Erenumab for the treatment of chronic resistant migraine

Layos-Romero, Almudena; López, Alberto Andrés; Rojas Bartolomé, Laura

doi:10.1016/j.medcle.2021.03.028

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Migraines have a high prevalence among these cases (14% of the population)<a class="elsevierStyleCrossRef" href="#bib0005">1</a> and are associated with significant disability, causing repercussions on the patients’ personal and working lives. This situation is magnified in the case of chronic migraines; that is, suffering from a headache for more than 15 days per month (eight days meeting migraine criteria) for more than three months.Treatment of migraines is based on hygienic measures, including the promotion of routines that improve the experience of pain, the use of a simple and effective analgesic regimen, and preventive treatment in case of frequent, disabling attacks or with a poor symptomatic response. Preventive treatments are initially oral, non-specific (antidepressants, neuromodulators, and antihypertensives, among others), and have significant side effects.The calcitonin gene-related peptide (CGRP) is one of the vasoactive peptides released into the meninges through the activation of the trigeminovascular system. These molecules cause sterile inflammation and are determinants in the onset of pain.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In the last year, monclonal antibodies against the CGRP or its receptor have been approved for subjects suffering from migraines for eight or more days a month (high-frequency episodic migraines and chronic migraines) and three or more failures of previous treatments used at sufficient doses for three months, provided that one of these treatments is botulinum toxin in case of chronic migraines.In this paper we describe our experience using erenumab 70 mg, a drug targeting the CGRP receptor. We identified a total of 28 patients (22 female and six male), with a mean age of 47 years (22–68), with chronic migraines with a mean clinical evolution of 24 years (5–47), and a mean of 7.6 previous preventive treatments (1–14). The following efficacy variables were collected: days with a migraine per month (DMM), days with a headache per month (DHM), and days requiring analgesics per month (DAM). Patients suffering from a headache due to abusing analgesics were quantified. The Headache Impact Test (HIT-6) questionnaire scale was used as a measure of disability (with a HIT-6 score >60 indicating severe disability, of 55–60 indicating moderate disability, of 50–54 indicating mild disability, and <50 indicating no disability). The recommendations of the official guidelines were used as treatment response criteria,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> i.e., a decrease >50% in the DMM, the DHM, or the DAM, and >5 points in the HIT-6 scale. Side effects were also collected.A decrease of 7.5, 7.3, and 8.6 was observed in the DMM, DHM, and DAM, respectively, after three months of treatment (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). After six months, this decrease was of 8.4, 8.9, and 9.8 in the DMM, DHM, and DAM, respectively. The number of patients meeting analgesic abuse criteria decreased from 12 to 9. The HIT-6 score dropped from 72 to 59 points, which entailed an improvement in all disability levels: of 100% cases of severe disability, only 35% continued to present with this degree, 21% had a moderate disability, 39% had a mild disability, and 4% had no disability. Of all patients, only four (14%) reported constipation, although one of them had to discontinue the drug because of this symptom. No other side effects were detected.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>These results support the effectiveness and safety of erenumab in subjects with chronic migraines, with a halving in the number of monthly migraine attacks and headaches, a 40% reduction in the number of days of analgesic consumption, and an improvement in self-perceived disability. Compared with the results reported from studies on the drug,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> our case series included patients with a longer clinical evolution of the condition, a greater number of previous preventive measures, and all had received an ineffecive treatment course with botulinum toxin and were highly disabled. Despite this, the reduction in the DMM, DHM, and DAM met efficacy criteria according to international guidelines, with a low rate of side effects." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Layos-Romero A, López AA, Rojas Bartolomé L. Erenumab para el tratamiento de migraña crónica farmacorresistente. Med Clin (Barc). 2022;158:96–97." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline (days); SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3 months (days); SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">6 months (days); SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Decrease (days) between 3 and 6 months (decrease %) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Days with a migraine per month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.72 (5–30) SD 7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.21 (0–25) SD 5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.32 (0–25) SD 5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.5–8.4 (51–57) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Days with a headache per month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.57 (0–30) SD 10.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.29 (0–30) SD 10.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.67 (0–30) SD 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3–8.9 (39–47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Days taking analgesics per month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.50 (5–30) SD 8.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.89 (2–30) SD 9.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.82 (3–30) SD 8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.6–9.8 (35–40) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIT-6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.18 (65–78) SD 4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.93 (45–72) SD 6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.14 (45–72) SD 6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.3–13 (17–18) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2809566.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results after three and six months of treatment." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of headache in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.J. 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ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

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Vol. 158. Issue 2.