Abstract
Aims
Clinical trials for calcitonin gene-related peptide (CGRP) inhibitors excluded the concomitant use of onabotulinumtoxinA; thus, there is a lack of efficacy and safety data of the combined therapies. Our study aims to examine the effectiveness of CGRP inhibitors with onabotulinumtoxinA by evaluating migraine reductions in headache days and severity.
Methods
Seventeen patients with chronic migraines were identified who had a partial or poor response to onabotulinumtoxinA, and were placed on dual therapy with a CGRP inhibitor. Patients’ initial headache days and severity ratings were compared to final values taken 1–6 months after adding the CGRP inhibitor to their treatment regime. Comparisons between headache days and severity ratings prior to and during dual treatment were performed utilizing the Kruskal–Wallis test. The significance was set at p < 0.05.
Results
Of 17 patients (16F/1 M), n = 9 were taking fremanezumab, n = 4 were taking erenumab, and n = 4 were taking galcanezumab. Patients’ average headache days per month was reduced from 27.6 ± 4.8 initially to 18.6 ± 9.4 post-treatment (p = 0.00651), and their average pain level was reduced from 8.4 ± 1.4 out of 10 to 5.4 ± 2.5 (p = 0.00074). No serious adverse side effects were reported from patients on dual therapy.
Conclusion
Patients with suboptimal response to onabotulinumtoxinA may benefit from CGRP inhibitors’ addition to their migraine regimens. Placebo-controlled randomized studies are advised to corroborate this finding.
Data availability
Deidentified data can be made available upon request.
References
(2019) The American headache society position statement on integrating new migraine treatments into clinical practice. Headache 59: 1–18.https://doi.org/10.1111/head.13456
CGRP Inhibitors. Drugs.com, https://www.drugs.com/drug-class/cgrp-inhibitors.html (2018, accessed 3 Feb 2021)
Tepper D (2020) Gepants. Headache 60:1037–1039. https://doi.org/10.1111/head.13791
Deng H, Li G, Nie H et al (2020) Efficacy and safety of calcitonin-gene-related peptide binding monoclonal antibodies for the preventive treatment of episodic migraine – an updated systematic review and meta-analysis. BMC Neurol 20:57. https://doi.org/10.1186/s12883-020-01633-3
Escher CM, Paracka L, Dressler D et al (2017) Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Ther Adv Neurol Disord 10:127–135. https://doi.org/10.1177/1756285616677005
Pellesi L, Do TP, Ashina H et al (2020) Dual therapy with anti-CGRP monoclonal antibodies and botulinum toxin for migraine prevention: is there a rationale? Headache 60:1056–1065. https://doi.org/10.1111/head.13843
Talbot J, Stuckey R, Crawford L et al (2021) Improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment – real world outcomes. J Headache Pain 22:5. https://doi.org/10.1186/s10194-020-01214-2
Acknowledgements
The authors wish to thank the staff at Hawaii Pacific Neuroscience for their valuable assistance in gathering the data.
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All authors contributed to the conception of the work, analysis and interpretation of the data. TT and EC drafted the letter, and RT, BN, YL, JL, VV, JV and KKL revised it critically for intellectual content.
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Patients’ records confidentiality was maintained and data deidentified. Written informed consent was not obtained, as this Letter to the Editor is based on the authors’ clinical experience.
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Toni, T., Tamanaha, R., Newman, B. et al. Effectiveness of dual migraine therapy with CGRP inhibitors and onabotulinumtoxinA injections: case series. Neurol Sci 42, 5373–5376 (2021). https://doi.org/10.1007/s10072-021-05547-x
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DOI: https://doi.org/10.1007/s10072-021-05547-x