Effectiveness of Anti-Calcitonin Gene-Related Peptide Medication in Vestibular Migraine: A Retrospective Cohort Study in an Asian Population.

IF 7.4 2区医学 Q1 CLINICAL NEUROLOGY

CNS drugs Pub Date : 2024-08-01 Epub Date: 2024-05-29 DOI:10.1007/s40263-024-01094-z

Teppei Kouga, Toru Miwa, Kishiko Sunami, Yoshiaki Itoh

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引用次数: 0

Abstract

Background: Migraine and dizziness often coexist, with vestibular migraine (VM) presenting with vestibular symptoms and headaches. Calcitonin gene-related peptide (CGRP) may be involved in motion-induced symptoms; however, studies on the use of anti-CGRP monoclonal antibodies (mAbs) for the treatment of VM have yielded conflicting results. This study aimed to clarify the effectiveness of anti-CGRP mAbs in VM treatment.

Methods: This retrospective observational cohort study, conducted between 1 January 2021 and 31 March 2023, assessed 12 Japanese patients with VM who were treated with anti-CGRP mAbs (CGRP group) for 6 months and 11 Japanese patients who received standard of care for VM and served as controls. Clinical questionnaires and equilibrium tests were administered, with primary outcomes including changes in Dizziness Handicap Inventory (DHI) scores compared with baseline values. Objective variables included the DHI score and explanatory variables included demographic data, balance test results, head-up tilt (HUT) test results, vestibular test results and questionnaire survey results. Analysis of variance was used to assess the treatment effects of anti-CGRP mAbs, and multivariate regression analysis was performed to identify mAb responders.

Results: After 6 months, the CGRP group showed significant improvements in DHI scores [0 versus 6 months, odds ratio (95% confidence interval): 22.01 (0.13-43.88)] and number of vertigo/dizziness attacks per month [0 versus 6 months: 10.28 (2.80-17.76)]. No significant difference was observed in the control group [DHI scores, 0 versus 6 months: 0.65 (-26.84 to 28.14); number of vertigo/dizziness attacks per month, 0 versus 6 months: - 8.07 (- 23.77 to 7.62)]. Multivariate regression analysis showed that autonomic function at baseline was associated with mAb response in patients [β estimates (95% confidence interval): 3.63 (0.21-7.06)].

Conclusions: Treatment with anti-CGRP mAbs was more effective than conventional treatment in preventing migraine in patients with VM. While the identified factors associated with treatment responsiveness offer valuable insights into personalised treatment approaches, further prospective studies are warranted to validate the findings due to our study's retrospective design and limited sample size.

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抗降钙素基因相关肽药物对前庭性偏头痛的疗效：亚洲人群的回顾性队列研究》。

背景：偏头痛和头晕常常同时存在，前庭性偏头痛（VM）表现为前庭症状和头痛。降钙素基因相关肽（CGRP）可能与运动诱发症状有关；然而，关于使用抗CGRP单克隆抗体（mAbs）治疗VM的研究结果却相互矛盾。本研究旨在明确抗 CGRP mAbs 在治疗血管瘤中的有效性：这项回顾性观察队列研究在 2021 年 1 月 1 日至 2023 年 3 月 31 日期间进行，评估了 12 名接受抗 CGRP mAbs（CGRP 组）治疗 6 个月的日本血管瘤患者，以及 11 名接受标准疗法治疗的日本血管瘤患者作为对照组。研究人员进行了临床问卷调查和平衡测试，主要结果包括头晕障碍量表（DHI）评分与基线值相比的变化。客观变量包括 DHI 分数，解释变量包括人口统计学数据、平衡测试结果、仰头倾斜（HUT）测试结果、前庭测试结果和问卷调查结果。方差分析用于评估抗CGRP mAb的治疗效果，多变量回归分析用于识别mAb应答者：6个月后，CGRP组的DHI评分[0与6个月相比，几率比（95%置信区间）：22.01（0.13-43.88）]和每月眩晕/头晕发作次数[0与6个月相比：10.28（2.80-17.76）]均有显著改善。在对照组中未观察到明显差异[DHI 评分，0 对 6 个月：0.65 (-26.84)] ：0.65 (-26.84 to 28.14)；每月眩晕/头晕发作次数，0 对 6 个月：- 8.07（-23.77 至 7.62）]。多变量回归分析显示，基线时的自主神经功能与患者的mAb反应有关[β估计值（95%置信区间）：3.63（0.21-7.06）]：抗CGRP mAb治疗在预防VM患者偏头痛方面比常规治疗更有效。虽然已确定的与治疗反应性相关的因素为个性化治疗方法提供了有价值的见解，但由于我们的研究是回顾性设计，样本量有限，因此有必要开展进一步的前瞻性研究来验证研究结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS drugs 医学-精神病学

CiteScore

12.00

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.