Ten fewer days of migraine per month in people over 65 thanks to antibody therapy

2023-06-26 12:48:35

A multicenter study led by the Bellvitge University Hospital (HUB) and the Neurological and Neurogenetic Diseases Research Group of the Bellvitge Biomedical Research Institute (IDIBELL) in which 18 participated Headache units of hospitals throughout Spain determines that the anti-CGRP drugs They are also effective and safe in people over 65 years of age.

Having that information was a pending subject, since this patient profile was excluded from clinical trials. Now it has been shown that this treatment represents a safe and effective therapeutic option for the management of chronic migraine in these patients.

Anti-CGRP antibodies are drugs available since 2019 that precisely block CGRP, a protein involved in pain processes and vasodilation associated with migraine. Due to their specific action on the protein, they are very well tolerated and effective without effects at other levels (except constipation, because the protein is also found in the neurons of the digestive system), since they block the pain pathway associated with migraine.

The results of the multicenter study, published this June in the scientific journal The Journal of Headache and Pain, determine that 60% of the patients have presented a reduction of more than 50% of days they suffered migraine. An observational study of real life has been carried out, with a sample of 162 patients74.1% of whom were women.

After six months of treatment with any monoclonal antibody (erenumab, galcanezumab and fremanezumab), patients have gone from an average of 18 migraine days per month to just eight. These results are comparable to what was already known about monoclonal antibodies in the general population. Regarding the adverse effects on the older than 65 yearsfewer have been detected with the administration of fremanezumab.

In parallel, the frequencies of headaches and the consumption of analgesics in the sample of patients in the study led by the Hospital de Bellvitge have been significantly reduced and the clinical evaluation scales have improved.

Therapeutic arsenal for a chronic ailment

“Migraine is a genetic disease that fluctuates throughout life. In elderly patients, who have not been adequately controlled, there is an increased risk of chronology for the time of evolutionfor having failed more preventive treatments and for the associated comorbidity,” he explained. Albert Muñoz-Vendrellneurologist at the Headache Unit at Bellvitge Hospital and IDIBELL researcher.

Until now, people over the age of 65 have not been included in clinical trials of monoclonal antibodies, so it was not known if they were as effective as for younger patients.

“The hypothesis was that they could suffer from more safety problems, since CGRP is a vasodilator and, theoretically, if the protein is blocked, there could be a increased cardiovascular risk in elderly patients with hypertension, dyslipidemia, or a history of previous cardiovascular events”, according to the neurologist. This latest study clears up the pending doubts about these treatments that expand the current approach to migraine, with good tolerance and safety.

In Catalonia alone, the team calculates that close to 900,000 people suffer from migraine. They are, above all, women in ages youths. Although the prevalence is lower in those over 65 years of age, comorbidity and chronicity may limit the prescription and response to treatment. The impact of migraine on the quality of life of patients is very serious, since migraine attacks represent almost complete disability, because the symptoms are not limited to headache, but also associated intolerance to external stimuli, activity physical and nausea.

In fact, the WHO considers it the sixth most disabling disease in the world and is the second leading cause of disability among neurological diseases, only behind stroke.

Reference:

Muñoz-Vendrell, A.et al. “Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients”. The Journal of Headache and Pain (2023).

Fuente:

Bellvitge University Hospital

Rights: Creative Commons.