The importance of an early onset of migraine prevention: an evidence-based, hypothesis-driven scoping literature review - PubMed
Source : https://pubmed.ncbi.nlm.nih.gov/35662957/
Recently approved migraine preventive therapies facilitate rapid control of migraine activity, potentially improving patients' lives and minimizing the societal burden of migraine. This review synthesizes available evidence on rates and timing of early onset of migraine prevention and identifies pat ...
Relevance: Recently approved migraine preventive therapies facilitate rapid control of migraine activity, potentially improving patients' lives and minimizing the societal burden of migraine. This review synthesizes available evidence on rates and timing of early onset of migraine prevention and identifies patient-level outcomes related to early onset prevention.
• Source: Therapeutic Advances in Neurological Disorders
• Conclusion: “No evidence was identified in any publication to support the null hypothesis that patients with migraine do not benefit from an early onset of prevention.”
• Researchers mined 16 peer-reviewed publications for the benefits of early preventive treatment of migraines (i.e., 30 days post administration). This review included two studies of onabotulinumtoxinA in chronic migraine and trial data for the anti-CGRP mAbs erenumab, fremanezumab, galcanezumab, and eptinezumab. These agents were assessed in patients with episodic or chronic migraine.
• Patient-reported data bolstering the early onset of preventive benefit was limited—probably due to no requirement to include these data in the clinical studies. In total, 4 of 16 publications described improvements in disability, function, and quality of life in patients as early as 4 week after beginning treatment.
• Experts typically assess the preventive benefit of treatment after at least 12 weeks of therapy. However, with newer preventive therapies, such as the anti-CGRP mAbs and the chemodenervation agent onabotulinumtoxinA, benefits are claimed within the first week.
• The term “early onset” was not consistently defined in the trial (i.e., Day 1 vs. Day 7).
• Limitations of the current study include lack of predefined endpoints and data derived from secondary or post hoc analysis of phase 2 or phase 3 trials. Additionally, the effect of prevention was infrequently reported via globally prevention, patient-reported outcome measures (PROMs). The investigators did not include data from abstracts or presentations and limited therapies to those approved by the FDA.
• The authors wrote, “A new threshold in clinical effectiveness for migraine preventive treatments may be achievable. Further studies with improved study designs, standardized outcome definitions, and more rigorous methodologies are warranted to fully evaluate the clinically relevant benefits associated with an early onset of prevention in patients with migraine.”