Migraine 27 Mar, 2023 Read Time: 4 mins

A spotlight on time in migraine management

Time lost providing patients with migraine with effective treatment is time lost for the patient’s quality of life, family life, and life opportunities, said experts at the Migraine Trust International Symposium 2022. Increasing evidence over time on the effectiveness and tolerability of calcitonin gene-related peptide pathway monoclonal antibody treatment is leading to changing times in migraine management.

The importance of time in patient management

Too many people are underdiagnosed and undertreated or inappropriately treated

The Chronic Migraine Epidemiology and Outcomes (CAMEO) Study details the large amount of time lost to patients due to barriers in care, said Professor Teshamae Monteith, Miami, FL.1

These barriers include lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered appropriate acute and preventive pharmacologic treatments when indicated, and not avoiding medication overuse.1

The interictal burden has a negative impact on health-related quality of life3

Too many people are underdiagnosed and undertreated or inappropriately treated, said Professor Monteith, who also highlighted:

  • The extremely variable migraine burden across individuals and in the same individual across the life span2
  • The interictal burden that has negatively impacts health-related quality of life through lifestyle changes, trigger avoidance, and effect on work, career, daily activities, and relationships3

Is it time to APPRAISE our approach to migraine prophylaxis?

Compared with oral SOC at Month 12, patients treated with CGRP pathway mAb were 6.48 times more likely to stay on treatment and achieve ≥50% reduction in MMD4

Dr Patricia Pozo-Rosich, Barcelona, Spain, presented the results of the APPRAISE trial — the first global, pragmatic,12-month prospective, randomized, active-controlled, Phase 4, open-label trial evaluating the long-term benefit of a calcitonin gene-related peptide (CGRP) pathway monoclonal antibody (mAb) treatment versus oral standard-of-care (SOC) preventives. All patients had episodic migraine and had failed one or two previous migraine preventives.4

Compared with patients treated with SOC oral preventives, patients treated with the CGRP pathway mAb were:

Compared with oral SOC, patients treated with CGRP pathway mAb were 13.75 times more likely to achieve a relevant clinical improvement at Month 124

  • 6.48 times more likely to stay on the initially assigned treatment through to Month 12 and achieve ≥50% reduction in monthly migraine days (MMD) at Month 124
  • 13.75 times more likely to achieve a relevant clinical improvement at Month 124
  • Much less likely to discontinue treatment due to adverse events (2.9% vs 23.3%)4

Compared with oral SOC, patients treated with CGRP pathway mAb were much less likely to discontinue treatment due to adverse events (2.9% vs 23.3%)4

Assessing the evidence for CGRP mAbs: What has time told us?

Professor Dagny Holle-Lee, Essen, Germany, presented the results of studies that answer patients’ questions about the use of CGRP pathway mAb treatment as follows:

  • What is the effect of pausing treatment with a CGRP mAb after 12 months? — Pausing results in a significant increase in mean number of MMD5
  • Is it beneficial to switch CGRP pathway mAb in non-responders? — Switching is an option and results in ≥30% reduction in headache days in 32% of patients and ≥50% reduction in headache days in 12%6

CGRP pathway mAbs are effective in some patients with drug-resistant migraine and chronic daily headache7

  • Are CGRP pathway mAbs effective in patients with drug-resistant migraine and chronic daily headache? — CGRP pathway mAbs are effective in some patients with drug-resistant migraine and chronic daily headache7
  • What are the results of head-to-head data for CGRP pathway mAb versus a first-line prophylactic medication? — Patients treated with CGRP pathway mAb are 2.76 times more likely to experience ≥50% reduction in MMD with a CGRP pathway mAb versus topiramate8

Changing times in migraine management: How do guidelines help?

The updated EHF guideline suggests that CGRP pathway mAbs are included as a first line treatment option for migraine requiring preventive treatment9

CGRP pathway mAbs have changed the migraine treatment paradigm with more timely treatment improving outcomes, said Professor Simona Sacco, L’Aquila, Italy.

The European Headache Federation (EHF) guideline has therefore been updated and now suggests that CGRP pathway mAbs are included as a first line treatment option for individuals with migraine who require preventive treatment.9

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References

  1. Buse DC, Armand CE, Charleston L 4th, et al. Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study. Headache. 2021;61(4):628–41.
  2. Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021–39.
  3. Lo SH, Gallop K, Smith T, et al. Real-world experience of interictal burden and treatment in migraine: a qualitative interview study. J Headache Pain. 2022;23(1):65.
  4. Gil-Gouveia R, Dolezil D, Paemeleire K, et al; Sustained benefit of monthly erenumab versus daily oral preventives in episodic migraine patients from the APPRAISE study. ePresentation: EPR-147. 8th Congress of the European Academy of Neurology - Europe 2022, June 25–28, 2022.
  5. Nsaka M, Scheffler A, Wurthmann S, et al. Real-world evidence following a mandatory treatment break after a 1-year prophylactic treatment with calcitonin gene-related peptide (pathway) monoclonal antibodies. Brain Behav. 2022;12(7):e2662.
  6. Overeem LH, Peikert A, Hofacker MD, et al. Effect of antibody switch in non-responders to a CGRP receptor antibody treatment in migraine: A multi-center retrospective cohort study. Cephalalgia. 2022;42(4–5):291–301.
  7. Scheffler A, Schenk H, Wurthmann S, et al. CGRP antibody therapy in patients with drug resistant migraine and chronic daily headache: a real-world experience. J Headache Pain. 2021;22(1):111.
  8. Reuter U, Ehrlich M, Gendolla A, et al. Erenumab versus topiramate for the prevention of migraine — a randomised, double-blind, active-controlled phase 4 trial. Cephalalgia. 2022;42(2):108–18.
  9. Sacco S, Amin FM, Ashina M, et al. European Headache Federation guideline on the use of monoclonal antibodies targeting the calcitonin gene related peptide pathway for migraine prevention – 2022 update. J Headache Pain. 2022;23(1):67.

This symposium was organized and funded by Novartis