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Abstract Details

Real-World Evidence for Control of Patients With Chronic Migraine Who Received Calcitonin Gene?Related Peptide (CGRP) Monoclonal Antibody Therapy Added to OnabotulinumtoxinA Treatment
Headache
Headache Posters (7:00 AM-5:00 PM)
011

Combination use of onabotulinumtoxinA and CGRPmAbs has the potential to be more effective than either treatment alone for CM prevention.

To collect real-world data to gain improved understanding of safety, tolerability, and potential benefits of adding CGRP monoclonal antibody therapy (CGRPmAb) to onabotulinumtoxinA treatment in patients with chronic migraine (CM).

This retrospective, longitudinal chart review included adults with CM treated at 1 clinic (October 2018–November 2019) with ≥2 consecutive onabotulinumtoxinA cycles before ≥1 month of onabotulinumtoxinA plus CGRPmAb (erenumab, fremanezumab, or galcanezumab) combination treatment. Charts at time of first CGRPmAb prescription (index date/baseline) and up to 4 visits over ≤12 months post-index were reviewed for safety/tolerability (adverse events [AEs], discontinuations) and outcome measures (monthly headache days [MHDs], headache intensity, migraine-related disability).

Of 300 charts reviewed, 257 patients met eligibility criteria (mean age: 50 years; 82% women). The most frequently prescribed CGRPmAb was erenumab (78%), followed by galcanezumab (16%) and fremanezumab (6%). Patients discontinued CGRPmAb more than onabotulinumtoxinA (23% vs 3%). AEs were reported in 28% of patients; the most common AE was constipation (9%). Mean MHDs were 21.5 days before initiating onabotulinumtoxinA and 12.1 days before adding CGRPmAb. After ~6 months of combination use, positive changes from baseline were noted: 82% of patients had decreased MHDs, 70% had reduced headache intensity, and 57% had improved migraine-related disability. Statistically significant decreases in MHDs from baseline occurred at all visits, with clinically significant mean decreases of 3.5–4.0 MHDs following ~6–12 months of combination treatment.

This real-world study of CM patients demonstrated clinically meaningful treatment benefits with onabotulinumtoxinA alone and additive benefits after adding CGRPmAb. Combination therapy was well tolerated with no new safety signals identified. More real-world studies and controlled trials are needed to further quantify potential benefits of this multimodal treatment paradigm.

Authors/Disclosures
Andrew M. Blumenfeld, MD, FAAN (The Los Angeles Headache Center)
PRESENTER
Dr. Blumenfeld has received personal compensation for serving as an employee of The Los Angeles Headache Center. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Allergan. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Best Doctors. Dr. Blumenfeld has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. Dr. Blumenfeld has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GLG. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theranica. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Aeon. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Revance. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lilly. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Abbvie. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aeon. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Revance. Dr. Blumenfeld has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Blumenfeld has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Axsome. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Speakers Bureau for Allergan. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. Dr. Blumenfeld has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Teva. Dr. Blumenfeld has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Lilly. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Lundbeck.
Benjamin M. Frishberg, MD, FAAN (The Neurology Center of Southern California) Dr. Frishberg has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BMS. Dr. Frishberg has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for novartis. Dr. Frishberg has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for genentech. Dr. Frishberg has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Lilly. Dr. Frishberg has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Roche. Dr. Frishberg has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Allergan. Dr. Frishberg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Lundbeck. Dr. Frishberg has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novartis. Dr. Frishberg has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for BMS. Dr. Frishberg has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biogen. Dr. Frishberg has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi. Dr. Frishberg has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven. Dr. Frishberg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Viela-Bio. Dr. Frishberg has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Horizon. Dr. Frishberg has received personal compensation in the range of $5,000-$9,999 for serving as an officer or member of the Board of Directors for Headache Cooperative of the Pacific. Dr. Frishberg has a non-compensated relationship as a Delegate with AMA that is relevant to AAN interests or activities.
Jack D. Schim, MD, FAAN Dr. Schim has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Aeon, Abbvie, Amgen, Biohaven, electroCore, Impel, Lilly, Lundbeck, Novartis, Promius, Revance, Teva, Upsher-Smith. Dr. Schim has received personal compensation in the range of $100,000-$499,999 for serving on a Speakers Bureau for Allergan, Amgen, Biohaven, electroCore, Lilly, Lundbeck, Novartis, Promius, Teva, Theranica, Upsher-Smith.
Ashley Iannone Ashley Iannone has nothing to disclose.
Larisa Yedigarova Larisa Yedigarova has received personal compensation for serving as an employee of AbbVie. Larisa Yedigarova has received stock or an ownership interest from AbbVie.
Aubrey Adams, PhD Dr. Manack Adams has received personal compensation for serving as an employee of Abbvie. Dr. Manack Adams has stock in Abbvie.