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Abstract Details

Real-World Evidence for Control of Chronic Migraine (CM) in Patients Meeting American Headache Society (AHS) Criteria Who Received Calcitonin Gene?Related Peptide Monoclonal Antibody (CGRPmAb) Therapy Added to OnabotulinumtoxinA Treatment
Headache
Headache Posters (7:00 AM-5:00 PM)
012

Combination use of onabotulinumtoxinA and CGRPmAbs has potential to be more effective than each therapy alone for CM prevention. In the primary analysis cohort, records from 257 adults with CM receiving onabotulinumtoxinA along with CGRPmAb showed that combination therapy was well tolerated and associated with additional reductions in monthly headache days (MHDs) and migraine-related disability (MIDAS). To better understand the applicability of these findings, a sensitivity analysis was conducted in a cohort aligned to the AHS position statement (Headache. 2019;59:1).

To evaluate real-world safety and potential benefits of adding CGRPmAb to onabotulinumtoxinA treatment in patients with CM.

This was a retrospective, longitudinal chart review of 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. Patients in the sensitivity analysis  cohort had ≥4 MHDs and MIDAS >11 or HIT-6 >50 score at baseline. Charts at CGRPmAb prescription visit (baseline) and ≤4 subsequent visits over ≤~12 months were reviewed for adverse events (AEs), discontinuations, MHDs, and MIDAS.

Of 300 charts reviewed, 172 patients met AHS criteria (mean age: 50 years; 83% women); 78% received erenumab (galcanezumab 17%; fremanezumab 5%). More patients discontinued CGRPmAbs than onabotulinumtoxinA (24% vs 3%). AEs were reported in 27% of patients; the most common was constipation (10%). Mean MHDs were 21.4 before initiating onabotulinumtoxinA and 13.4 before adding CGRPmAb (baseline). MHDs significantly decreased from baseline at all visits (mean decrease at ~6 months: 3.9 days [95% CI: −5.0,−2.7]). After ~6 months, ≥58% had clinically meaningful MIDAS improvement (≥5-point decrease).

Combination use of onabotulinumtoxinA and CGRPmAb demonstrated clinically meaningful improvements in headache frequency and migraine-related disability compared with onabotulinumtoxinA alone in patients with high baseline MHDs and disability treated according to AHS guidance.

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.