Efficacy and Tolerability of CGRP Monoclonal Antibody Medications in Patients with Chronic Migraine Undergoing Treatment with OnabotulinumtoxinA

Fred Cohen, MD

AHSAM 2020 - Oral session
Published on October 2, 2020 | NEW

7 minute
7 minute

Key messages

  • Data on the efficacy and safety of onabotulinumtoxinA in combination with calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) treatment in patients with chronic migraine is currently limited.
  • The addition of a CGRP mAb medication to patients undergoing onabotulinumtoxinA treatment for chronic migraine results in a significant reduction in monthly headache days and pain severity.
  • Background

    What do we already know about this topic?
  • Findings

    What does this study add?
  • Perspectives

    How does this study impact clinical practice?
  • Expert commentary

    by Deena Kuruvilla, MD, FAHS

Key messages

  • Data on the efficacy and safety of onabotulinumtoxinA in combination with calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) treatment in patients with chronic migraine is currently limited.
  • The addition of a CGRP mAb medication to patients undergoing onabotulinumtoxinA treatment for chronic migraine results in a significant reduction in monthly headache days and pain severity.

Background

What do we already know about this topic?

  • OnabotulinumtoxinA and CGRP mAbs are widely used treatments for chronic migraine.1
  • There is limited data on the efficacy and safety of onabotulinumtoxinA in combination with CGRP mAb treatment in patients partially responsive to onabotulinumtoxinA.1

How was this study conducted?

  • A retrospective chart review of adult patients with chronic migraine (N=153) receiving treatment with onabotulinumtoxinA who were then prescribed additional CGRP mAb medication (fremanezumab, galcanezumab, or erenumab) between May 2018 to May 2019.
  • Patients were excluded if they received any additional therapy during the study period or if their treatment with a CGRP mAb medication was less than 2 months.
  • The primary outcome was the change in number of monthly headache days.

Findings

What does this study add?

  • Average monthly headache days were significantly reduced by 43% from baseline following initiation of onabotulinumtoxinA treatment alone.
  • OnabotulinumtoxinA plus a CGRP mAb medication significantly reduced average monthly headache days by 65.6% from baseline.
  • CGRP mAb medications were well-tolerated with 8.5% of patients reporting side effects that included constipation, injection site reaction, and/or fatigue.

Perspectives

How does this study impact clinical practice?

  • Patients with chronic migraine undergoing treatment with onabotulinumtoxinA can experience a significant further reduction in monthly headache days and pain severity with the addition of a CGRP mAb medication.
  • Future prospective studies evaluating combination therapy are warranted.

Perspectives

How does this study impact clinical practice?

  • Patients with chronic migraine undergoing treatment with onabotulinumtoxinA can experience a significant further reduction in monthly headache days and pain severity with the addition of a CGRP mAb medication.
  • Future prospective studies evaluating combination therapy are warranted.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

Fred Cohen, MD
Montefiore Medical Center
Great Neck, New York

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

In addition, an expert commentary on the topic has been provided by:

Deena Kuruvilla, MD, FAHS
Yale School of Medicine, New Haven, CT

Deena Kuruvilla, MD, FAHS
Yale School of Medicine, New Haven, CT

Dr. Deena Kuruvilla MD is a board-certified neurologist who is fellowship-trained in headache medicine. She is an assistant professor at the Yale School of Medicine. She is also certified in the subspecialty of Headache Medicine by the United Council for Neurologic Subspecialties and is a Fellow of the American Headache Society. Dr. Kuruvilla is a frequent moderator and speaker at national headache conferences, and her work has been featured in JAMACephalgia, and the Wall Street Journal. She is the former chair of the complementary and integrative medicine section and current chair of the women's health section of the American Headache Society.

1. Agostani EC, et al. Current and emerging evidence-based treatment options in chronic migraine: a narrative review. J Headache Pain. 2019;20:92.

Headache
Chronic Migraine

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