Blood Pressure in Migraine Patients Treated With Monoclonal Anti-CGRP (receptor) Antibodies: A Prospective Follow-up Study
Source : https://n.neurology.org/content/early/2022/10/04/WNL.0000000000201008
Background and Objectives: Anti-CGRP (receptor) antibodies are approved as preventive treatment for migraine. Recent concerns have been raised after a retrospective analysis of post-marketing case reports of elevated BP associated with erenumab. In this prospective follow-up study we aimed to assess the safety regarding blood pressure (BP) in a real world setting.
Discussion: The mean systolic and diastolic BP increased after anti-CGRP (receptor) antibodies were started. The majority of patients remained within the normal blood pressure limits, but some patients required antihypertensive treatment. Physicians should be aware that people with migraine may be at risk to develop hypertension when treated with anti-CGRP (receptor) antibodies and this should be added to (inter)national treatment guidelines.
• Source: Journal of Neurology, Neurosurgery, & Psychiatry
• Discussion: “Orthoptic measurements can be used to diagnose MG by quantifying EOM ]extraocular muscle] weakness and fatiguability. Drift during persistent gaze on a Hess chart is specific for MG and could be used for diagnostic purposes. The Hess chart examination is widely available, inexpensive and fast. Moreover, orthoptic measurements may be a clinically relevant outcome measure for clinical trials.”
• Diagnosing ocular MG is difficult due to the paucity of serum antibodies. In the current study, researchers assessed EOM weakness via orthoptic measures such as the adapted Hess chart examination.
• Dutch researchers performed a prospective study in patients with 20 patients with MG (i.e., antibody positive MG) and 14 seronegative MG patients. They assessed orthoptic measures in 19 healthy vs. 18 control participants with Graves orbitopathy, chronic progressive external ophthalmoplegia, or oculopharyngeal muscular dystrophy.
• Increasing dosages from 70 mg to 140 mg did not impact BP levels.
• “Our data suggest that there might be a different effect for renumber than for fremanezumab. Our results seem to demonstrate a larger and more consistent effect on the BP in patients treated with adenoma than in patients treated with fremanezumab,” the authors wrote. “We cannot for certain conclude whether there are indeed differences between these 2 drugs or what the reason for these differences would be. One reason could be that erenumab might have a larger inhibiting effect on the CGRP pathway than fremanezumab, although this seems unlikely given the similar clinical efficacy of both drugs.”
• Limitations of the current study include it being underpowered and the presence of white-coat hypertension.