现实生活中药物使用不足:galcanezumab对东南亚中等收入国家实现极低频发作性偏头痛的影响

IF 7.3 1区 医学 Q1 CLINICAL NEUROLOGY
Wanakorn Rattanawong, Prakit Anukoolwittaya, Akarin Hiransuthikul, Thanakit Pongpitakmetha, Auranee Trisataya, Sekh Thanprasertsuk, Alan Rapoport
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引用次数: 0

摘要

背景:偏头痛的进展,特别是从发作性偏头痛到慢性偏头痛(CM),增加了疾病负担和医疗保健费用。了解“用药不足头痛”的新概念应鼓励卫生保健提供者考虑使用降钙素基因相关肽(CGRP)单克隆抗体进行早期干预。在病程早期给予Galcanezumab,可以预防偏头痛的慢性化,并有一个强大的反应,比在偏头痛晚期开始。我们的目的是确定galcanezumab在泰国的真实世界环境中治疗高频发作性偏头痛(HFEM)和CM患者的甚低频发作性偏头痛(VLFEM)的疗效。方法:在2023年至2024年间进行了一项单中心、回顾性、真实世界的队列研究。被诊断为HFEM或CM的18岁或以上的成年人被纳入该试验,并分为两组:galcanezumab和口服偏头痛预防药物(OMPM)。在galcanezumab组,口服预防药物在3个月内逐渐减少。主要结果是两组患者在第3个月和第6个月达到VLFEM的百分比的差异。次要结局包括偏头痛分级改善、持续反应和头痛天数减少的差异。结果:共纳入62例患者,每组31例,中位年龄36.5岁(IQR: 29.0 ~ 48.0),女性占82%。两组患者的基线人口统计学特征无显著差异。与OMPM组相比,galcanezumab组患者达到VLFEM的累积发生率显著高于OMPM组(第3个月时为45.2%对19.4%,第6个月时为52.9%对32.4%,p = 0.03)。6个月的随访后,与接受OMPM的患者相比,接受galcanezumab治疗的HFEM患者更有可能在偏头痛类别中获得任何改善(92.9% vs. 46.7%, p = 0.01)。在15例在第3个月达到VLFEM的患者中,接受galcanezumab的患者中有81.8%(9/11)和接受OMPM的患者中有50.0%(2/4)能够在第6个月维持VLFEM。结论:本研究强调了早期开始抗cgrp治疗的益处,特别是对于头痛天数较少的患者,并强调了中低收入国家可获得偏头痛特异性治疗的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medication underuse in real-life practice: the impact of galcanezumab towards achieving very low frequency episodic migraine in a southeast Asian middle-income nation.

Background: Migraine progression, particularly from episodic to chronic migraine (CM), increases disease burden and healthcare costs. Understanding the new concept of "Medication Underuse Headache" should encourage the health care provider to consider early intervention with calcitonin gene-related peptide (CGRP) monoclonal antibodies. Galcanezumab given early in the course of the disease, may prevent migraine chronification and have a robust response, moreso than when initiated in later stages of migraine. We aimed to determine the efficacy of galcanezumab in achieving very low-frequency episodic migraine (VLFEM) among patients with high-frequency episodic migraine (HFEM) and CM in a real world-setting in Thailand.

Methods: A single-center, retrospective real-world, cohort study was conducted between 2023 and 2024. Adults aged 18 years or more who were diagnosed with HFEM or CM were included in this trial and categorized into two groups: galcanezumab and oral migraine preventive medication (OMPM). In the galcanezumab group, oral preventive medications were slowly tapered off within 3 months. The primary outcome was the differences in percentage of patients achieving VLFEM at months 3 and 6 between the two groups. Secondary outcomes included the differences in migraine class improvement, sustained response, and headache day reduction.

Results: A total of 62 patients (31 in each group) were included: median age was 36.5 (IQR: 29.0-48.0) and 82% were female. There were no significant differences in the baseline demographic features between the two groups. The cumulative incidence of patients achieving VLFEM was significantly higher among the galcanezumab group compared to OMPM group (45.2% vs. 19.4% at month 3 and 52.9% vs. 32.4% at month 6, p = 0.03). After 6 months of follow-up, patients with HFEM who received galcanezumab were significantly more likely to achieve any improvements in migraine class compared to those who received OMPM (92.9% vs. 46.7%, p = 0.01). Among 15 patients who achieved VLFEM at month 3, 81.8% (9/11) of those who received galcanezumab and 50.0% (2/4) of those who received OMPM were able to sustain VLFEM at month 6.

Conclusions: This study emphasizes the benefit of early anti-CGRP therapy initiation, especially in patients with fewer headache days, and highlights the need for accessible migraine-specific treatments in low- to middle-income countries.

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来源期刊
Journal of Headache and Pain
Journal of Headache and Pain 医学-临床神经学
CiteScore
11.80
自引率
13.50%
发文量
143
审稿时长
6-12 weeks
期刊介绍: The Journal of Headache and Pain, a peer-reviewed open-access journal published under the BMC brand, a part of Springer Nature, is dedicated to researchers engaged in all facets of headache and related pain syndromes. It encompasses epidemiology, public health, basic science, translational medicine, clinical trials, and real-world data. With a multidisciplinary approach, The Journal of Headache and Pain addresses headache medicine and related pain syndromes across all medical disciplines. It particularly encourages submissions in clinical, translational, and basic science fields, focusing on pain management, genetics, neurology, and internal medicine. The journal publishes research articles, reviews, letters to the Editor, as well as consensus articles and guidelines, aimed at promoting best practices in managing patients with headaches and related pain.
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