CGRP monoclonal antibodies reduce headaches in older patients
Calcitonin gene-related peptide, or CGRP, monoclonal antibodies reduced headache frequency among a small cohort of older adults with migraine, data show.
The study was presented at the virtual American Headache Society Annual Scientific Meeting.
There is limited data on the safety and efficacy of these treatments among older adults, according to Payal Patel Soni, MD, a headache medicine fellow at Cleveland Clinic’s Neurologic Institute.
“Adults older than age 65 were excluded from the galcanezumab and erenumab’s chronic and episodic migraine trials,” Soni told Healio Primary Care. “Adults older than 70 were excluded from the fremanezumab chronic and episodic migraine trial.”
Soni and colleagues retrospectively reviewed charts of 30 patients treated with erenumab, one treated with fremanezumab and one treated with galcanezumab. All patients were aged 65 to 84 years and received treatment in the Cleveland Clinic health system. At baseline, they had an average of 20 headache days every 3 months.
After 3 months of treatment, 17 patients reported an average of 13.9 fewer headache days, a 39.7% reduction, according to the researchers. Among 11 patients with documented Headache Impact Test-6 scores before and after treatment, eight had lower scores after treatment — six of which were clinically significant — and one had a higher score.
In addition, among five patients simultaneously receiving Botox for migraine, two reported that the addition of a CGRP therapy led to fewer days with headache. Five patients reported adverse events while taking a CGRP, the most common being constipation and nausea. No patients reported cardiac or cerebrovascular events following treatment.
“This last point is important because the elderly population is more at risk for cardiovascular and cerebrovascular disease,” Soni said, noting that additional studies with larger sample sizes are needed to verify these results, as well as studies examining other newer migraine medications such as Vyepti, Nurtec and Ubrelvy in older patients.
When choosing a preventive migraine treatment for older patients, Soni said primary care physicians should thoroughly evaluate their comorbidities and past experience with other migraine preventives.
“CGRPs, particularly erenumab, have a higher rate of constipation, so PCPs should ask patients about constipation and bowel movements,” she added.