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Additive Interaction Between Onabotulinumtoxin-A and Erenumab in Patients With Refractory Migraine

In the last decade, notable progresses have been observed in chronic migraine preventive treatments. According to the European Headache Federation and national provisions, onabotulinumtoxin-A (BTX-A) and monoclonal antibodies acting on the pathway of calcitonin gene–related peptide (CGRP-mAbs) shoul...

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Autores principales: Silvestro, Marcello, Tessitore, Alessandro, Scotto di Clemente, Fabrizio, Battista, Giorgia, Tedeschi, Gioacchino, Russo, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060469/
https://www.ncbi.nlm.nih.gov/pubmed/33897608
http://dx.doi.org/10.3389/fneur.2021.656294
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author Silvestro, Marcello
Tessitore, Alessandro
Scotto di Clemente, Fabrizio
Battista, Giorgia
Tedeschi, Gioacchino
Russo, Antonio
author_facet Silvestro, Marcello
Tessitore, Alessandro
Scotto di Clemente, Fabrizio
Battista, Giorgia
Tedeschi, Gioacchino
Russo, Antonio
author_sort Silvestro, Marcello
collection PubMed
description In the last decade, notable progresses have been observed in chronic migraine preventive treatments. According to the European Headache Federation and national provisions, onabotulinumtoxin-A (BTX-A) and monoclonal antibodies acting on the pathway of calcitonin gene–related peptide (CGRP-mAbs) should not be administered in combination due to supposed superimposable mechanism of action and high costs. On the other hand, preclinical observations demonstrated that these therapeutic classes, although operating directly or indirectly on the CGRP pathway, act on different fibers. Specifically, the CGRP-mAbs prevent the activation of the Aδ-fibers, whereas BTX-A acts on C-fibers. Therefore, it can be argued that a combined therapy may provide an additive or synergistic effect on the trigeminal nociceptive pathway. In the present study, we report a case series of 10 patients with chronic migraine who experienced significant benefits with the combination of both erenumab and BTX-A compared to each therapeutic strategy alone. A reduction in frequency and intensity of headache attacks (although not statistically significant probably due to the low sample size) was observed in migraine patients treated with a combined therapy with BTX-A and erenumab compared to both BTX-A and erenumab alone. Moreover, the combined therapy with BTX-A and erenumab resulted in a statistically significant reduction in the symptomatic drug intake and in migraine-related disability probably related to a reduced necessity or also to a better responsiveness to rescue treatments. Present data suggest a remodulation of current provisions depriving patients of an effective therapeutic strategy in peculiar migraine endophenotypes.
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spelling pubmed-80604692021-04-23 Additive Interaction Between Onabotulinumtoxin-A and Erenumab in Patients With Refractory Migraine Silvestro, Marcello Tessitore, Alessandro Scotto di Clemente, Fabrizio Battista, Giorgia Tedeschi, Gioacchino Russo, Antonio Front Neurol Neurology In the last decade, notable progresses have been observed in chronic migraine preventive treatments. According to the European Headache Federation and national provisions, onabotulinumtoxin-A (BTX-A) and monoclonal antibodies acting on the pathway of calcitonin gene–related peptide (CGRP-mAbs) should not be administered in combination due to supposed superimposable mechanism of action and high costs. On the other hand, preclinical observations demonstrated that these therapeutic classes, although operating directly or indirectly on the CGRP pathway, act on different fibers. Specifically, the CGRP-mAbs prevent the activation of the Aδ-fibers, whereas BTX-A acts on C-fibers. Therefore, it can be argued that a combined therapy may provide an additive or synergistic effect on the trigeminal nociceptive pathway. In the present study, we report a case series of 10 patients with chronic migraine who experienced significant benefits with the combination of both erenumab and BTX-A compared to each therapeutic strategy alone. A reduction in frequency and intensity of headache attacks (although not statistically significant probably due to the low sample size) was observed in migraine patients treated with a combined therapy with BTX-A and erenumab compared to both BTX-A and erenumab alone. Moreover, the combined therapy with BTX-A and erenumab resulted in a statistically significant reduction in the symptomatic drug intake and in migraine-related disability probably related to a reduced necessity or also to a better responsiveness to rescue treatments. Present data suggest a remodulation of current provisions depriving patients of an effective therapeutic strategy in peculiar migraine endophenotypes. Frontiers Media S.A. 2021-04-08 /pmc/articles/PMC8060469/ /pubmed/33897608 http://dx.doi.org/10.3389/fneur.2021.656294 Text en Copyright © 2021 Silvestro, Tessitore, Scotto di Clemente, Battista, Tedeschi and Russo. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Silvestro, Marcello
Tessitore, Alessandro
Scotto di Clemente, Fabrizio
Battista, Giorgia
Tedeschi, Gioacchino
Russo, Antonio
Additive Interaction Between Onabotulinumtoxin-A and Erenumab in Patients With Refractory Migraine
title Additive Interaction Between Onabotulinumtoxin-A and Erenumab in Patients With Refractory Migraine
title_full Additive Interaction Between Onabotulinumtoxin-A and Erenumab in Patients With Refractory Migraine
title_fullStr Additive Interaction Between Onabotulinumtoxin-A and Erenumab in Patients With Refractory Migraine
title_full_unstemmed Additive Interaction Between Onabotulinumtoxin-A and Erenumab in Patients With Refractory Migraine
title_short Additive Interaction Between Onabotulinumtoxin-A and Erenumab in Patients With Refractory Migraine
title_sort additive interaction between onabotulinumtoxin-a and erenumab in patients with refractory migraine
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060469/
https://www.ncbi.nlm.nih.gov/pubmed/33897608
http://dx.doi.org/10.3389/fneur.2021.656294
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