• Albert Muñoz-Vendrell, Sergio Campoy, Edoardo Caronna, Alicia Alpuente, Marta Torres-Ferrus, Candela Nieves Castellanos, Marina Olivier, Jaume Campdelacreu, Joan Prat, Javier Camiña Muñiz, Francisco José Molina Martínez, Ane Mínguez-Olaondo, Marta Ruibal Salgado, Sonia Santos Lasaosa, María Pilar Navarro Pérez, Noemí Morollón, Alba López Bravo, Luis Miguel Cano Sánchez, Sonia María García-Sánchez, Jésica García-Ull, Laura Rubio-Flores, Alicia Gonzalez-Martinez, Sonia Quintas, Ana Echavarría Íñiguez, Sendoa Gil Luque, María Victoria Castro-Sánchez, Vanesa Adell Ortega, Jessica García Alhama, Nuria Berrocal-Izquierdo, Robert Belvís, Samuel Díaz-Insa, Patricia Pozo-Rosich, and Mariano Huerta-Villanueva.
• Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de La Feixa Llarga S/N, 08907, Barcelona, Spain. amunoz@bellvitgehospital.cat.
• J Headache Pain. 2023 Jun 2; 24 (1): 6363.

BackgroundAnti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life.MethodsIn this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies.ResultsA total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%).ConclusionsAnti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice.© 2023. The Author(s).

21 keywords...

hide…