Fracaso de un anticuerpo monoclonal anti-CGRP en el tratamiento de la migraña. ¿Tiene sentido probar otro? / Failure of an anti-CGRP monoclonal antibody in the treatment of migraine. Is it worthwhile trying another one?

Introducción: La migraña es una enfermedad neurológica altamente prevalente y la búsqueda de un tratamiento eficaz que mejore la calidad de vida del paciente es fundamental. En 2018 se aprobaron en España los anticuerpos monoclonales anti-CGRP como tratamiento preventivo, y han demostrado eficacia al reducir el número de crisis de migraña al mes frente a placebo. Pacientes y métodos: Estudio descriptivo y retrospectivo de 14 pacientes con migraña episódica de alta frecuencia y crónica, en seguimiento en nuestra unidad de cefaleas, en los que se ha realizado el cambio de un monoclonal anti-CGRP por ineficacia. Se han recogido datos epidemiológicos y variables relacionadas con la respuesta a ambos fármacos, como los días de cefalea al mes y los días de migraña al mes, además de escalas validadas de calidad de vida (Migraine Disability Assessment Scale y Headache Impact Test-6). Resultados: El 50% de los pacientes son varones, con una mediana de edad de 46,5, y el 92% estaba diagnosticado de migraña crónica. Se realizó un seguimiento de entre seis y 12 meses tras el cambio de tratamiento en el 91,6%, y se observó mejoría significativa en el 33% de los pacientes. Además, en el 50% se objetivó respuesta inicial tras tres dosis con el primer monoclonal. Conclusiones: En nuestra serie, el 66% de los pacientes que no respondieron a un primer fármaco respondió inicialmente al cambio, y esta mejoría se mantuvo en el 36%. Se precisan estudios más amplios para aclarar esta diferencia de respuesta a los distintos anticuerpos monoclonales anti-CGRP.(AU)

Introduction: Migraine is a highly prevalent neurological disease and the search for an effective treatment to improve the patient’s quality of life is essential. In 2018, anti-CGRP monoclonal antibodies were approved in Spain as a preventive treatment, and have proved to be effective in reducing the number of migraine crisis per month compared to placebo. Patients and methods: We conducted a descriptive and retrospective study of 14 patients suffering from high-frequency or chronic episodic migraine, under follow-up in our headache unit, in whom an anti-CGRP monoclonal was changed due to its ineffectiveness. Epidemiological data and variables related to the response to both drugs were collected, such as headache days per month and migraine days per month, as well as validated quality of life scales (Migraine Disability Assessment Scale and Headache Impact Test-6). Results: 50% of patients were males, with a median age of 46.5 years and 92% were diagnosed with chronic migraine. A follow-up of 6 to 12 months after the change of treatment was performed in 91.6% and significant improvement was observed in 33% of the patients. In addition, 50% had an initial response after three doses of the first monoclonal drug. Conclusions: In our series, 66% of patients who did not respond to a first drug responded initially to the switch and this improvement was maintained in 36% of them. Larger studies are needed to clarify this difference in response to different anti-CGRP monoclonal antibodies.(AU)

[Failure of an anti-CGRP monoclonal antibody in the treatment of migraine. Is it worthwhile trying another one?] / Fracaso de un anticuerpo monoclonal anti-CGRP en el tratamiento de la migraña. ¿Tiene sentido probar otro?

INTRODUCTION: Migraine is a highly prevalent neurological disease and the search for an effective treatment to improve the patient's quality of life is essential. In 2018, anti-CGRP monoclonal antibodies were approved in Spain as a preventive treatment, and have proved to be effective in reducing the number of migraine crisis per month compared to placebo. PATIENTS AND METHODS: We conducted a descriptive and retrospective study of 14 patients suffering from high-frequency or chronic episodic migraine, under follow-up in our headache unit, in whom an anti-CGRP monoclonal was changed due to its ineffectiveness. Epidemiological data and variables related to the response to both drugs were collected, such as headache days per month and migraine days per month, as well as validated quality of life scales (Migraine Disability Assessment Scale and Headache Impact Test-6). RESULTS: 50% of patients were males, with a median age of 46.5 years and 92% were diagnosed with chronic migraine. A follow-up of 6 to 12 months after the change of treatment was performed in 91.6% and significant improvement was observed in 33% of the patients. In addition, 50% had an initial response after three doses of the first monoclonal drug. CONCLUSIONS: In our series, 66% of patients who did not respond to a first drug responded initially to the switch and this improvement was maintained in 36% of them. Larger studies are needed to clarify this difference in response to different anti-CGRP monoclonal antibodies.

TITLE: Fracaso de un anticuerpo monoclonal anti-CGRP en el tratamiento de la migraña. ¿Tiene sentido probar otro?Introducción. La migraña es una enfermedad neurológica altamente prevalente y la búsqueda de un tratamiento eficaz que mejore la calidad de vida del paciente es fundamental. En 2018 se aprobaron en España los anticuerpos monoclonales anti-CGRP como tratamiento preventivo, y han demostrado eficacia al reducir el número de crisis de migraña al mes frente a placebo. Pacientes y métodos. Estudio descriptivo y retrospectivo de 14 pacientes con migraña episódica de alta frecuencia y crónica, en seguimiento en nuestra unidad de cefaleas, en los que se ha realizado el cambio de un monoclonal anti-CGRP por ineficacia. Se han recogido datos epidemiológicos y variables relacionadas con la respuesta a ambos fármacos, como los días de cefalea al mes y los días de migraña al mes, además de escalas validadas de calidad de vida (Migraine Disability Assessment Scale y Headache Impact Test-6). Resultados. El 50% de los pacientes son varones, con una mediana de edad de 46,5, y el 92% estaba diagnosticado de migraña crónica. Se realizó un seguimiento de entre seis y 12 meses tras el cambio de tratamiento en el 91,6%, y se observó mejoría significativa en el 33% de los pacientes. Además, en el 50% se objetivó respuesta inicial tras tres dosis con el primer monoclonal. Conclusiones. En nuestra serie, el 66% de los pacientes que no respondieron a un primer fármaco respondió inicialmente al cambio, y esta mejoría se mantuvo en el 36%. Se precisan estudios más amplios para aclarar esta diferencia de respuesta a los distintos anticuerpos monoclonales anti-CGRP.

Case fatality of COVID-19 in patients with neurodegenerative dementia. / Análisis de letalidad por COVID-19 en pacientes con demencia neurodegenerativa.

INTRODUCTION: The elderly population is the group most threatened by COVID-19, with the highest mortality rates. This study aims to analyse the case fatality of COVID-19 in a cohort of patients with degenerative dementia. METHODS: We conducted a descriptive case-control study of a sample of patients diagnosed with primary neurodegenerative dementia. RESULTS: Twenty-four of the 88 patients with COVID-19 included in the study died: 10/23 (43.4%) patients diagnosed with dementia and 14/65 (21.5%) controls; this difference was statistically significant. DISCUSSION: Our results suggest that case fatality of COVID-19 is significantly higher among patients with primary degenerative dementia than in other patients with similar mean ages and comorbidities.

[Case fatality of COVID-19 in patients with neurodegenerative dementia]. / Análisis de letalidad por COVID-19 en pacientes con demencia neurodegenerativa.

Introduction: The elderly population is the group most threatened by COVID-19, with the highest mortality rates. This study aims to analyse the case fatality of COVID-19 in a cohort of patients with degenerative dementia. Methods: We conducted a descriptive case-control study of a sample of patients diagnosed with primary neurodegenerative dementia. Results: Twenty-four of the 88 patients with COVID-19 included in the study died: 10/23 (43.4%) patients diagnosed with dementia and 14/65 (21.5%) controls; this difference was statistically significant. Discussion: Our results suggest that case fatality of COVID-19 is significantly higher among patients with primary degenerative dementia than in other patients with similar mean ages and comorbidities.