• Pain Med · Mar 2024

    Multicenter Study

    Effectiveness, tolerability and response predictors of preventive anti-CGRP mAbs for migraine in patients over 65 years old: a multicenter real-world case-control study.

    • Alicia Gonzalez-Martinez, Ancor Sanz-García, David García-Azorín, Jaime Rodríguez-Vico, Alex Jaimes, Andrea Gómez García, Javier Casas-Limón, Javier Díaz de Terán, María Sastre-Real, Javier Membrilla, Germán Latorre, Carlos Calle de Miguel, Sendoa Gil Luque, Cristina Trevino-Peinado, Sonia Quintas, Patricia Heredia, Ana Echavarría-Íñiguez, Ángel Guerrero-Peral, Álvaro Sierra, Nuria González-García, Jesús Porta-Etessam, and Ana Beatriz Gago-Veiga.
    • Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid, Madrid 28006, Spain.
    • Pain Med. 2024 Mar 1; 25 (3): 194202194-202.

    ObjectiveTo evaluate clinical characteristics, effectiveness, and tolerability of preventive anti- calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) in the elderly. Anti-CGRP mAbs have demonstrated efficacy and safety in patients with migraine although there is limited information regarding the elderly.DesignWe performed a multicenter case-control study of cases (patients over 65 years old) and controls (sex-matched patients under 55 years old) with migraine receiving anti-CGRP mAbs.MethodsWe included the demographic characteristics, effectiveness-reduction in the number of monthly headache days (MHD) and monthly migraine days (MMD), 30%, 50%, and 75% responder rates-and treatment emergent adverse events (TEAEs). The primary endpoint was the 50% response rate regarding MHD at weeks 20-24; exploratory 50% response predictors in the elderly were evaluated.ResultsIn total, 228 patients were included: 114 cases , 114 controls-. Among cases 84.2% (96/114) were women, 79.8% (91/114) CM; mean age of cases 70.1 years old (range: 66-86); mean age of controls was 42.9 years old(range: 38-49). Cases had a higher percentage of vascular risk factors (P < .05),older age of onset (P < .001) and more reported prior preventive treatments (P < .001). Regarding effectiveness in cases, 50% response rate was achieved by 57.5% (42/73) at 20-24 weeks, with lower reduction in the MHD at 8-12 weeks (5 [7.2], 8 [9.1]; P = .001) and a higher reduction in MMD at 20-24 weeks (10.7 [9.1], 9.2 [7.7]; P = .04) compared to the control group. The percentage of TEAEs was similar in the 2 groups. Diagnosis of episodic migraine (EM) (P = .03) and lower number of MHD at baseline (P = .001) were associated with a 50% response in the elderly in univariate analysis.ConclusionsOur study provides real world evidence of effectiveness and safety of anti-CGRP mAbs for migraine in patients without upper age-limit and possible predictors of anti-CGRP response in the elderly.© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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