Key clinical point: Migraine was significantly associated with fetal-type posterior cerebral artery (PCA) status in patients with ischemic stroke.

Major finding: Fetal-type PCA status was independently associated with migraine (adjusted odds ratio [aOR] 2.06; P = .005). The other factors independently associated with migraine were hypertension (aOR 1.97; P = .011), female gender (aOR 2.03; P = .017) and National Institutes of Health Stroke Scale score at admission (aOR 1.08; P = .018).

Study details: This cross-sectional study included 750 patients aged ≥18 years with ischemic stroke, of which 11.3% had migraine history.

Disclosures: This study received no specific funding. The authors declared no conflicts of interest.

Source: Zhang Y et al. The association between migraine and fetal-type posterior cerebral artery in patients with ischemic stroke. Cerebrovasc Dis. 2022 (May 13). Doi: 10.1159/000524616

Key clinical point: Migraine was significantly associated with fetal-type posterior cerebral artery (PCA) status in patients with ischemic stroke.

Major finding: Fetal-type PCA status was independently associated with migraine (adjusted odds ratio [aOR] 2.06; P = .005). The other factors independently associated with migraine were hypertension (aOR 1.97; P = .011), female gender (aOR 2.03; P = .017) and National Institutes of Health Stroke Scale score at admission (aOR 1.08; P = .018).

Study details: This cross-sectional study included 750 patients aged ≥18 years with ischemic stroke, of which 11.3% had migraine history.

Disclosures: This study received no specific funding. The authors declared no conflicts of interest.

Source: Zhang Y et al. The association between migraine and fetal-type posterior cerebral artery in patients with ischemic stroke. Cerebrovasc Dis. 2022 (May 13). Doi: 10.1159/000524616

Key clinical point: Migraine was significantly associated with fetal-type posterior cerebral artery (PCA) status in patients with ischemic stroke.

Major finding: Fetal-type PCA status was independently associated with migraine (adjusted odds ratio [aOR] 2.06; P = .005). The other factors independently associated with migraine were hypertension (aOR 1.97; P = .011), female gender (aOR 2.03; P = .017) and National Institutes of Health Stroke Scale score at admission (aOR 1.08; P = .018).

Study details: This cross-sectional study included 750 patients aged ≥18 years with ischemic stroke, of which 11.3% had migraine history.

Disclosures: This study received no specific funding. The authors declared no conflicts of interest.

Source: Zhang Y et al. The association between migraine and fetal-type posterior cerebral artery in patients with ischemic stroke. Cerebrovasc Dis. 2022 (May 13). Doi: 10.1159/000524616

Key clinical point: Erenumab is effective and well tolerated in patients with chronic migraine who did not respond to previous migraine treatments.

Major finding: Overall, 71.4% of patients treated with erenumab achieved ≥30% reduction in monthly migraine days from baseline to 9-12 weeks and 34.0% of patients at all assessment periods through 52 weeks. Constipation was the most common adverse event and 13.7% of patients discontinued treatment because of a lack of tolerability.

Study details: The data come from a 52-week, prospective, observational study including 300 patients with chronic migraine who received ≥1 dose of erenumab, of which 273 and 119 patients completed 12 and 52 weeks of treatment, respectively.

Disclosures: This study was funded by and conducted in collaboration with Novartis Pharma AG, Basel, Switzerland. Some authors reported being consultants, speakers, or scientific advisors for or receiving personal fees from various sources, including Novartis. Two authors declared being employees of and holding stocks in Novartis.

Source: Cullum CK et al. Real-world long-term efficacy and safety of erenumab in adults with chronic migraine: A 52-week, single-center, prospective, observational study. J Headache Pain. 2022;23(1):61 Jun 2). Doi: 10.1186/s10194-022-01433-9

Key clinical point: Erenumab is effective and well tolerated in patients with chronic migraine who did not respond to previous migraine treatments.

Major finding: Overall, 71.4% of patients treated with erenumab achieved ≥30% reduction in monthly migraine days from baseline to 9-12 weeks and 34.0% of patients at all assessment periods through 52 weeks. Constipation was the most common adverse event and 13.7% of patients discontinued treatment because of a lack of tolerability.

Study details: The data come from a 52-week, prospective, observational study including 300 patients with chronic migraine who received ≥1 dose of erenumab, of which 273 and 119 patients completed 12 and 52 weeks of treatment, respectively.

Disclosures: This study was funded by and conducted in collaboration with Novartis Pharma AG, Basel, Switzerland. Some authors reported being consultants, speakers, or scientific advisors for or receiving personal fees from various sources, including Novartis. Two authors declared being employees of and holding stocks in Novartis.

Source: Cullum CK et al. Real-world long-term efficacy and safety of erenumab in adults with chronic migraine: A 52-week, single-center, prospective, observational study. J Headache Pain. 2022;23(1):61 Jun 2). Doi: 10.1186/s10194-022-01433-9

Key clinical point: Erenumab is effective and well tolerated in patients with chronic migraine who did not respond to previous migraine treatments.

Major finding: Overall, 71.4% of patients treated with erenumab achieved ≥30% reduction in monthly migraine days from baseline to 9-12 weeks and 34.0% of patients at all assessment periods through 52 weeks. Constipation was the most common adverse event and 13.7% of patients discontinued treatment because of a lack of tolerability.

Study details: The data come from a 52-week, prospective, observational study including 300 patients with chronic migraine who received ≥1 dose of erenumab, of which 273 and 119 patients completed 12 and 52 weeks of treatment, respectively.

Disclosures: This study was funded by and conducted in collaboration with Novartis Pharma AG, Basel, Switzerland. Some authors reported being consultants, speakers, or scientific advisors for or receiving personal fees from various sources, including Novartis. Two authors declared being employees of and holding stocks in Novartis.

Source: Cullum CK et al. Real-world long-term efficacy and safety of erenumab in adults with chronic migraine: A 52-week, single-center, prospective, observational study. J Headache Pain. 2022;23(1):61 Jun 2). Doi: 10.1186/s10194-022-01433-9

Key clinical point: Intravenous (IV) ketorolac plus metoclopramide failed to improve pain intensity in children presenting to the emergency department (ED) for the acute treatment of migraine compared with metoclopramide monotherapy.

Major finding: The mean change in pain intensity as assessed by a 100 mm Visual Analog Scale at 120 minutes was −44 mm (95% CI 32-57 mm) in the monotherapy group and −36 mm (95% CI 23-49 mm) in the ketorolac group, corresponding to a mean difference of 8 mm between the groups (P = .355), with no significant between-group difference in headache recurrence and adverse events.

Study details: Findings are from a double-blind, randomized placebo-controlled trial including 53 children aged 6-17 years presenting to the ED for the acute treatment of migraine. They were randomly assigned to receive IV ketorolac plus metoclopramide (n = 26) or IV metoclopramide plus placebo (n = 27).

Disclosures: This study was funded by the Canadian Institutes of Health Research through a Drug Safety and Effectiveness Network grant. The authors declared no conflicts of interest.

Source: Richer LP et al. A randomized trial of ketorolac and metoclopramide for migraine in the emergency department. Headache. 2022 ; 62: 681-689 (Jun 7). Doi: 10.1111/head.14307

Key clinical point: Intravenous (IV) ketorolac plus metoclopramide failed to improve pain intensity in children presenting to the emergency department (ED) for the acute treatment of migraine compared with metoclopramide monotherapy.

Major finding: The mean change in pain intensity as assessed by a 100 mm Visual Analog Scale at 120 minutes was −44 mm (95% CI 32-57 mm) in the monotherapy group and −36 mm (95% CI 23-49 mm) in the ketorolac group, corresponding to a mean difference of 8 mm between the groups (P = .355), with no significant between-group difference in headache recurrence and adverse events.

Study details: Findings are from a double-blind, randomized placebo-controlled trial including 53 children aged 6-17 years presenting to the ED for the acute treatment of migraine. They were randomly assigned to receive IV ketorolac plus metoclopramide (n = 26) or IV metoclopramide plus placebo (n = 27).

Disclosures: This study was funded by the Canadian Institutes of Health Research through a Drug Safety and Effectiveness Network grant. The authors declared no conflicts of interest.

Source: Richer LP et al. A randomized trial of ketorolac and metoclopramide for migraine in the emergency department. Headache. 2022 ; 62: 681-689 (Jun 7). Doi: 10.1111/head.14307

Key clinical point: Intravenous (IV) ketorolac plus metoclopramide failed to improve pain intensity in children presenting to the emergency department (ED) for the acute treatment of migraine compared with metoclopramide monotherapy.

Major finding: The mean change in pain intensity as assessed by a 100 mm Visual Analog Scale at 120 minutes was −44 mm (95% CI 32-57 mm) in the monotherapy group and −36 mm (95% CI 23-49 mm) in the ketorolac group, corresponding to a mean difference of 8 mm between the groups (P = .355), with no significant between-group difference in headache recurrence and adverse events.

Study details: Findings are from a double-blind, randomized placebo-controlled trial including 53 children aged 6-17 years presenting to the ED for the acute treatment of migraine. They were randomly assigned to receive IV ketorolac plus metoclopramide (n = 26) or IV metoclopramide plus placebo (n = 27).

Disclosures: This study was funded by the Canadian Institutes of Health Research through a Drug Safety and Effectiveness Network grant. The authors declared no conflicts of interest.

Source: Richer LP et al. A randomized trial of ketorolac and metoclopramide for migraine in the emergency department. Headache. 2022 ; 62: 681-689 (Jun 7). Doi: 10.1111/head.14307

Key clinical point: Patients hospitalized with refractory chronic migraine treated with continuous multiday lidocaine infusions showed a significant improvement in pain immediately after the infusion, with some patients maintaining this improvement at 1 month.

Major finding: Median pain ratings decreased from 7.0 on admission to 1.0 at discharge (P < .001), with 87.8% of admissions being cases of acute response. Among acute responders with data on average pain, 43.2% demonstrated sustained response at 1 month.

Study details: The data come from a retrospective cohort study of 609 hospital admissions involving 537 patients with refractory chronic migraine who received continuous multiday lidocaine infusions.

Disclosures: This study did not receive any specific funding. SD Silberstein declared serving as a consultant and advisory panel member for and receiving honoraria from various sources.

Source: Schwenk ES et al. Lidocaine infusions for refractory chronic migraine: A retrospective analysis. Reg Anesth Pain Med. 2022;47:408-413 (May 23). Doi: 10.1136/rapm-2021-103180

Key clinical point: Patients hospitalized with refractory chronic migraine treated with continuous multiday lidocaine infusions showed a significant improvement in pain immediately after the infusion, with some patients maintaining this improvement at 1 month.

Major finding: Median pain ratings decreased from 7.0 on admission to 1.0 at discharge (P < .001), with 87.8% of admissions being cases of acute response. Among acute responders with data on average pain, 43.2% demonstrated sustained response at 1 month.

Study details: The data come from a retrospective cohort study of 609 hospital admissions involving 537 patients with refractory chronic migraine who received continuous multiday lidocaine infusions.

Disclosures: This study did not receive any specific funding. SD Silberstein declared serving as a consultant and advisory panel member for and receiving honoraria from various sources.

Source: Schwenk ES et al. Lidocaine infusions for refractory chronic migraine: A retrospective analysis. Reg Anesth Pain Med. 2022;47:408-413 (May 23). Doi: 10.1136/rapm-2021-103180

Key clinical point: Patients hospitalized with refractory chronic migraine treated with continuous multiday lidocaine infusions showed a significant improvement in pain immediately after the infusion, with some patients maintaining this improvement at 1 month.

Major finding: Median pain ratings decreased from 7.0 on admission to 1.0 at discharge (P < .001), with 87.8% of admissions being cases of acute response. Among acute responders with data on average pain, 43.2% demonstrated sustained response at 1 month.

Study details: The data come from a retrospective cohort study of 609 hospital admissions involving 537 patients with refractory chronic migraine who received continuous multiday lidocaine infusions.

Disclosures: This study did not receive any specific funding. SD Silberstein declared serving as a consultant and advisory panel member for and receiving honoraria from various sources.

Source: Schwenk ES et al. Lidocaine infusions for refractory chronic migraine: A retrospective analysis. Reg Anesth Pain Med. 2022;47:408-413 (May 23). Doi: 10.1136/rapm-2021-103180

Key clinical point: Cold interventions, including cold-gel headband, cold-gel cap, and intraoral cooling, provide instant relief from pain in patients with migraine; however, their long-term effects on pain are not significant.

Major finding: The cold intervention group vs. control group led to a significant reduction in pain on a visual analog scale score at 30 minutes (standard mean difference [SMD] −3.21; P = .02) but a nonsignificant reduction in the score at 24 hours (SMD −0.44; P = .07) after the intervention.

Study details: This was a meta-analysis of 6 studies (4 randomized controlled trials and 2 quasi-experimental studies) that included adult patients with migraine who underwent a cold intervention.

Disclosures: The study was partially sponsored by the Ministry of Science and Technology, Israel. The authors declared no conflicts of interest.

Source: Hsu Y-Y et al. Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis. J Clin Nurs. 2022 (May 20). Doi: 10.1111/jocn.16368

Key clinical point: Cold interventions, including cold-gel headband, cold-gel cap, and intraoral cooling, provide instant relief from pain in patients with migraine; however, their long-term effects on pain are not significant.

Major finding: The cold intervention group vs. control group led to a significant reduction in pain on a visual analog scale score at 30 minutes (standard mean difference [SMD] −3.21; P = .02) but a nonsignificant reduction in the score at 24 hours (SMD −0.44; P = .07) after the intervention.

Study details: This was a meta-analysis of 6 studies (4 randomized controlled trials and 2 quasi-experimental studies) that included adult patients with migraine who underwent a cold intervention.

Disclosures: The study was partially sponsored by the Ministry of Science and Technology, Israel. The authors declared no conflicts of interest.

Source: Hsu Y-Y et al. Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis. J Clin Nurs. 2022 (May 20). Doi: 10.1111/jocn.16368

Key clinical point: Cold interventions, including cold-gel headband, cold-gel cap, and intraoral cooling, provide instant relief from pain in patients with migraine; however, their long-term effects on pain are not significant.

Major finding: The cold intervention group vs. control group led to a significant reduction in pain on a visual analog scale score at 30 minutes (standard mean difference [SMD] −3.21; P = .02) but a nonsignificant reduction in the score at 24 hours (SMD −0.44; P = .07) after the intervention.

Study details: This was a meta-analysis of 6 studies (4 randomized controlled trials and 2 quasi-experimental studies) that included adult patients with migraine who underwent a cold intervention.

Disclosures: The study was partially sponsored by the Ministry of Science and Technology, Israel. The authors declared no conflicts of interest.

Source: Hsu Y-Y et al. Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis. J Clin Nurs. 2022 (May 20). Doi: 10.1111/jocn.16368

Key clinical point: As a migraine preventive agent, fremanezumab is effective across the full patient spectrum, including those with episodic migraine (EM), chronic migraine (CM), and difficult-to-treat (DTT) migraine (patients with medication overuse [MO], major depressive disorder [MDD], generalized anxiety disorder [GAD], or exposure to a different calcitonin gene-related peptide monoclonal antibody [CGRP mAb]).

Major finding: At month 6, the mean monthly migraine days reduced in patients with EM (−7.7 days), CM (−10.1 days), MO (−10.8 days), MDD (−9.9 days), GAD (−9.5 days), and prior CGRP mAb exposure (−9.0 days).

Study details: Findings are from a retrospective, online chart review study that collected data from 1003 patients with EM/CM aged ≥18 years at fremanezumab initiation, including those with DTT migraine, and 421 clinicians treating patients with EM/CM in a US-based practice.

Disclosures: This study was funded by Teva Pharmaceuticals. All authors declared being current or former employees of Teva Pharmaceuticals or Analysis Group, which performed these analyses funded by Teva.

Source: Driessen MT et al. Real-world effectiveness after initiating fremanezumab treatment in US patients with episodic and chronic migraine or difficult-to-treat migraine. J Headache Pain. 2022;23:56 (May 16). Doi: 10.1186/s10194-022-01415-x

Key clinical point: As a migraine preventive agent, fremanezumab is effective across the full patient spectrum, including those with episodic migraine (EM), chronic migraine (CM), and difficult-to-treat (DTT) migraine (patients with medication overuse [MO], major depressive disorder [MDD], generalized anxiety disorder [GAD], or exposure to a different calcitonin gene-related peptide monoclonal antibody [CGRP mAb]).

Major finding: At month 6, the mean monthly migraine days reduced in patients with EM (−7.7 days), CM (−10.1 days), MO (−10.8 days), MDD (−9.9 days), GAD (−9.5 days), and prior CGRP mAb exposure (−9.0 days).

Study details: Findings are from a retrospective, online chart review study that collected data from 1003 patients with EM/CM aged ≥18 years at fremanezumab initiation, including those with DTT migraine, and 421 clinicians treating patients with EM/CM in a US-based practice.

Disclosures: This study was funded by Teva Pharmaceuticals. All authors declared being current or former employees of Teva Pharmaceuticals or Analysis Group, which performed these analyses funded by Teva.

Source: Driessen MT et al. Real-world effectiveness after initiating fremanezumab treatment in US patients with episodic and chronic migraine or difficult-to-treat migraine. J Headache Pain. 2022;23:56 (May 16). Doi: 10.1186/s10194-022-01415-x

Key clinical point: As a migraine preventive agent, fremanezumab is effective across the full patient spectrum, including those with episodic migraine (EM), chronic migraine (CM), and difficult-to-treat (DTT) migraine (patients with medication overuse [MO], major depressive disorder [MDD], generalized anxiety disorder [GAD], or exposure to a different calcitonin gene-related peptide monoclonal antibody [CGRP mAb]).

Major finding: At month 6, the mean monthly migraine days reduced in patients with EM (−7.7 days), CM (−10.1 days), MO (−10.8 days), MDD (−9.9 days), GAD (−9.5 days), and prior CGRP mAb exposure (−9.0 days).

Study details: Findings are from a retrospective, online chart review study that collected data from 1003 patients with EM/CM aged ≥18 years at fremanezumab initiation, including those with DTT migraine, and 421 clinicians treating patients with EM/CM in a US-based practice.

Disclosures: This study was funded by Teva Pharmaceuticals. All authors declared being current or former employees of Teva Pharmaceuticals or Analysis Group, which performed these analyses funded by Teva.

Source: Driessen MT et al. Real-world effectiveness after initiating fremanezumab treatment in US patients with episodic and chronic migraine or difficult-to-treat migraine. J Headache Pain. 2022;23:56 (May 16). Doi: 10.1186/s10194-022-01415-x

Key clinical point: A dose of 120 mg  galcanezumab  subcutaneously safely and effectively reduces headache frequency, intensity, and duration in patients with episodic and chronic migraine and previous unsuccessful preventive treatments.

Major finding: The 6-month galcanezumab treatment led to a significant decrease in the headache attack frequency (−14.19 headache days/month; P < .001), headache attack pain intensity (numerical rating scale score −2.74; P < .001), and headache attack duration (−6.65 hours; P < .001).

Study details: The data come from an observational, prospective study including 43 patients with episodic high frequency and chronic migraine and unsuccessful treatment with ≥3 preventive medication classes who received monthly 120 mg galcanezumab subcutaneously.

Disclosures: This study received no specific funding. Some authors declared receiving speaker honoraria and travel funding from various sources and serving as associate editors of neurology journals such as European Journal of Neurology.

Source: Silvestro M et al. Galcanezumab effect on “whole pain burden” and multidimensional outcomes in migraine patients with previous unsuccessful treatments: A real-world experience. J Headache Pain. 2022;23:69 (Jun 13. Doi:  10.1186/s10194-022-01436-6

Key clinical point: A dose of 120 mg  galcanezumab  subcutaneously safely and effectively reduces headache frequency, intensity, and duration in patients with episodic and chronic migraine and previous unsuccessful preventive treatments.

Major finding: The 6-month galcanezumab treatment led to a significant decrease in the headache attack frequency (−14.19 headache days/month; P < .001), headache attack pain intensity (numerical rating scale score −2.74; P < .001), and headache attack duration (−6.65 hours; P < .001).

Study details: The data come from an observational, prospective study including 43 patients with episodic high frequency and chronic migraine and unsuccessful treatment with ≥3 preventive medication classes who received monthly 120 mg galcanezumab subcutaneously.

Disclosures: This study received no specific funding. Some authors declared receiving speaker honoraria and travel funding from various sources and serving as associate editors of neurology journals such as European Journal of Neurology.

Source: Silvestro M et al. Galcanezumab effect on “whole pain burden” and multidimensional outcomes in migraine patients with previous unsuccessful treatments: A real-world experience. J Headache Pain. 2022;23:69 (Jun 13. Doi:  10.1186/s10194-022-01436-6

Key clinical point: A dose of 120 mg  galcanezumab  subcutaneously safely and effectively reduces headache frequency, intensity, and duration in patients with episodic and chronic migraine and previous unsuccessful preventive treatments.

Major finding: The 6-month galcanezumab treatment led to a significant decrease in the headache attack frequency (−14.19 headache days/month; P < .001), headache attack pain intensity (numerical rating scale score −2.74; P < .001), and headache attack duration (−6.65 hours; P < .001).

Study details: The data come from an observational, prospective study including 43 patients with episodic high frequency and chronic migraine and unsuccessful treatment with ≥3 preventive medication classes who received monthly 120 mg galcanezumab subcutaneously.

Disclosures: This study received no specific funding. Some authors declared receiving speaker honoraria and travel funding from various sources and serving as associate editors of neurology journals such as European Journal of Neurology.

Source: Silvestro M et al. Galcanezumab effect on “whole pain burden” and multidimensional outcomes in migraine patients with previous unsuccessful treatments: A real-world experience. J Headache Pain. 2022;23:69 (Jun 13. Doi:  10.1186/s10194-022-01436-6

Key clinical point: A higher dose of onabotulinumtoxinA (Botox®) may decrease the number of headache and severe headache days in patients with chronic migraine who had an unsatisfactory response to the conventional 150-unit dose.

Major finding: After receiving 3 rounds of 200 units onabotulinumtoxinA, patients had a significant reduction in headache (13.62 ± 10.79 to 11.02 ± 10.61) and severe headache (5.88 ± 6.73 to 4.01 ± 4.89) days (both P < .001).

Study details: This retrospective paired comparison study included 175 patients with chronic migraine who received ≥3 rounds of 150 units onabotulinumtoxinA followed by ≥3 rounds of 200 units onabotulinumtoxinA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Zandieh A, Cutrer FM. OnabotulinumtoxinA in chronic migraine: Is the response dose dependent? BMC Neurol. 2022;22:218 (Jun 13). Doi: 10.1186/s12883-022-02742-x

Key clinical point: A higher dose of onabotulinumtoxinA (Botox®) may decrease the number of headache and severe headache days in patients with chronic migraine who had an unsatisfactory response to the conventional 150-unit dose.

Major finding: After receiving 3 rounds of 200 units onabotulinumtoxinA, patients had a significant reduction in headache (13.62 ± 10.79 to 11.02 ± 10.61) and severe headache (5.88 ± 6.73 to 4.01 ± 4.89) days (both P < .001).

Study details: This retrospective paired comparison study included 175 patients with chronic migraine who received ≥3 rounds of 150 units onabotulinumtoxinA followed by ≥3 rounds of 200 units onabotulinumtoxinA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Zandieh A, Cutrer FM. OnabotulinumtoxinA in chronic migraine: Is the response dose dependent? BMC Neurol. 2022;22:218 (Jun 13). Doi: 10.1186/s12883-022-02742-x

Key clinical point: A higher dose of onabotulinumtoxinA (Botox®) may decrease the number of headache and severe headache days in patients with chronic migraine who had an unsatisfactory response to the conventional 150-unit dose.

Major finding: After receiving 3 rounds of 200 units onabotulinumtoxinA, patients had a significant reduction in headache (13.62 ± 10.79 to 11.02 ± 10.61) and severe headache (5.88 ± 6.73 to 4.01 ± 4.89) days (both P < .001).

Study details: This retrospective paired comparison study included 175 patients with chronic migraine who received ≥3 rounds of 150 units onabotulinumtoxinA followed by ≥3 rounds of 200 units onabotulinumtoxinA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Zandieh A, Cutrer FM. OnabotulinumtoxinA in chronic migraine: Is the response dose dependent? BMC Neurol. 2022;22:218 (Jun 13). Doi: 10.1186/s12883-022-02742-x

As states ban or limit abortion in the wake of the demise of Roe v. Wade, physicians are turning their attention to widely-used drugs that can cause birth defects. At issue: Should these drugs still be prescribed to women of childbearing age if they don’t have the option of terminating their pregnancies?

javi_indy/ Thinkstock

“Doctors are going to understandably be terrified that a patient may become pregnant using a teratogen that they have prescribed,” said University of Pittsburgh rheumatologist Mehret Birru Talabi, MD, PhD, who works in a state where the future of abortion rights is uncertain. “While this was a feared outcome before Roe v. Wade was overturned, abortion provided an escape hatch by which women could avoid having to continue a pregnancy and potentially raise a child with congenital anomalies. I believe that prescribing is going to become much more defensive and conservative. Some clinicians may choose not to prescribe these medications to patients who have childbearing potential, even if they don’t have much risk for pregnancy.”

Other physicians expressed similar concerns in interviews. Duke University, Durham, N.C., rheumatologist Megan E. B. Clowse, MD, MPH, fears that physicians will be wary of prescribing a variety of medications – including new ones for which there are few pregnancy data – if abortion is unavailable. “Women who receive these new or teratogenic medications will likely lose their reproductive autonomy and be forced to choose between having sexual relationships with men, obtaining procedures that make them permanently sterile, or using contraception that may cause intolerable side effects,” she said. “I am very concerned that young women with rheumatic disease will now be left with active disease resulting in joint damage and renal failure.”

Abortion is now banned in at least six states, according to The New York Times. That number may rise to 16 as more restrictions become law. Another five states aren’t expected to ban abortion soon but have implemented gestational age limits on abortion or are expected to adopt them. In another nine states, courts or lawmakers will decide whether abortion remains legal.

Only 20 states and the District of Columbia have firm abortion protections in place.

Numerous drugs are considered teratogens, which means they may cause birth defects. Thalidomide is the most infamous, but there are many more, including several used in rheumatology, dermatology, and gastroenterology. Among the most widely used teratogenic medications are the acne drugs isotretinoin and methotrexate, which are used to treat a variety of conditions, such as cancer, rheumatoid arthritis, and psoriasis.

Dr. Clowse, who helps manage an industry-supported website devoted to reproductive care for women with lupus (www.LupusPregnancy.org), noted that several drugs linked to birth defects and pregnancy loss are commonly prescribed in rheumatology.

“Methotrexate is the most common medication and has been the cornerstone of rheumatoid arthritis [treatment] for at least two decades,” she said. “Mycophenolate is our best medication to treat lupus nephritis, which is inflammation in the kidneys caused by lupus. This is a common complication for young women with lupus, and all of our guideline-recommended treatment regimens include a medication that causes pregnancy loss and birth defects, either mycophenolate or cyclophosphamide.”

Rheumatologists also prescribe a large number of new drugs for which there are few data about pregnancy risks. “It typically takes about two decades to have sufficient data about the safety of our medications,” she said.

Reflecting the sensitivity of the topic, Dr. Clowse made clear that her opinions don’t represent the views of her institution. She works in North Carolina, where the fate of abortion rights is uncertain, according to The New York Times.

What about alternatives? “The short answer is that some of these medications work really well and sometimes much better than the nonteratogenic alternatives,” said Dr. Birru Talabi. “I’m worried about methotrexate. It has been used to induce abortions but is primarily used in the United States as a highly effective treatment for cancer as well as a myriad of rheumatic diseases. If legislators try to restrict access to methotrexate, we may see increasing disability and even death among people who need this medication but cannot access it.”

Rheumatologists aren’t the only physicians who are worrying about the fates of their patients in a new era of abortion restrictions. Gastroenterologist Sunanda Kane, MD, MSPH, of the Mayo Clinic, Rochester, Minn., said several teratogenic medications are used in her field to treat constipation, viral hepatitis, and inflammatory bowel disease.

“When treating women of childbearing age, there are usually alternatives. If we do prescribe a medication with a high teratogenic potential, we counsel and document that we have discussed two forms of birth control to avoid pregnancy. We usually do not prescribe a drug with teratogenic potential with the ‘out’ being an abortion if a pregnancy does occur,” she said. However, “if abortion is not even on the table as an option, we may be much less likely to prescribe these medications. This will be particularly true in patients who clearly do not have the means to travel to have an abortion in any situation.”

Abortion is expected to remain legal in Minnesota, where Dr. Kane practices, but it may be restricted or banned in nearby Wisconsin, depending on the state legislature. None of her patients have had abortions after becoming pregnant while taking the medications, she said, although she “did have a patient who because of her religious faith did not have an abortion after exposure and ended up with a stillbirth.”

The crackdown on abortion won’t just pose risks to patients who take potentially dangerous medications, physicians said. Dr. Kane said pregnancy itself is a significant risk for patients with “very active, uncontrolled gastrointestinal conditions where a pregnancy could be harmful to the mother’s health or result in offspring that are very unhealthy.” These include decompensated cirrhosis, uncontrolled Crohn’s disease or ulcerative colitis, refractory gastroparesis, uncontrolled celiac sprue, and chronic pancreatitis, she said.

“There have been times when after shared decisionmaking, a patient with very active inflammatory bowel disease has decided to terminate the pregnancy because of her own ongoing health issues,” she said. “Not having this option will potentially lead to disastrous results.”

Dr. Clowse, the Duke University rheumatologist, echoed Dr. Kane’s concerns about women who are too sick to bear children. “The removal of abortion rights puts the lives and quality of life for women with rheumatic disease at risk. For patients with lupus and other systemic rheumatic disease, pregnancy can be medically catastrophic, leading to permanent harm and even death to the woman and her offspring. I am worried that women in these conditions will die without lifesaving pregnancy terminations, due to worries about the legal consequences for their physicians.”

The U.S. Supreme Court’s ruling that overturned Roe v. Wade has also raised the prospect that the court could ultimately allow birth control to be restricted or outlawed.

While the ruling states that “nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion,” Justice Clarence Thomas wrote a concurrence in which he said that the court should reconsider a 1960s ruling that forbids the banning of contraceptives. Republicans have dismissed concerns about bans being allowed, although Democrats, including the president and vice president, starkly warn that they could happen.

“If we as providers have to be concerned that there will be an unplanned pregnancy because of the lack of access to contraception,” Dr. Kane said, “this will have significant downstream consequences to the kind of care we can provide and might just drive some providers to not give care to female patients at all given this concern.”

The physicians quoted in this article report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

As states ban or limit abortion in the wake of the demise of Roe v. Wade, physicians are turning their attention to widely-used drugs that can cause birth defects. At issue: Should these drugs still be prescribed to women of childbearing age if they don’t have the option of terminating their pregnancies?

javi_indy/ Thinkstock

“Doctors are going to understandably be terrified that a patient may become pregnant using a teratogen that they have prescribed,” said University of Pittsburgh rheumatologist Mehret Birru Talabi, MD, PhD, who works in a state where the future of abortion rights is uncertain. “While this was a feared outcome before Roe v. Wade was overturned, abortion provided an escape hatch by which women could avoid having to continue a pregnancy and potentially raise a child with congenital anomalies. I believe that prescribing is going to become much more defensive and conservative. Some clinicians may choose not to prescribe these medications to patients who have childbearing potential, even if they don’t have much risk for pregnancy.”

Other physicians expressed similar concerns in interviews. Duke University, Durham, N.C., rheumatologist Megan E. B. Clowse, MD, MPH, fears that physicians will be wary of prescribing a variety of medications – including new ones for which there are few pregnancy data – if abortion is unavailable. “Women who receive these new or teratogenic medications will likely lose their reproductive autonomy and be forced to choose between having sexual relationships with men, obtaining procedures that make them permanently sterile, or using contraception that may cause intolerable side effects,” she said. “I am very concerned that young women with rheumatic disease will now be left with active disease resulting in joint damage and renal failure.”

Abortion is now banned in at least six states, according to The New York Times. That number may rise to 16 as more restrictions become law. Another five states aren’t expected to ban abortion soon but have implemented gestational age limits on abortion or are expected to adopt them. In another nine states, courts or lawmakers will decide whether abortion remains legal.

Only 20 states and the District of Columbia have firm abortion protections in place.

Numerous drugs are considered teratogens, which means they may cause birth defects. Thalidomide is the most infamous, but there are many more, including several used in rheumatology, dermatology, and gastroenterology. Among the most widely used teratogenic medications are the acne drugs isotretinoin and methotrexate, which are used to treat a variety of conditions, such as cancer, rheumatoid arthritis, and psoriasis.

Dr. Clowse, who helps manage an industry-supported website devoted to reproductive care for women with lupus (www.LupusPregnancy.org), noted that several drugs linked to birth defects and pregnancy loss are commonly prescribed in rheumatology.

“Methotrexate is the most common medication and has been the cornerstone of rheumatoid arthritis [treatment] for at least two decades,” she said. “Mycophenolate is our best medication to treat lupus nephritis, which is inflammation in the kidneys caused by lupus. This is a common complication for young women with lupus, and all of our guideline-recommended treatment regimens include a medication that causes pregnancy loss and birth defects, either mycophenolate or cyclophosphamide.”

Rheumatologists also prescribe a large number of new drugs for which there are few data about pregnancy risks. “It typically takes about two decades to have sufficient data about the safety of our medications,” she said.

Reflecting the sensitivity of the topic, Dr. Clowse made clear that her opinions don’t represent the views of her institution. She works in North Carolina, where the fate of abortion rights is uncertain, according to The New York Times.

What about alternatives? “The short answer is that some of these medications work really well and sometimes much better than the nonteratogenic alternatives,” said Dr. Birru Talabi. “I’m worried about methotrexate. It has been used to induce abortions but is primarily used in the United States as a highly effective treatment for cancer as well as a myriad of rheumatic diseases. If legislators try to restrict access to methotrexate, we may see increasing disability and even death among people who need this medication but cannot access it.”

Rheumatologists aren’t the only physicians who are worrying about the fates of their patients in a new era of abortion restrictions. Gastroenterologist Sunanda Kane, MD, MSPH, of the Mayo Clinic, Rochester, Minn., said several teratogenic medications are used in her field to treat constipation, viral hepatitis, and inflammatory bowel disease.

“When treating women of childbearing age, there are usually alternatives. If we do prescribe a medication with a high teratogenic potential, we counsel and document that we have discussed two forms of birth control to avoid pregnancy. We usually do not prescribe a drug with teratogenic potential with the ‘out’ being an abortion if a pregnancy does occur,” she said. However, “if abortion is not even on the table as an option, we may be much less likely to prescribe these medications. This will be particularly true in patients who clearly do not have the means to travel to have an abortion in any situation.”

Abortion is expected to remain legal in Minnesota, where Dr. Kane practices, but it may be restricted or banned in nearby Wisconsin, depending on the state legislature. None of her patients have had abortions after becoming pregnant while taking the medications, she said, although she “did have a patient who because of her religious faith did not have an abortion after exposure and ended up with a stillbirth.”

The crackdown on abortion won’t just pose risks to patients who take potentially dangerous medications, physicians said. Dr. Kane said pregnancy itself is a significant risk for patients with “very active, uncontrolled gastrointestinal conditions where a pregnancy could be harmful to the mother’s health or result in offspring that are very unhealthy.” These include decompensated cirrhosis, uncontrolled Crohn’s disease or ulcerative colitis, refractory gastroparesis, uncontrolled celiac sprue, and chronic pancreatitis, she said.

“There have been times when after shared decisionmaking, a patient with very active inflammatory bowel disease has decided to terminate the pregnancy because of her own ongoing health issues,” she said. “Not having this option will potentially lead to disastrous results.”

Dr. Clowse, the Duke University rheumatologist, echoed Dr. Kane’s concerns about women who are too sick to bear children. “The removal of abortion rights puts the lives and quality of life for women with rheumatic disease at risk. For patients with lupus and other systemic rheumatic disease, pregnancy can be medically catastrophic, leading to permanent harm and even death to the woman and her offspring. I am worried that women in these conditions will die without lifesaving pregnancy terminations, due to worries about the legal consequences for their physicians.”

The U.S. Supreme Court’s ruling that overturned Roe v. Wade has also raised the prospect that the court could ultimately allow birth control to be restricted or outlawed.

While the ruling states that “nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion,” Justice Clarence Thomas wrote a concurrence in which he said that the court should reconsider a 1960s ruling that forbids the banning of contraceptives. Republicans have dismissed concerns about bans being allowed, although Democrats, including the president and vice president, starkly warn that they could happen.

“If we as providers have to be concerned that there will be an unplanned pregnancy because of the lack of access to contraception,” Dr. Kane said, “this will have significant downstream consequences to the kind of care we can provide and might just drive some providers to not give care to female patients at all given this concern.”

The physicians quoted in this article report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

As states ban or limit abortion in the wake of the demise of Roe v. Wade, physicians are turning their attention to widely-used drugs that can cause birth defects. At issue: Should these drugs still be prescribed to women of childbearing age if they don’t have the option of terminating their pregnancies?

javi_indy/ Thinkstock

“Doctors are going to understandably be terrified that a patient may become pregnant using a teratogen that they have prescribed,” said University of Pittsburgh rheumatologist Mehret Birru Talabi, MD, PhD, who works in a state where the future of abortion rights is uncertain. “While this was a feared outcome before Roe v. Wade was overturned, abortion provided an escape hatch by which women could avoid having to continue a pregnancy and potentially raise a child with congenital anomalies. I believe that prescribing is going to become much more defensive and conservative. Some clinicians may choose not to prescribe these medications to patients who have childbearing potential, even if they don’t have much risk for pregnancy.”

Other physicians expressed similar concerns in interviews. Duke University, Durham, N.C., rheumatologist Megan E. B. Clowse, MD, MPH, fears that physicians will be wary of prescribing a variety of medications – including new ones for which there are few pregnancy data – if abortion is unavailable. “Women who receive these new or teratogenic medications will likely lose their reproductive autonomy and be forced to choose between having sexual relationships with men, obtaining procedures that make them permanently sterile, or using contraception that may cause intolerable side effects,” she said. “I am very concerned that young women with rheumatic disease will now be left with active disease resulting in joint damage and renal failure.”

Abortion is now banned in at least six states, according to The New York Times. That number may rise to 16 as more restrictions become law. Another five states aren’t expected to ban abortion soon but have implemented gestational age limits on abortion or are expected to adopt them. In another nine states, courts or lawmakers will decide whether abortion remains legal.

Only 20 states and the District of Columbia have firm abortion protections in place.

Numerous drugs are considered teratogens, which means they may cause birth defects. Thalidomide is the most infamous, but there are many more, including several used in rheumatology, dermatology, and gastroenterology. Among the most widely used teratogenic medications are the acne drugs isotretinoin and methotrexate, which are used to treat a variety of conditions, such as cancer, rheumatoid arthritis, and psoriasis.

Dr. Clowse, who helps manage an industry-supported website devoted to reproductive care for women with lupus (www.LupusPregnancy.org), noted that several drugs linked to birth defects and pregnancy loss are commonly prescribed in rheumatology.

“Methotrexate is the most common medication and has been the cornerstone of rheumatoid arthritis [treatment] for at least two decades,” she said. “Mycophenolate is our best medication to treat lupus nephritis, which is inflammation in the kidneys caused by lupus. This is a common complication for young women with lupus, and all of our guideline-recommended treatment regimens include a medication that causes pregnancy loss and birth defects, either mycophenolate or cyclophosphamide.”

Rheumatologists also prescribe a large number of new drugs for which there are few data about pregnancy risks. “It typically takes about two decades to have sufficient data about the safety of our medications,” she said.

Reflecting the sensitivity of the topic, Dr. Clowse made clear that her opinions don’t represent the views of her institution. She works in North Carolina, where the fate of abortion rights is uncertain, according to The New York Times.

What about alternatives? “The short answer is that some of these medications work really well and sometimes much better than the nonteratogenic alternatives,” said Dr. Birru Talabi. “I’m worried about methotrexate. It has been used to induce abortions but is primarily used in the United States as a highly effective treatment for cancer as well as a myriad of rheumatic diseases. If legislators try to restrict access to methotrexate, we may see increasing disability and even death among people who need this medication but cannot access it.”

Rheumatologists aren’t the only physicians who are worrying about the fates of their patients in a new era of abortion restrictions. Gastroenterologist Sunanda Kane, MD, MSPH, of the Mayo Clinic, Rochester, Minn., said several teratogenic medications are used in her field to treat constipation, viral hepatitis, and inflammatory bowel disease.

“When treating women of childbearing age, there are usually alternatives. If we do prescribe a medication with a high teratogenic potential, we counsel and document that we have discussed two forms of birth control to avoid pregnancy. We usually do not prescribe a drug with teratogenic potential with the ‘out’ being an abortion if a pregnancy does occur,” she said. However, “if abortion is not even on the table as an option, we may be much less likely to prescribe these medications. This will be particularly true in patients who clearly do not have the means to travel to have an abortion in any situation.”

Abortion is expected to remain legal in Minnesota, where Dr. Kane practices, but it may be restricted or banned in nearby Wisconsin, depending on the state legislature. None of her patients have had abortions after becoming pregnant while taking the medications, she said, although she “did have a patient who because of her religious faith did not have an abortion after exposure and ended up with a stillbirth.”

The crackdown on abortion won’t just pose risks to patients who take potentially dangerous medications, physicians said. Dr. Kane said pregnancy itself is a significant risk for patients with “very active, uncontrolled gastrointestinal conditions where a pregnancy could be harmful to the mother’s health or result in offspring that are very unhealthy.” These include decompensated cirrhosis, uncontrolled Crohn’s disease or ulcerative colitis, refractory gastroparesis, uncontrolled celiac sprue, and chronic pancreatitis, she said.

“There have been times when after shared decisionmaking, a patient with very active inflammatory bowel disease has decided to terminate the pregnancy because of her own ongoing health issues,” she said. “Not having this option will potentially lead to disastrous results.”

Dr. Clowse, the Duke University rheumatologist, echoed Dr. Kane’s concerns about women who are too sick to bear children. “The removal of abortion rights puts the lives and quality of life for women with rheumatic disease at risk. For patients with lupus and other systemic rheumatic disease, pregnancy can be medically catastrophic, leading to permanent harm and even death to the woman and her offspring. I am worried that women in these conditions will die without lifesaving pregnancy terminations, due to worries about the legal consequences for their physicians.”

The U.S. Supreme Court’s ruling that overturned Roe v. Wade has also raised the prospect that the court could ultimately allow birth control to be restricted or outlawed.

While the ruling states that “nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion,” Justice Clarence Thomas wrote a concurrence in which he said that the court should reconsider a 1960s ruling that forbids the banning of contraceptives. Republicans have dismissed concerns about bans being allowed, although Democrats, including the president and vice president, starkly warn that they could happen.

“If we as providers have to be concerned that there will be an unplanned pregnancy because of the lack of access to contraception,” Dr. Kane said, “this will have significant downstream consequences to the kind of care we can provide and might just drive some providers to not give care to female patients at all given this concern.”

The physicians quoted in this article report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: Patients with inflammatory bowel disease (IBD) who consumed processed meat more frequently had a higher mortality risk; however, no such association was observed for the consumption of other types of meat.

Major finding: The risk for all-cause mortality was higher in patients with IBD who consumed processed meat >4.0 vs. 0-0.9 times/week (hazard ratio 1.52; 95% CI 1.05-2.19; P trend for each 25 g increment = .075). However, the consumption of fish, unprocessed poultry, and unprocessed red meat had no significant association with mortality.

Study details: Findings are from a retrospective cohort analysis of 5763 patients with IBD from the UK Biobank cohort.

Disclosures: This study was funded by the National Natural Science Foundation of China. X Wang declared receiving research grants. The other authors declared no conflicts of interest.

Source: Chen H, Fu T. Dan L, et al. Meat consumption and all-cause mortality in 5763 patients with inflammatory bowel disease: A retrospective cohort study. EClinicalMedicine. 2022;47:101406 (Apr 21). Doi: 10.1016/j.eclinm.2022.101406

Key clinical point: Patients with inflammatory bowel disease (IBD) who consumed processed meat more frequently had a higher mortality risk; however, no such association was observed for the consumption of other types of meat.

Major finding: The risk for all-cause mortality was higher in patients with IBD who consumed processed meat >4.0 vs. 0-0.9 times/week (hazard ratio 1.52; 95% CI 1.05-2.19; P trend for each 25 g increment = .075). However, the consumption of fish, unprocessed poultry, and unprocessed red meat had no significant association with mortality.

Study details: Findings are from a retrospective cohort analysis of 5763 patients with IBD from the UK Biobank cohort.

Disclosures: This study was funded by the National Natural Science Foundation of China. X Wang declared receiving research grants. The other authors declared no conflicts of interest.

Source: Chen H, Fu T. Dan L, et al. Meat consumption and all-cause mortality in 5763 patients with inflammatory bowel disease: A retrospective cohort study. EClinicalMedicine. 2022;47:101406 (Apr 21). Doi: 10.1016/j.eclinm.2022.101406

Key clinical point: Patients with inflammatory bowel disease (IBD) who consumed processed meat more frequently had a higher mortality risk; however, no such association was observed for the consumption of other types of meat.

Major finding: The risk for all-cause mortality was higher in patients with IBD who consumed processed meat >4.0 vs. 0-0.9 times/week (hazard ratio 1.52; 95% CI 1.05-2.19; P trend for each 25 g increment = .075). However, the consumption of fish, unprocessed poultry, and unprocessed red meat had no significant association with mortality.

Study details: Findings are from a retrospective cohort analysis of 5763 patients with IBD from the UK Biobank cohort.

Disclosures: This study was funded by the National Natural Science Foundation of China. X Wang declared receiving research grants. The other authors declared no conflicts of interest.

Source: Chen H, Fu T. Dan L, et al. Meat consumption and all-cause mortality in 5763 patients with inflammatory bowel disease: A retrospective cohort study. EClinicalMedicine. 2022;47:101406 (Apr 21). Doi: 10.1016/j.eclinm.2022.101406