RESUMO
BACKGROUND: Some variables have been proposed as predictors of efficacy of OnabotulinumtoxinA in chronic migraine patients, but data available are inconclusive. We aimed to analyse the influence of single nucleotide polymorphisms in the response to OnabotulinumtoxinA. METHODS: We included 156 female patients treated with OnabotulinumtoxinA accordingly to PREEMPT paradigm in three headache units. OnabotulinumtoxinA was offered to patients that had not responded to topiramate and at least one other preventative. Age at first procedure was 43.7 ± 11.8 years (16-74). Patients with a reduction of at least 50% in the number of migraine days after two OnabotulinumtoxinA procedures were considered as responders. We analysed 25 polymorphisms selected for their relevance regarding migraine pathophysiology and their association with migraine according to previously published genome-wide association studies. Genotyping was performed using KASP probes and a LightCycler-480 (Roche-Diagnostics). Allelic, genotypic frequencies and dominance/recesivity hypothesis of the allelic variants were compared between responders and non-responders by Fisher's exact test. RESULTS: Response to treatment with OnabotulinumtoxinA was achieved in 120 patients (76,9%). Two polymorphisms showed differences: CALCA rs3781719, where allele C represents 26.9% in responders and 40.9% in non-responders (p = 0.007, OR = 3.11 (1.33-7.26)); and TRPV1 rs222749, where allele A represents 4.17% in responders and 12.5% in non-responders (p = 0.013, OR = 3.29 (1.28-8.43)). No significant differences in rest of polymorphisms or clinical or demographic variables were found. CONCLUSIONS: Polymorphic variations of CALCA and TRPV1 genes might play a role as prognostic markers of efficacy of OnabotulinumtoxinA in chronic migraine female patients in our population.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Peptídeo Relacionado com Gene de Calcitonina/genética , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/genética , Polimorfismo de Nucleotídeo Único/genética , Canais de Cátion TRPV/genética , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Frequência do Gene , Estudo de Associação Genômica Ampla/métodos , Humanos , Pessoa de Meia-Idade , Fármacos Neuromusculares/uso terapêutico , Estudos Prospectivos , Topiramato/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To determine the ease of access by telephone when making medical appointments. DESIGN: Cross-sectional, observational, random sample. SETTING: Primary care, Murcia Region. PATIENTS AND OTHER PARTICIPANTS: Centres with a previous appointments system (n = 25) and a random sample of the 276 practitioners involved (n = 97). We ruled out 4 practitioners for not having a telephone in their outer consulting room. MEASUREMENTS AND MAIN RESULTS: We made telephone calls until we had obtained appointments with each of the practitioners, across three hour blocks. The result was an average of 2,333 calls/appointment, with a deflection of 2,271. The mode and median were 1, and the range 26. We found differences in the distribution of the calls across the three blocks (p < 0.05). Comparing rural centres with urban, we found a lower average number of calls in the first two blocks (p < 0.01). CONCLUSIONS: Telephone accessibility is at an appropriate level, both in rural and urban areas.