Author:
Muñoz-Vendrell Albert,Campoy Sergio,Caronna Edoardo,Alpuente Alicia,Torres-Ferrus Marta,Nieves Castellanos Candela,Olivier Marina,Campdelacreu Jaume,Prat Joan,Camiña Muñiz Javier,Molina Martínez Francisco José,Mínguez-Olaondo Ane,Ruibal Salgado Marta,Santos Lasaosa Sonia,Navarro Pérez María Pilar,Morollón Noemí,López Bravo Alba,Cano Sánchez Luis Miguel,García-Sánchez Sonia María,García-Ull Jésica,Rubio-Flores Laura,Gonzalez-Martinez Alicia,Quintas Sonia,Echavarría Íñiguez Ana,Gil Luque Sendoa,Castro-Sánchez María Victoria,Adell Ortega Vanesa,García Alhama Jessica,Berrocal-Izquierdo Nuria,Belvís Robert,Díaz-Insa Samuel,Pozo-Rosich Patricia,Huerta-Villanueva Mariano
Abstract
Abstract
Background
Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life.
Methods
In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies.
Results
A total of 162 patients were included, median age 68 years (range 65–87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%).
Conclusions
Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice.
Graphical Abstract
Publisher
Springer Science and Business Media LLC
Subject
Anesthesiology and Pain Medicine,Neurology (clinical),General Medicine