Clinical Edge Journal Scan

Key clinical point: High dietary intake of sodium, estimated according to 24-hour urinary sodium excretion, was associated with a greater likelihood of atopic dermatitis (AD) diagnosis, having active AD, and increasing severity of AD.

Major finding: A 1-g increase in estimated 24-hour urine sodium excretion was associated with an increased likelihood of AD (adjusted odds ratio [aOR] 1.11; 95% CI 1.07-1.14), active AD (aOR 1.16; 95% CI 1.05-1.28), and increasing AD severity (aOR 1.11; 95% CI 1.07-1.15).

Study details: This cross-sectional study evaluated the association between high levels of dietary sodium intake and AD prevalence, activity, and severity in 215,832 adults from the UK Biobank cohort, of whom 10,839 had AD.

Disclosures: This study was supported by grants from the Medical Student in Aging Research Program and US National Institute on Aging and by the National Eczema Association. One author declared receiving research funding to her institution and consulting fees from various sources.

Source: Chiang BM, Ye M, Chattopadhyay A, et al. Sodium intake and atopic dermatitis. JAMA Dermatol. 2024 (Jun 5). doi: 10.1001/jamadermatol.2024.1544 Source

Key clinical point: High dietary intake of sodium, estimated according to 24-hour urinary sodium excretion, was associated with a greater likelihood of atopic dermatitis (AD) diagnosis, having active AD, and increasing severity of AD.

Major finding: A 1-g increase in estimated 24-hour urine sodium excretion was associated with an increased likelihood of AD (adjusted odds ratio [aOR] 1.11; 95% CI 1.07-1.14), active AD (aOR 1.16; 95% CI 1.05-1.28), and increasing AD severity (aOR 1.11; 95% CI 1.07-1.15).

Study details: This cross-sectional study evaluated the association between high levels of dietary sodium intake and AD prevalence, activity, and severity in 215,832 adults from the UK Biobank cohort, of whom 10,839 had AD.

Disclosures: This study was supported by grants from the Medical Student in Aging Research Program and US National Institute on Aging and by the National Eczema Association. One author declared receiving research funding to her institution and consulting fees from various sources.

Source: Chiang BM, Ye M, Chattopadhyay A, et al. Sodium intake and atopic dermatitis. JAMA Dermatol. 2024 (Jun 5). doi: 10.1001/jamadermatol.2024.1544 Source

Key clinical point: High dietary intake of sodium, estimated according to 24-hour urinary sodium excretion, was associated with a greater likelihood of atopic dermatitis (AD) diagnosis, having active AD, and increasing severity of AD.

Major finding: A 1-g increase in estimated 24-hour urine sodium excretion was associated with an increased likelihood of AD (adjusted odds ratio [aOR] 1.11; 95% CI 1.07-1.14), active AD (aOR 1.16; 95% CI 1.05-1.28), and increasing AD severity (aOR 1.11; 95% CI 1.07-1.15).

Study details: This cross-sectional study evaluated the association between high levels of dietary sodium intake and AD prevalence, activity, and severity in 215,832 adults from the UK Biobank cohort, of whom 10,839 had AD.

Disclosures: This study was supported by grants from the Medical Student in Aging Research Program and US National Institute on Aging and by the National Eczema Association. One author declared receiving research funding to her institution and consulting fees from various sources.

Source: Chiang BM, Ye M, Chattopadhyay A, et al. Sodium intake and atopic dermatitis. JAMA Dermatol. 2024 (Jun 5). doi: 10.1001/jamadermatol.2024.1544 Source

A hot topic of PsA research is whether treating psoriasis patients with biologics reduces the risk of developing PsA. Floris and colleagues analyzed data from 1023 patients with psoriasis aged 18 years or older, of whom 29.6% received biologics at least once and 21.0% had PsA. They observed that patients treated at least once vs never treated with biologics had a significantly lower risk for PsA. The "protective" effect of biologics against PsA persisted irrespective of the class of biologic used. However, the study has many built-in biases; it was not a prospective study of psoriasis patients without PsA, but rather a retrospective analysis of data collected at enrollment. Nevertheless, effective psoriasis therapies may indeed reduce the risk for PsA; prospective interventional studies are required and are currently underway.

Development of radiographic damage indicates severe PsA and affects quality of life and physical function. Identifying patients at risk for joint damage may help treatment stratification. Using data from a real-world cohort of 476 patients with early PsA, of whom 14% demonstrated progressive radiographic damage, Koc and colleagues found that female sex was a protective factor whereas old age and initial radiographic damage were risk factors for radiographic progression. These results are consistent with previous studies. Male sex, older age, and presence of radiographic damage at first visit should prompt more aggressive management to prevent further joint damage.

Regarding newer treatments, Gossec and colleagues demonstrated that bimekizumab, a monoclonal antibody targeting both interleukin (IL)-17A and IL-17F, improved disease effects in a rapid and sustained manner in patients with PsA who had not used biologic disease-modifying antirheumatic drugs or had prior inadequate response to tumor necrosis factor inhibitors. Bimekizumab is a welcome addition to the drugs available to manage PsA. Its comparative efficacy against other targeted therapies, especially other IL-17 inhibitors, is yet to be determined.

Finally, a study from the Greek multicenter PsA registry by Vassilakis and colleagues showed that, of 467 patients with PsA, 16.5% had D2T PsA. Compared with non–D2T patients, those with D2T disease were more likely to have extensive psoriasis at diagnosis, higher body mass index, and a history of inflammatory bowel disease (IBD). Treatment-resistant disease is increasingly prevalent in PsA. Certain diseases and comorbidities, such as IBD and obesity, are associated with D2T PsA. A uniform definition of D2T PsA and prospective studies to identify risk factors, as well as new strategies to manage D2T PsA, are required.

A hot topic of PsA research is whether treating psoriasis patients with biologics reduces the risk of developing PsA. Floris and colleagues analyzed data from 1023 patients with psoriasis aged 18 years or older, of whom 29.6% received biologics at least once and 21.0% had PsA. They observed that patients treated at least once vs never treated with biologics had a significantly lower risk for PsA. The "protective" effect of biologics against PsA persisted irrespective of the class of biologic used. However, the study has many built-in biases; it was not a prospective study of psoriasis patients without PsA, but rather a retrospective analysis of data collected at enrollment. Nevertheless, effective psoriasis therapies may indeed reduce the risk for PsA; prospective interventional studies are required and are currently underway.

Development of radiographic damage indicates severe PsA and affects quality of life and physical function. Identifying patients at risk for joint damage may help treatment stratification. Using data from a real-world cohort of 476 patients with early PsA, of whom 14% demonstrated progressive radiographic damage, Koc and colleagues found that female sex was a protective factor whereas old age and initial radiographic damage were risk factors for radiographic progression. These results are consistent with previous studies. Male sex, older age, and presence of radiographic damage at first visit should prompt more aggressive management to prevent further joint damage.

Regarding newer treatments, Gossec and colleagues demonstrated that bimekizumab, a monoclonal antibody targeting both interleukin (IL)-17A and IL-17F, improved disease effects in a rapid and sustained manner in patients with PsA who had not used biologic disease-modifying antirheumatic drugs or had prior inadequate response to tumor necrosis factor inhibitors. Bimekizumab is a welcome addition to the drugs available to manage PsA. Its comparative efficacy against other targeted therapies, especially other IL-17 inhibitors, is yet to be determined.

Finally, a study from the Greek multicenter PsA registry by Vassilakis and colleagues showed that, of 467 patients with PsA, 16.5% had D2T PsA. Compared with non–D2T patients, those with D2T disease were more likely to have extensive psoriasis at diagnosis, higher body mass index, and a history of inflammatory bowel disease (IBD). Treatment-resistant disease is increasingly prevalent in PsA. Certain diseases and comorbidities, such as IBD and obesity, are associated with D2T PsA. A uniform definition of D2T PsA and prospective studies to identify risk factors, as well as new strategies to manage D2T PsA, are required.

A hot topic of PsA research is whether treating psoriasis patients with biologics reduces the risk of developing PsA. Floris and colleagues analyzed data from 1023 patients with psoriasis aged 18 years or older, of whom 29.6% received biologics at least once and 21.0% had PsA. They observed that patients treated at least once vs never treated with biologics had a significantly lower risk for PsA. The "protective" effect of biologics against PsA persisted irrespective of the class of biologic used. However, the study has many built-in biases; it was not a prospective study of psoriasis patients without PsA, but rather a retrospective analysis of data collected at enrollment. Nevertheless, effective psoriasis therapies may indeed reduce the risk for PsA; prospective interventional studies are required and are currently underway.

Development of radiographic damage indicates severe PsA and affects quality of life and physical function. Identifying patients at risk for joint damage may help treatment stratification. Using data from a real-world cohort of 476 patients with early PsA, of whom 14% demonstrated progressive radiographic damage, Koc and colleagues found that female sex was a protective factor whereas old age and initial radiographic damage were risk factors for radiographic progression. These results are consistent with previous studies. Male sex, older age, and presence of radiographic damage at first visit should prompt more aggressive management to prevent further joint damage.

Regarding newer treatments, Gossec and colleagues demonstrated that bimekizumab, a monoclonal antibody targeting both interleukin (IL)-17A and IL-17F, improved disease effects in a rapid and sustained manner in patients with PsA who had not used biologic disease-modifying antirheumatic drugs or had prior inadequate response to tumor necrosis factor inhibitors. Bimekizumab is a welcome addition to the drugs available to manage PsA. Its comparative efficacy against other targeted therapies, especially other IL-17 inhibitors, is yet to be determined.

Finally, a study from the Greek multicenter PsA registry by Vassilakis and colleagues showed that, of 467 patients with PsA, 16.5% had D2T PsA. Compared with non–D2T patients, those with D2T disease were more likely to have extensive psoriasis at diagnosis, higher body mass index, and a history of inflammatory bowel disease (IBD). Treatment-resistant disease is increasingly prevalent in PsA. Certain diseases and comorbidities, such as IBD and obesity, are associated with D2T PsA. A uniform definition of D2T PsA and prospective studies to identify risk factors, as well as new strategies to manage D2T PsA, are required.

A hot topic of PsA research is whether treating psoriasis patients with biologics reduces the risk of developing PsA. Floris and colleagues analyzed data from 1023 patients with psoriasis aged 18 years or older, of whom 29.6% received biologics at least once and 21.0% had PsA. They observed that patients treated at least once vs never treated with biologics had a significantly lower risk for PsA. The "protective" effect of biologics against PsA persisted irrespective of the class of biologic used. However, the study has many built-in biases; it was not a prospective study of psoriasis patients without PsA, but rather a retrospective analysis of data collected at enrollment. Nevertheless, effective psoriasis therapies may indeed reduce the risk for PsA; prospective interventional studies are required and are currently underway.

Development of radiographic damage indicates severe PsA and affects quality of life and physical function. Identifying patients at risk for joint damage may help treatment stratification. Using data from a real-world cohort of 476 patients with early PsA, of whom 14% demonstrated progressive radiographic damage, Koc and colleagues found that female sex was a protective factor whereas old age and initial radiographic damage were risk factors for radiographic progression. These results are consistent with previous studies. Male sex, older age, and presence of radiographic damage at first visit should prompt more aggressive management to prevent further joint damage.

Regarding newer treatments, Gossec and colleagues demonstrated that bimekizumab, a monoclonal antibody targeting both interleukin (IL)-17A and IL-17F, improved disease effects in a rapid and sustained manner in patients with PsA who had not used biologic disease-modifying antirheumatic drugs or had prior inadequate response to tumor necrosis factor inhibitors. Bimekizumab is a welcome addition to the drugs available to manage PsA. Its comparative efficacy against other targeted therapies, especially other IL-17 inhibitors, is yet to be determined.

Finally, a study from the Greek multicenter PsA registry by Vassilakis and colleagues showed that, of 467 patients with PsA, 16.5% had D2T PsA. Compared with non–D2T patients, those with D2T disease were more likely to have extensive psoriasis at diagnosis, higher body mass index, and a history of inflammatory bowel disease (IBD). Treatment-resistant disease is increasingly prevalent in PsA. Certain diseases and comorbidities, such as IBD and obesity, are associated with D2T PsA. A uniform definition of D2T PsA and prospective studies to identify risk factors, as well as new strategies to manage D2T PsA, are required.

A hot topic of PsA research is whether treating psoriasis patients with biologics reduces the risk of developing PsA. Floris and colleagues analyzed data from 1023 patients with psoriasis aged 18 years or older, of whom 29.6% received biologics at least once and 21.0% had PsA. They observed that patients treated at least once vs never treated with biologics had a significantly lower risk for PsA. The "protective" effect of biologics against PsA persisted irrespective of the class of biologic used. However, the study has many built-in biases; it was not a prospective study of psoriasis patients without PsA, but rather a retrospective analysis of data collected at enrollment. Nevertheless, effective psoriasis therapies may indeed reduce the risk for PsA; prospective interventional studies are required and are currently underway.

Development of radiographic damage indicates severe PsA and affects quality of life and physical function. Identifying patients at risk for joint damage may help treatment stratification. Using data from a real-world cohort of 476 patients with early PsA, of whom 14% demonstrated progressive radiographic damage, Koc and colleagues found that female sex was a protective factor whereas old age and initial radiographic damage were risk factors for radiographic progression. These results are consistent with previous studies. Male sex, older age, and presence of radiographic damage at first visit should prompt more aggressive management to prevent further joint damage.

Regarding newer treatments, Gossec and colleagues demonstrated that bimekizumab, a monoclonal antibody targeting both interleukin (IL)-17A and IL-17F, improved disease effects in a rapid and sustained manner in patients with PsA who had not used biologic disease-modifying antirheumatic drugs or had prior inadequate response to tumor necrosis factor inhibitors. Bimekizumab is a welcome addition to the drugs available to manage PsA. Its comparative efficacy against other targeted therapies, especially other IL-17 inhibitors, is yet to be determined.

Finally, a study from the Greek multicenter PsA registry by Vassilakis and colleagues showed that, of 467 patients with PsA, 16.5% had D2T PsA. Compared with non–D2T patients, those with D2T disease were more likely to have extensive psoriasis at diagnosis, higher body mass index, and a history of inflammatory bowel disease (IBD). Treatment-resistant disease is increasingly prevalent in PsA. Certain diseases and comorbidities, such as IBD and obesity, are associated with D2T PsA. A uniform definition of D2T PsA and prospective studies to identify risk factors, as well as new strategies to manage D2T PsA, are required.

A hot topic of PsA research is whether treating psoriasis patients with biologics reduces the risk of developing PsA. Floris and colleagues analyzed data from 1023 patients with psoriasis aged 18 years or older, of whom 29.6% received biologics at least once and 21.0% had PsA. They observed that patients treated at least once vs never treated with biologics had a significantly lower risk for PsA. The "protective" effect of biologics against PsA persisted irrespective of the class of biologic used. However, the study has many built-in biases; it was not a prospective study of psoriasis patients without PsA, but rather a retrospective analysis of data collected at enrollment. Nevertheless, effective psoriasis therapies may indeed reduce the risk for PsA; prospective interventional studies are required and are currently underway.

Development of radiographic damage indicates severe PsA and affects quality of life and physical function. Identifying patients at risk for joint damage may help treatment stratification. Using data from a real-world cohort of 476 patients with early PsA, of whom 14% demonstrated progressive radiographic damage, Koc and colleagues found that female sex was a protective factor whereas old age and initial radiographic damage were risk factors for radiographic progression. These results are consistent with previous studies. Male sex, older age, and presence of radiographic damage at first visit should prompt more aggressive management to prevent further joint damage.

Regarding newer treatments, Gossec and colleagues demonstrated that bimekizumab, a monoclonal antibody targeting both interleukin (IL)-17A and IL-17F, improved disease effects in a rapid and sustained manner in patients with PsA who had not used biologic disease-modifying antirheumatic drugs or had prior inadequate response to tumor necrosis factor inhibitors. Bimekizumab is a welcome addition to the drugs available to manage PsA. Its comparative efficacy against other targeted therapies, especially other IL-17 inhibitors, is yet to be determined.

Finally, a study from the Greek multicenter PsA registry by Vassilakis and colleagues showed that, of 467 patients with PsA, 16.5% had D2T PsA. Compared with non–D2T patients, those with D2T disease were more likely to have extensive psoriasis at diagnosis, higher body mass index, and a history of inflammatory bowel disease (IBD). Treatment-resistant disease is increasingly prevalent in PsA. Certain diseases and comorbidities, such as IBD and obesity, are associated with D2T PsA. A uniform definition of D2T PsA and prospective studies to identify risk factors, as well as new strategies to manage D2T PsA, are required.

Medications classified as anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb), a relatively new category of migraine therapy, have shown strong evidence of efficacy for migraine treatment and prevention. However, as these medications — which include Aimovig (erenumab), Emgality (galcanezumab), Ajovy (fremanezumab), and Vyepti (eptinezumab) — are new, their long-term outcomes are not known; in addition, they are expensive and they do not work for everyone. Patients who are doing relatively well on other medications might ask about switching to one of the anti-CGRP mAb so that they can experience the better outcomes and low side-effect profile that they've been hearing about. New research is showing some prognostic indicators that can help identify which patients might experience a better response to anti-CGRP mAb.

A prospective real-world study published in the May 2024 issue of Journal of Neurology, Neurosurgery, and Psychiatry included 5818 patients who had been treated with an anti-CGRP mAb for high-frequency episodic or chronic migraine. The researchers assessed responses after 6 months of use, defining a good response as ≥50% reduction in monthly headache days and excellent response as ≥75% reduction in monthly headache days. They found that several pretreatment baseline factors were predictors of a good or excellent 6-month response: older age, the presence of unilateral pain, the absence of depression, fewer monthly migraine days, and lower Migraine Disability Assessment (MIDAS) score. Notably, men and women experienced comparable outcomes. While it's not completely clear why these factors were associated with better responses to anti-CGRP mAb, the results could help in selecting patients who might or might not benefit from this new medication class.

Results of a prospective study published in the May 2024 in The Journal of Headache and Pain demonstrated that patients treated with eptinezumab for 3 months experienced a reduction of monthly headaches, migraines, and the use of acute medication. The patients who had previously had an inadequate response to or were unable to tolerate other anti-CGRP mAb (erenumab, galcanezumab, fremanezumab) were less likely to experience improvement with eptinezumab than patients who had not had previous unsuccessful attempts with anti-CGRP mAb. This suggests that it might not be beneficial for patents to try multiple medications in this category if they have had an inadequate response or intolerability to others in the same drug class.

Lifestyle factors can play a role in migraine outcomes and may reduce the need for medication. A study published in The Journal of Headache and Pain in May 2024 examined the relationship between migraine and the American Heart Association (AHA) Guidelines for Cardiovascular Health recommended lifestyle factors. The study included 332,895 participants, with a median follow-up of 13.58 years. Researchers found that maintaining targeted or recommended body mass index (BMI), physical activity, sleep duration, sleep pattern, and sedentary time were associated with substantial reductions in migraine risk.

Diet, another lifestyle factor, can also have an effect on migraine. Avoiding dietary triggers is a well-known adjustment that many patients are advised to make. Overall diet quality can play a role in migraine outcomes as well. According to a study published in the May 2024 issue of Nutritional Neuroscience, participants who followed a diet that qualified as having a high Carbohydrate Quality Index (CQI) had lower migraine severity and duration than participants whose diets did not qualify as high CQI. The study included 266 women (age 18-45 years), using a 147-item food frequency questionnaire to assess CQI. The CQI, a relatively new index for measuring carbohydrate quality, includes four components: glycemic index, dietary fiber intake, ratio of whole grain to total grain, ratio of solid carbohydrates to total (solid + liquid) carbohydrates.¹ A low glycemic index and higher scores for the other three factors translates to a high CQI.

While the results of the AHA/migraine study and the CQI/migraine study are interesting, the physiologic reasons for the outcomes and validation of the results need further investigation. It's not clear whether the decrease in migraines that's associated with optimal carbohydrate intake is associated with outcomes such as low BMI or better sleep, or whether carbohydrate metabolism could be an independent factor.

Predictive factors can be beneficial in making migraine treatment decisions. While trial and error will always remain part of optimal migraine therapy, customizing treatment on the basis of an individual patient's characteristics can help in reaching an effective treatment and better quality of life sooner.

Additional References

1. Sawicki CM, Lichtenstein AH, Rogers GT, et al. Comparison of indices of carbohydrate quality and food sources of dietary fiber on longitudinal changes in waist circumference in the Framingham Offspring Cohort. Nutrients. 2021;13:997. Source

Medications classified as anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb), a relatively new category of migraine therapy, have shown strong evidence of efficacy for migraine treatment and prevention. However, as these medications — which include Aimovig (erenumab), Emgality (galcanezumab), Ajovy (fremanezumab), and Vyepti (eptinezumab) — are new, their long-term outcomes are not known; in addition, they are expensive and they do not work for everyone. Patients who are doing relatively well on other medications might ask about switching to one of the anti-CGRP mAb so that they can experience the better outcomes and low side-effect profile that they've been hearing about. New research is showing some prognostic indicators that can help identify which patients might experience a better response to anti-CGRP mAb.

A prospective real-world study published in the May 2024 issue of Journal of Neurology, Neurosurgery, and Psychiatry included 5818 patients who had been treated with an anti-CGRP mAb for high-frequency episodic or chronic migraine. The researchers assessed responses after 6 months of use, defining a good response as ≥50% reduction in monthly headache days and excellent response as ≥75% reduction in monthly headache days. They found that several pretreatment baseline factors were predictors of a good or excellent 6-month response: older age, the presence of unilateral pain, the absence of depression, fewer monthly migraine days, and lower Migraine Disability Assessment (MIDAS) score. Notably, men and women experienced comparable outcomes. While it's not completely clear why these factors were associated with better responses to anti-CGRP mAb, the results could help in selecting patients who might or might not benefit from this new medication class.

Results of a prospective study published in the May 2024 in The Journal of Headache and Pain demonstrated that patients treated with eptinezumab for 3 months experienced a reduction of monthly headaches, migraines, and the use of acute medication. The patients who had previously had an inadequate response to or were unable to tolerate other anti-CGRP mAb (erenumab, galcanezumab, fremanezumab) were less likely to experience improvement with eptinezumab than patients who had not had previous unsuccessful attempts with anti-CGRP mAb. This suggests that it might not be beneficial for patents to try multiple medications in this category if they have had an inadequate response or intolerability to others in the same drug class.

Lifestyle factors can play a role in migraine outcomes and may reduce the need for medication. A study published in The Journal of Headache and Pain in May 2024 examined the relationship between migraine and the American Heart Association (AHA) Guidelines for Cardiovascular Health recommended lifestyle factors. The study included 332,895 participants, with a median follow-up of 13.58 years. Researchers found that maintaining targeted or recommended body mass index (BMI), physical activity, sleep duration, sleep pattern, and sedentary time were associated with substantial reductions in migraine risk.

Diet, another lifestyle factor, can also have an effect on migraine. Avoiding dietary triggers is a well-known adjustment that many patients are advised to make. Overall diet quality can play a role in migraine outcomes as well. According to a study published in the May 2024 issue of Nutritional Neuroscience, participants who followed a diet that qualified as having a high Carbohydrate Quality Index (CQI) had lower migraine severity and duration than participants whose diets did not qualify as high CQI. The study included 266 women (age 18-45 years), using a 147-item food frequency questionnaire to assess CQI. The CQI, a relatively new index for measuring carbohydrate quality, includes four components: glycemic index, dietary fiber intake, ratio of whole grain to total grain, ratio of solid carbohydrates to total (solid + liquid) carbohydrates.¹ A low glycemic index and higher scores for the other three factors translates to a high CQI.

While the results of the AHA/migraine study and the CQI/migraine study are interesting, the physiologic reasons for the outcomes and validation of the results need further investigation. It's not clear whether the decrease in migraines that's associated with optimal carbohydrate intake is associated with outcomes such as low BMI or better sleep, or whether carbohydrate metabolism could be an independent factor.

Predictive factors can be beneficial in making migraine treatment decisions. While trial and error will always remain part of optimal migraine therapy, customizing treatment on the basis of an individual patient's characteristics can help in reaching an effective treatment and better quality of life sooner.

Additional References

1. Sawicki CM, Lichtenstein AH, Rogers GT, et al. Comparison of indices of carbohydrate quality and food sources of dietary fiber on longitudinal changes in waist circumference in the Framingham Offspring Cohort. Nutrients. 2021;13:997. Source

Medications classified as anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb), a relatively new category of migraine therapy, have shown strong evidence of efficacy for migraine treatment and prevention. However, as these medications — which include Aimovig (erenumab), Emgality (galcanezumab), Ajovy (fremanezumab), and Vyepti (eptinezumab) — are new, their long-term outcomes are not known; in addition, they are expensive and they do not work for everyone. Patients who are doing relatively well on other medications might ask about switching to one of the anti-CGRP mAb so that they can experience the better outcomes and low side-effect profile that they've been hearing about. New research is showing some prognostic indicators that can help identify which patients might experience a better response to anti-CGRP mAb.

A prospective real-world study published in the May 2024 issue of Journal of Neurology, Neurosurgery, and Psychiatry included 5818 patients who had been treated with an anti-CGRP mAb for high-frequency episodic or chronic migraine. The researchers assessed responses after 6 months of use, defining a good response as ≥50% reduction in monthly headache days and excellent response as ≥75% reduction in monthly headache days. They found that several pretreatment baseline factors were predictors of a good or excellent 6-month response: older age, the presence of unilateral pain, the absence of depression, fewer monthly migraine days, and lower Migraine Disability Assessment (MIDAS) score. Notably, men and women experienced comparable outcomes. While it's not completely clear why these factors were associated with better responses to anti-CGRP mAb, the results could help in selecting patients who might or might not benefit from this new medication class.

Results of a prospective study published in the May 2024 in The Journal of Headache and Pain demonstrated that patients treated with eptinezumab for 3 months experienced a reduction of monthly headaches, migraines, and the use of acute medication. The patients who had previously had an inadequate response to or were unable to tolerate other anti-CGRP mAb (erenumab, galcanezumab, fremanezumab) were less likely to experience improvement with eptinezumab than patients who had not had previous unsuccessful attempts with anti-CGRP mAb. This suggests that it might not be beneficial for patents to try multiple medications in this category if they have had an inadequate response or intolerability to others in the same drug class.

Lifestyle factors can play a role in migraine outcomes and may reduce the need for medication. A study published in The Journal of Headache and Pain in May 2024 examined the relationship between migraine and the American Heart Association (AHA) Guidelines for Cardiovascular Health recommended lifestyle factors. The study included 332,895 participants, with a median follow-up of 13.58 years. Researchers found that maintaining targeted or recommended body mass index (BMI), physical activity, sleep duration, sleep pattern, and sedentary time were associated with substantial reductions in migraine risk.

Diet, another lifestyle factor, can also have an effect on migraine. Avoiding dietary triggers is a well-known adjustment that many patients are advised to make. Overall diet quality can play a role in migraine outcomes as well. According to a study published in the May 2024 issue of Nutritional Neuroscience, participants who followed a diet that qualified as having a high Carbohydrate Quality Index (CQI) had lower migraine severity and duration than participants whose diets did not qualify as high CQI. The study included 266 women (age 18-45 years), using a 147-item food frequency questionnaire to assess CQI. The CQI, a relatively new index for measuring carbohydrate quality, includes four components: glycemic index, dietary fiber intake, ratio of whole grain to total grain, ratio of solid carbohydrates to total (solid + liquid) carbohydrates.¹ A low glycemic index and higher scores for the other three factors translates to a high CQI.

While the results of the AHA/migraine study and the CQI/migraine study are interesting, the physiologic reasons for the outcomes and validation of the results need further investigation. It's not clear whether the decrease in migraines that's associated with optimal carbohydrate intake is associated with outcomes such as low BMI or better sleep, or whether carbohydrate metabolism could be an independent factor.

Predictive factors can be beneficial in making migraine treatment decisions. While trial and error will always remain part of optimal migraine therapy, customizing treatment on the basis of an individual patient's characteristics can help in reaching an effective treatment and better quality of life sooner.

Additional References

1. Sawicki CM, Lichtenstein AH, Rogers GT, et al. Comparison of indices of carbohydrate quality and food sources of dietary fiber on longitudinal changes in waist circumference in the Framingham Offspring Cohort. Nutrients. 2021;13:997. Source

Key clinical point: High adherence to the carbohydrate quality index (CQI) was associated with a significant reduction in headache severity and duration in women with migraine.

Major finding: High CQI adherence was associated with low odds of moderate pain (adjusted odds ratio [aOR] 0.37; P = .01), severe pain (aOR 0.22; P = .001), and prolonged headache duration (aOR 0.54; P = .03). Moreover, there was no significant correlation between CQI and migraine disability assessment scores (P > .05).

Study details: This cross-sectional study assessed the association of CQI with headache severity, disability, and duration in 266 women with migraine using a 147-item semiquantitative food frequency questionnaire.

Disclosures: The authors did not disclose any source of funding. The authors declared no conflicts of interest.

Source: Jebraeili H, Mirzababaei A, Abaj F, Mirzaei K. The association between carbohydrate quality index and headache severity, disability and duration among women with migraine: A cross-sectional study. Nutr Neurosci. 2024 (May 28). doi: 10.1080/1028415X.2024.2310880 Source

Key clinical point: High adherence to the carbohydrate quality index (CQI) was associated with a significant reduction in headache severity and duration in women with migraine.

Major finding: High CQI adherence was associated with low odds of moderate pain (adjusted odds ratio [aOR] 0.37; P = .01), severe pain (aOR 0.22; P = .001), and prolonged headache duration (aOR 0.54; P = .03). Moreover, there was no significant correlation between CQI and migraine disability assessment scores (P > .05).

Study details: This cross-sectional study assessed the association of CQI with headache severity, disability, and duration in 266 women with migraine using a 147-item semiquantitative food frequency questionnaire.

Disclosures: The authors did not disclose any source of funding. The authors declared no conflicts of interest.

Source: Jebraeili H, Mirzababaei A, Abaj F, Mirzaei K. The association between carbohydrate quality index and headache severity, disability and duration among women with migraine: A cross-sectional study. Nutr Neurosci. 2024 (May 28). doi: 10.1080/1028415X.2024.2310880 Source

Key clinical point: High adherence to the carbohydrate quality index (CQI) was associated with a significant reduction in headache severity and duration in women with migraine.

Major finding: High CQI adherence was associated with low odds of moderate pain (adjusted odds ratio [aOR] 0.37; P = .01), severe pain (aOR 0.22; P = .001), and prolonged headache duration (aOR 0.54; P = .03). Moreover, there was no significant correlation between CQI and migraine disability assessment scores (P > .05).

Study details: This cross-sectional study assessed the association of CQI with headache severity, disability, and duration in 266 women with migraine using a 147-item semiquantitative food frequency questionnaire.

Disclosures: The authors did not disclose any source of funding. The authors declared no conflicts of interest.

Source: Jebraeili H, Mirzababaei A, Abaj F, Mirzaei K. The association between carbohydrate quality index and headache severity, disability and duration among women with migraine: A cross-sectional study. Nutr Neurosci. 2024 (May 28). doi: 10.1080/1028415X.2024.2310880 Source

Key clinical point: Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA in patients with chronic migraine (CM), even in those who were difficult-to-treat (DTT) and did not respond to ≥3 preventive treatments.

Major finding: At 6 months, CGRP mAb vs onabotulinumtoxinA significantly reduced monthly migraine days (−13.0 vs −8.7 days/month; P < .001) in overall populations, with a similar reduction observed in those who were DTT (−13.0 vs −9.1 days/month; P < .001). Both treatments were well tolerated, with no treatment discontinuation being observed because of adverse events.

Study details: This multicenter, real-world study included 316 and 333 patients with CM who received ≥1 dose of CGRP mAb and onabotulinumtoxinA, respectively, and of whom 544 were DTT and had failed to respond ≥3 preventive treatments.

Disclosures: This study was funded by Taiwan National Science and Technology Council and others. Three authors declared receiving research grants, personal fees as advisors or speakers, or honoraria as speakers from various sources.

Source: Wang Y-F, Yang F-C, Chen L-A, et al. Comparative effectiveness and tolerability of calcitonin gene-related peptide (CGRP) monoclonal antibodies and onabotulinumtoxinA in chronic migraine: A multicenter, real-world study in Taiwan. Eur J Neurol. 2024 :e16372 (Jun 5). doi: 10.1111/ene.16372 Source

Key clinical point: Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA in patients with chronic migraine (CM), even in those who were difficult-to-treat (DTT) and did not respond to ≥3 preventive treatments.

Major finding: At 6 months, CGRP mAb vs onabotulinumtoxinA significantly reduced monthly migraine days (−13.0 vs −8.7 days/month; P < .001) in overall populations, with a similar reduction observed in those who were DTT (−13.0 vs −9.1 days/month; P < .001). Both treatments were well tolerated, with no treatment discontinuation being observed because of adverse events.

Study details: This multicenter, real-world study included 316 and 333 patients with CM who received ≥1 dose of CGRP mAb and onabotulinumtoxinA, respectively, and of whom 544 were DTT and had failed to respond ≥3 preventive treatments.

Disclosures: This study was funded by Taiwan National Science and Technology Council and others. Three authors declared receiving research grants, personal fees as advisors or speakers, or honoraria as speakers from various sources.

Source: Wang Y-F, Yang F-C, Chen L-A, et al. Comparative effectiveness and tolerability of calcitonin gene-related peptide (CGRP) monoclonal antibodies and onabotulinumtoxinA in chronic migraine: A multicenter, real-world study in Taiwan. Eur J Neurol. 2024 :e16372 (Jun 5). doi: 10.1111/ene.16372 Source

Key clinical point: Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA in patients with chronic migraine (CM), even in those who were difficult-to-treat (DTT) and did not respond to ≥3 preventive treatments.

Major finding: At 6 months, CGRP mAb vs onabotulinumtoxinA significantly reduced monthly migraine days (−13.0 vs −8.7 days/month; P < .001) in overall populations, with a similar reduction observed in those who were DTT (−13.0 vs −9.1 days/month; P < .001). Both treatments were well tolerated, with no treatment discontinuation being observed because of adverse events.

Study details: This multicenter, real-world study included 316 and 333 patients with CM who received ≥1 dose of CGRP mAb and onabotulinumtoxinA, respectively, and of whom 544 were DTT and had failed to respond ≥3 preventive treatments.

Disclosures: This study was funded by Taiwan National Science and Technology Council and others. Three authors declared receiving research grants, personal fees as advisors or speakers, or honoraria as speakers from various sources.

Source: Wang Y-F, Yang F-C, Chen L-A, et al. Comparative effectiveness and tolerability of calcitonin gene-related peptide (CGRP) monoclonal antibodies and onabotulinumtoxinA in chronic migraine: A multicenter, real-world study in Taiwan. Eur J Neurol. 2024 :e16372 (Jun 5). doi: 10.1111/ene.16372 Source

Key clinical point: Patients with migraine who switched one or multiple times among available anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) treatments showed lower treatment response and higher disease burden than those who adhered to one anti-CGRP mAb treatment.

Major finding: Overall, 73.1% patients did not switch their anti-CGRP mAb, while 20.6% switched once, 5.4% switched twice, and 0.9% switched three or more times. The ≥50% response rate for monthly migraine days was 64.7% in patients who did not switch among anti-CGRP mAb, but it worsened in those who switched once (50.7%) or twice (25.0%) during their last treatment cycle.

Study details: This real-world retrospective study used data from the Neuro TransData registry and included 655 patients with migraine who received at least one anti-CGRP mAb.

Disclosures: The authors did not disclose any source of funding. The authors declared no competing interests.

Source: Hong JB, Israel-Willner H, Peikert A, et al, and the NTD Study Group. Therapeutic patterns and migraine disease burden in switchers of CGRP-targeted monoclonal antibodies — insights from the German NeuroTransData registry. J Headache Pain. 2024;25:90 (Jun 3). doi: 10.1186/s10194-024-01790-7 Source

Key clinical point: Patients with migraine who switched one or multiple times among available anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) treatments showed lower treatment response and higher disease burden than those who adhered to one anti-CGRP mAb treatment.

Major finding: Overall, 73.1% patients did not switch their anti-CGRP mAb, while 20.6% switched once, 5.4% switched twice, and 0.9% switched three or more times. The ≥50% response rate for monthly migraine days was 64.7% in patients who did not switch among anti-CGRP mAb, but it worsened in those who switched once (50.7%) or twice (25.0%) during their last treatment cycle.

Study details: This real-world retrospective study used data from the Neuro TransData registry and included 655 patients with migraine who received at least one anti-CGRP mAb.

Disclosures: The authors did not disclose any source of funding. The authors declared no competing interests.

Source: Hong JB, Israel-Willner H, Peikert A, et al, and the NTD Study Group. Therapeutic patterns and migraine disease burden in switchers of CGRP-targeted monoclonal antibodies — insights from the German NeuroTransData registry. J Headache Pain. 2024;25:90 (Jun 3). doi: 10.1186/s10194-024-01790-7 Source

Key clinical point: Patients with migraine who switched one or multiple times among available anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) treatments showed lower treatment response and higher disease burden than those who adhered to one anti-CGRP mAb treatment.

Major finding: Overall, 73.1% patients did not switch their anti-CGRP mAb, while 20.6% switched once, 5.4% switched twice, and 0.9% switched three or more times. The ≥50% response rate for monthly migraine days was 64.7% in patients who did not switch among anti-CGRP mAb, but it worsened in those who switched once (50.7%) or twice (25.0%) during their last treatment cycle.

Study details: This real-world retrospective study used data from the Neuro TransData registry and included 655 patients with migraine who received at least one anti-CGRP mAb.

Disclosures: The authors did not disclose any source of funding. The authors declared no competing interests.

Source: Hong JB, Israel-Willner H, Peikert A, et al, and the NTD Study Group. Therapeutic patterns and migraine disease burden in switchers of CGRP-targeted monoclonal antibodies — insights from the German NeuroTransData registry. J Headache Pain. 2024;25:90 (Jun 3). doi: 10.1186/s10194-024-01790-7 Source

Key clinical point: A meta-analysis of real-world studies provided strong evidence that erenumab was effective and safe in patients with migraine.

Major finding: At 3 months, erenumab significantly reduced monthly migraine days (mean difference [MD] −7.18 days), monthly headache days (MD −6.89 days), headache impact test-6 scores (MD −6.97), medication days (MD −6.22 days), acute monthly intake (MD −15.75), and pain intensity (MD −1.71), and the results were consistent at 6 and 12 months. The proportion change difference of any adverse event was 0.34 and 0.43 at 6 and 12 months, respectively, with constipation being the most common adverse event (0.19 and 0.20 at 6 and 12 months, respectively).

Study details: Findings are from a meta-analysis of 53 real-world studies including 6509 patients with migraine who were treated with erenumab.

Disclosures: This study was funded by the University of Castilla – La Mancha, Spain. The authors declared no conflicts of interest.

Source: Fernández-Bravo-Rodrigo J, Cavero-Redondo I, Lucerón-Lucas-Torres M, et al. Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis. Eur J Pharmacol. 2024;975:176702 (May 31). doi: 10.1016/j.ejphar.2024.17670 Source

Key clinical point: A meta-analysis of real-world studies provided strong evidence that erenumab was effective and safe in patients with migraine.

Major finding: At 3 months, erenumab significantly reduced monthly migraine days (mean difference [MD] −7.18 days), monthly headache days (MD −6.89 days), headache impact test-6 scores (MD −6.97), medication days (MD −6.22 days), acute monthly intake (MD −15.75), and pain intensity (MD −1.71), and the results were consistent at 6 and 12 months. The proportion change difference of any adverse event was 0.34 and 0.43 at 6 and 12 months, respectively, with constipation being the most common adverse event (0.19 and 0.20 at 6 and 12 months, respectively).

Study details: Findings are from a meta-analysis of 53 real-world studies including 6509 patients with migraine who were treated with erenumab.

Disclosures: This study was funded by the University of Castilla – La Mancha, Spain. The authors declared no conflicts of interest.

Source: Fernández-Bravo-Rodrigo J, Cavero-Redondo I, Lucerón-Lucas-Torres M, et al. Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis. Eur J Pharmacol. 2024;975:176702 (May 31). doi: 10.1016/j.ejphar.2024.17670 Source

Key clinical point: A meta-analysis of real-world studies provided strong evidence that erenumab was effective and safe in patients with migraine.

Major finding: At 3 months, erenumab significantly reduced monthly migraine days (mean difference [MD] −7.18 days), monthly headache days (MD −6.89 days), headache impact test-6 scores (MD −6.97), medication days (MD −6.22 days), acute monthly intake (MD −15.75), and pain intensity (MD −1.71), and the results were consistent at 6 and 12 months. The proportion change difference of any adverse event was 0.34 and 0.43 at 6 and 12 months, respectively, with constipation being the most common adverse event (0.19 and 0.20 at 6 and 12 months, respectively).

Study details: Findings are from a meta-analysis of 53 real-world studies including 6509 patients with migraine who were treated with erenumab.

Disclosures: This study was funded by the University of Castilla – La Mancha, Spain. The authors declared no conflicts of interest.

Source: Fernández-Bravo-Rodrigo J, Cavero-Redondo I, Lucerón-Lucas-Torres M, et al. Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis. Eur J Pharmacol. 2024;975:176702 (May 31). doi: 10.1016/j.ejphar.2024.17670 Source

Key clinical point: Migraine, migraine with aura (MA), and migraine without aura (MO) were not associated with a higher risk for atrial fibrillation (AF), with migraine and its subtypes serving as a protective factor for AF in individuals age ≥ 55 years with migraine.

Major finding: No significant association was found between migraine (adjusted hazard ratio [aHR] 0.76; 95% CI 0.48-1.18), MA (aHR 1.00; 95% CI 0.59-1.70), or MO (aHR 0.50; 95% CI 0.23-1.06) and the risk for AF. However, among patients age ≥ 55 years, the risk for AF was significantly lower in those with migraine (aHR 0.53; 95% CI 0.39-0.73), MA (aHR 0.58; 95% CI 0.38-0.87), or MO (aHR 0.48; 95% CI 0.30-0.78) than in those without headache.

Study details: This prospective, population-based 9-year follow-up study included 39,340 individuals (age ≥ 20 years) without AF who answered the headache questionnaire during the Trøndelag Health Study; of these, 1524 (3.8%) developed AF.

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

Source: Giri S, Tronvik E, Dalen H, et al. Migraine and risk of atrial fibrillation: A 9-year follow-up based on the Trøndelag Health Study. Cephalalgia. 2024 (May 29). doi: 10.1177/03331024241254517 Source

Key clinical point: Migraine, migraine with aura (MA), and migraine without aura (MO) were not associated with a higher risk for atrial fibrillation (AF), with migraine and its subtypes serving as a protective factor for AF in individuals age ≥ 55 years with migraine.

Major finding: No significant association was found between migraine (adjusted hazard ratio [aHR] 0.76; 95% CI 0.48-1.18), MA (aHR 1.00; 95% CI 0.59-1.70), or MO (aHR 0.50; 95% CI 0.23-1.06) and the risk for AF. However, among patients age ≥ 55 years, the risk for AF was significantly lower in those with migraine (aHR 0.53; 95% CI 0.39-0.73), MA (aHR 0.58; 95% CI 0.38-0.87), or MO (aHR 0.48; 95% CI 0.30-0.78) than in those without headache.

Study details: This prospective, population-based 9-year follow-up study included 39,340 individuals (age ≥ 20 years) without AF who answered the headache questionnaire during the Trøndelag Health Study; of these, 1524 (3.8%) developed AF.

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

Source: Giri S, Tronvik E, Dalen H, et al. Migraine and risk of atrial fibrillation: A 9-year follow-up based on the Trøndelag Health Study. Cephalalgia. 2024 (May 29). doi: 10.1177/03331024241254517 Source

Key clinical point: Migraine, migraine with aura (MA), and migraine without aura (MO) were not associated with a higher risk for atrial fibrillation (AF), with migraine and its subtypes serving as a protective factor for AF in individuals age ≥ 55 years with migraine.

Major finding: No significant association was found between migraine (adjusted hazard ratio [aHR] 0.76; 95% CI 0.48-1.18), MA (aHR 1.00; 95% CI 0.59-1.70), or MO (aHR 0.50; 95% CI 0.23-1.06) and the risk for AF. However, among patients age ≥ 55 years, the risk for AF was significantly lower in those with migraine (aHR 0.53; 95% CI 0.39-0.73), MA (aHR 0.58; 95% CI 0.38-0.87), or MO (aHR 0.48; 95% CI 0.30-0.78) than in those without headache.

Study details: This prospective, population-based 9-year follow-up study included 39,340 individuals (age ≥ 20 years) without AF who answered the headache questionnaire during the Trøndelag Health Study; of these, 1524 (3.8%) developed AF.

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

Source: Giri S, Tronvik E, Dalen H, et al. Migraine and risk of atrial fibrillation: A 9-year follow-up based on the Trøndelag Health Study. Cephalalgia. 2024 (May 29). doi: 10.1177/03331024241254517 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were well tolerated and effective in treating high-frequency episodic or chronic migraine, with factors such as unilateral pain, fewer migraine days, and lower disability associated with good and excellent responses to anti-CGRP mAb treatment.

Major finding: At 6 months, 56.5% and 26.7% patients receiving anti-CGRP mAb showed good and excellent responses (≥50% vs ≥75% reduction in monthly headache days), respectively. The presence of unilateral pain, fewer monthly migraine days, and a low Migraine Disability Assessment Score were independent predictors of good (area under the curve [AUC] 0.648; 95% CI 0.616-0.680) and excellent (AUC 0.691; 95% CI 0.651-0.731) responses to anti-CGRP mAb treatment.

Study details: This prospective multicenter real-world study included 4963 patients with high-frequency episodic or chronic migraine who received anti-CGRP mAb treatment with a 6-month follow-up.

Disclosures: This study did not receive specific funding from any sources. Several authors declared receiving speaker honoraria, travel grants, or honoraria from or having other ties with various sources.

Source: Caronna E, Gallardo VJ, Egeo G, et al, for the EUREkA study group. Redefining migraine prevention: Early treatment with anti-CGRP monoclonal antibodies enhances response in the real world. J Neurol Neurosurg Psychiatry. 2024 (May 22). doi: 10.1136/jnnp-2023-333295 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were well tolerated and effective in treating high-frequency episodic or chronic migraine, with factors such as unilateral pain, fewer migraine days, and lower disability associated with good and excellent responses to anti-CGRP mAb treatment.

Major finding: At 6 months, 56.5% and 26.7% patients receiving anti-CGRP mAb showed good and excellent responses (≥50% vs ≥75% reduction in monthly headache days), respectively. The presence of unilateral pain, fewer monthly migraine days, and a low Migraine Disability Assessment Score were independent predictors of good (area under the curve [AUC] 0.648; 95% CI 0.616-0.680) and excellent (AUC 0.691; 95% CI 0.651-0.731) responses to anti-CGRP mAb treatment.

Study details: This prospective multicenter real-world study included 4963 patients with high-frequency episodic or chronic migraine who received anti-CGRP mAb treatment with a 6-month follow-up.

Disclosures: This study did not receive specific funding from any sources. Several authors declared receiving speaker honoraria, travel grants, or honoraria from or having other ties with various sources.

Source: Caronna E, Gallardo VJ, Egeo G, et al, for the EUREkA study group. Redefining migraine prevention: Early treatment with anti-CGRP monoclonal antibodies enhances response in the real world. J Neurol Neurosurg Psychiatry. 2024 (May 22). doi: 10.1136/jnnp-2023-333295 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were well tolerated and effective in treating high-frequency episodic or chronic migraine, with factors such as unilateral pain, fewer migraine days, and lower disability associated with good and excellent responses to anti-CGRP mAb treatment.

Major finding: At 6 months, 56.5% and 26.7% patients receiving anti-CGRP mAb showed good and excellent responses (≥50% vs ≥75% reduction in monthly headache days), respectively. The presence of unilateral pain, fewer monthly migraine days, and a low Migraine Disability Assessment Score were independent predictors of good (area under the curve [AUC] 0.648; 95% CI 0.616-0.680) and excellent (AUC 0.691; 95% CI 0.651-0.731) responses to anti-CGRP mAb treatment.

Study details: This prospective multicenter real-world study included 4963 patients with high-frequency episodic or chronic migraine who received anti-CGRP mAb treatment with a 6-month follow-up.

Disclosures: This study did not receive specific funding from any sources. Several authors declared receiving speaker honoraria, travel grants, or honoraria from or having other ties with various sources.

Source: Caronna E, Gallardo VJ, Egeo G, et al, for the EUREkA study group. Redefining migraine prevention: Early treatment with anti-CGRP monoclonal antibodies enhances response in the real world. J Neurol Neurosurg Psychiatry. 2024 (May 22). doi: 10.1136/jnnp-2023-333295 Source