDs, MHDs, and days and number of intakes of acute medication during each trimester of treatment. Patients were compared across tertiles of the overall CM duration.
RESULTS: The study included 335 individuals with CM, with a median (interquartile range [IQR]) age of 48 (39-57) years; 270 (80.6%) were women. Patients in the highest tertile of CM duration (aged 18-60 years) were older than patients in the lower duration tertiles (0-7 years and 8-18 years, respectively), with a median (IQR) age of 56 (48-64) years compared with 42 (31-50) years, and 48 (39-56)years, respectively (p = 0.025); however, this difference was likely due to a correlation between age and disease duration. The change in MMDs from baseline to the last trimester of treatment (10-12 months) was comparable across tertiles of CM duration (median [IQR] -12 [-18 to -5] days, -12 [-17 to -6] days, and -12 [-18 to -4] days; p = 0.946). No difference emerged in secondary outcomes, suggesting a similar time to onset of anti-CGRP mAbs effect across all tertiles of CM duration.
CONCLUSIONS: Our data showed that anti-CGRP mAbs are effective and have a rapid onset of action in CM regardless of disease duration.
摘要：
目的：我们评估了靶向降钙素基因相关肽（CGRP）途径的单克隆抗体（mAb）的有效性是否随着慢性偏头痛（CM）持续时间超过12个月而发生变化。
背景：在大多数患者中，CM是一种进行性疾病，始于发作性偏头痛。较长的CM持续时间可能与更困难的治疗有关，可能是因为时间化的潜在机制得到了加强。因此,与后期治疗相比,早期CM治疗可带来更好的结局.
方法：这项队列研究包括2019年4月至2023年5月在两个三级头痛中心接受抗CGRPmAb治疗的CM个体。主要结果包括从基线到治疗的第三个三个月的每月偏头痛天数（MMD）的变化，10-12个月。次要结果确定了对抗CGRPmAb的反应在CM持续时间较短的个体中是否起效更快；它们包括MMD的变化，每月头痛天数（MHD），与基线相比，每三个月的急性药物摄入量和天数。其他结果包括持续的MMD，MHD,以及每三个月治疗期间急性药物的摄入天数和数量。对患者的总CM持续时间进行了比较。
结果：该研究包括335名CM患者，中位(四分位距[IQR])年龄为48(39-57)岁;270名(80.6%)为女性。CM持续时间最高的患者（年龄18-60岁）的年龄大于持续时间较低的患者（0-7年和8-18年，分别)，年龄中位数（IQR）为56（48-64）岁，而年龄中位数为42（31-50）岁，48（39-56）年，分别(p=0.025)；然而，这种差异可能是由于年龄和病程之间的相关性.从基线到治疗的最后三个月（10-12个月）的MMD变化在CM持续时间的三个月之间具有可比性（中位数[IQR]-12[-18至-5]天，-12[-17至-6]天，和-12[-18至-4]天；p=0.946)。次要结局没有差异，表明抗CGRPmAb作用的起效时间在CM持续时间的所有三元之间相似。
结论：我们的数据表明抗CGRPmAb在CM中有效且起效迅速，无论病程长短。
背景：在大多数患者中，CM是一种进行性疾病，始于发作性偏头痛。较长的CM持续时间可能与更困难的治疗有关，可能是因为时间化的潜在机制得到了加强。因此,与后期治疗相比,早期CM治疗可带来更好的结局.
方法：这项队列研究包括2019年4月至2023年5月在两个三级头痛中心接受抗CGRPmAb治疗的CM个体。主要结果包括从基线到治疗的第三个三个月的每月偏头痛天数（MMD）的变化，10-12个月。次要结果确定了对抗CGRPmAb的反应在CM持续时间较短的个体中是否起效更快；它们包括MMD的变化，每月头痛天数（MHD），与基线相比，每三个月的急性药物摄入量和天数。其他结果包括持续的MMD，MHD,以及每三个月治疗期间急性药物的摄入天数和数量。对患者的总CM持续时间进行了比较。
结果：该研究包括335名CM患者，中位(四分位距[IQR])年龄为48(39-57)岁;270名(80.6%)为女性。CM持续时间最高的患者（年龄18-60岁）的年龄大于持续时间较低的患者（0-7年和8-18年，分别)，年龄中位数（IQR）为56（48-64）岁，而年龄中位数为42（31-50）岁，48（39-56）年，分别(p=0.025)；然而，这种差异可能是由于年龄和病程之间的相关性.从基线到治疗的最后三个月（10-12个月）的MMD变化在CM持续时间的三个月之间具有可比性（中位数[IQR]-12[-18至-5]天，-12[-17至-6]天，和-12[-18至-4]天；p=0.946)。次要结局没有差异，表明抗CGRPmAb作用的起效时间在CM持续时间的所有三元之间相似。
结论：我们的数据表明抗CGRPmAb在CM中有效且起效迅速，无论病程长短。
