RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine
Por:
del Rincón, CR, Gonzalez-Martinez, A, Quintas, S, García-Azorín, D, Lázaro, IF, Guerrero-Peral, AL, Osorio, YG, Santos-Lasaosa, S, Oria, CG, Rodríguez, NS, Díez, FI, Iñiguez, AE, Luque, SG, Huerta-Villanueva, M, Díaz, SC, Muñoz-Vendrell, A, Ros, AL, Sánchez-Soblechero, A, Juanes, FV, Kortazar-Zubizarreta, I, Echeverria, A, Rodríguez-Vico, J, Sánchez, AJ, Garcia, AG, Sánchez-Mateos, NM, Belvis, R, Pérez, MPN, García-Monco, JC, Escudero, MRA, Montes, N, Gago-Veiga, AB
Publicada:
25 ene 2024
Ahead of Print:
1 ene 2024
Resumen:
Background and purpose: According to the latest European guidelines, discontinuation of monoclonal antibodies against calcitonin gene-related peptide (anti-CGRP MAb) may be considered after 12-18 months of treatment. However, some patients may worsen after discontinuation. In this study, we assessed the response following treatment resumption. Methods: This was a prospective study conducted in 14 Headache Units in Spain. We included patients with response to anti-CGRP MAb with clinical worsening after withdrawal and resumption of treatment. Numbers of monthly migraine days (MMD) and monthly headache days (MHD) were obtained at four time points: before starting anti-CGRP MAb (T-baseline); last month of first treatment period (T-suspension); month of restart due to worsening (T-worsening); and 3 months after resumption (T-reintroduction). The response rate to resumption was calculated. Possible differences among periods were analysed according to MMD and MHD. Results: A total of 360 patients, 82% women, with a median (interquartile range [IQR]) age at migraine onset of 18 (12) years. The median (IQR) MHD at T-baseline was 20 (13) and MMD was 5 (6); at T-suspension, the median (IQR) MHD was 5 (6) and MMD was 4 (5); at T-worsening, the median (IQR) MHD was 16 (13) and MMD was 12 (6); and at T-reintroduction, the median (IQR) MHD was 8 (8) and MHD was 5 (5). In the second period of treatment, a 50% response rate was achieved by 57.4% of patients in MHD and 65.8% in MMD. Multivariate models showed significant differences in MHD between the third month after reintroduction and last month before suspension of first treatment period (p < 0.001). Conclusion: The results suggest that anti-CGRP MAb therapy is effective after reintroduction. However, 3 months after resumption, one third of the sample reached the same improvement as after the first treatment period.
Filiaciones:
del Rincón, CR:
Univ Autonoma Madrid UAM, Inst Invest Sanitaria Princesa IIS Princesa, Madrid, Spain
Gonzalez-Martinez, A:
Univ Autonoma Madrid UAM, Hosp Univ La Princesa, Dept Neurol, Madrid, Spain
Univ Autonoma Madrid UAM, Inst Invest Sanitaria Princesa IIS Princesa, Madrid, Spain
Hosp Univ La Princesa, Neurol Dept, Calle Diego Leon 62,7th Fl, Madrid 28006, Spain
Quintas, S:
Univ Autonoma Madrid UAM, Hosp Univ La Princesa, Dept Neurol, Madrid, Spain
García-Azorín, D:
Hosp Clin Univ Valladolid, Headache Unit, Valladolid, Spain
Univ Valladolid, Dept Med, Valladolid, Spain
Lázaro, IF:
Univ Autonoma Madrid UAM, Hosp Univ La Princesa, Dept Neurol, Madrid, Spain
Guerrero-Peral, AL:
Hosp Clin Univ Valladolid, Headache Unit, Valladolid, Spain
Univ Valladolid, Dept Med, Valladolid, Spain
Osorio, YG:
Hosp Clin Univ Valladolid, Headache Unit, Valladolid, Spain
Santos-Lasaosa, S:
Hosp Clin Univ Lozano Blesa, Headache Unit, Zaragoza, Spain
Oria, CG:
Hosp Clin Univ Lozano Blesa, Headache Unit, Zaragoza, Spain
Rodríguez, NS:
Hosp Clin Univ Lozano Blesa, Headache Unit, Zaragoza, Spain
Díez, FI:
Hosp Virgen del Rocio, Headache Unit, Seville, Spain
Iñiguez, AE:
Hosp Virgen del Rocio, Headache Unit, Seville, Spain
Luque, SG:
Hosp Virgen del Rocio, Headache Unit, Seville, Spain
Huerta-Villanueva, M:
Hosp Viladecans IDIBELL, Neurol Dept Neurol, Barcelona, Spain
Hosp Univ Bellvitge IDIBELL, Serv Neurol, Unidad Cefaleas, Barcelona, Spain
Díaz, SC:
Hosp Clin Univ Burgos, Headache Unit, Burgos, Spain
Hosp Viladecans IDIBELL, Neurol Dept Neurol, Barcelona, Spain
Muñoz-Vendrell, A:
Hosp Univ Bellvitge IDIBELL, Serv Neurol, Unidad Cefaleas, Barcelona, Spain
Ros, AL:
Hosp Univ Bellvitge IDIBELL, Serv Neurol, Unidad Cefaleas, Barcelona, Spain
Sánchez-Soblechero, A:
Hosp Univ Gregorio Maranon, Headache Unit, Madrid, Spain
Juanes, FV:
Hosp Univ Gregorio Maranon, Headache Unit, Madrid, Spain
Kortazar-Zubizarreta, I:
Araba Univ Hosp Txagorritxu, Hosp Alava, Bioaraba Hlth Res Inst, Dept Neurol, Vitoria, Spain
Echeverria, A:
Araba Univ Hosp Txagorritxu, Hosp Alava, Bioaraba Hlth Res Inst, Dept Neurol, Vitoria, Spain
Rodríguez-Vico, J:
Hosp Fdn Jimenez Diaz, Headache Unit, Madrid, Spain
Sánchez, AJ:
Araba Univ Hosp Txagorritxu, Hosp Alava, Bioaraba Hlth Res Inst, Dept Neurol, Vitoria, Spain
Garcia, AG:
Araba Univ Hosp Txagorritxu, Hosp Alava, Bioaraba Hlth Res Inst, Dept Neurol, Vitoria, Spain
Sánchez-Mateos, NM:
Hosp Fdn Jimenez Diaz, Headache Unit, Madrid, Spain
Belvis, R:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Pérez, MPN:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
García-Monco, JC:
Univ Hosp Basurto, Bilbao, Spain
Escudero, MRA:
Univ Hosp Basurto, Bilbao, Spain
Montes, N:
Inst Invest Sanitaria La Princesa IIS IP, Unidad Metodol, Madrid, Spain
Hosp Univ La Princesa, Serv Reumatol, Madrid, Spain
CEU Univ, Univ San Pablo, Fac Pharm, Plant Physiol Pharmaceut & Hlth Sci Dept, Boadilla Del Monte, Spain
Gago-Veiga, AB:
Univ Autonoma Madrid UAM, Hosp Univ La Princesa, Dept Neurol, Madrid, Spain
Univ Autonoma Madrid UAM, Inst Invest Sanitaria Princesa IIS Princesa, Madrid, Spain
Hosp Univ Cruces, Headache Unit, Baracaldo, Vizcaya, Spain
Hosp Obispo Polanco Teruel, Inst Invest Sanitaria Aragon, Zaragoza, Spain
Hosp Univ Cent Asturias, Oviedo, Spain
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