American Headache Society Annual Meeting
American Headache Society Annual Meeting
Source/Disclosures
Source: Soni PP, et al. CGRP monoclonal antibodies in the treatment of migraine in elderly patients: A single center experience. Presented at: American Headache Society Annual Meeting; June 15-30, 2020 (virtual meeting).

Disclosures: Healio Primary Care was unable to confirm relevant financial disclosures at the time of publication.
August 04, 2020
1 min read
Save

CGRP monoclonal antibodies reduce headaches in older patients

Source/Disclosures
Source: Soni PP, et al. CGRP monoclonal antibodies in the treatment of migraine in elderly patients: A single center experience. Presented at: American Headache Society Annual Meeting; June 15-30, 2020 (virtual meeting).

Disclosures: Healio Primary Care was unable to confirm relevant financial disclosures at the time of publication.
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

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.

Of 32 older patients who received a CGRP monoclonal antibody, 17 reported an average of 13.9 fewer headache days
Reference: Soni PP, et al. CGRP monoclonal antibodies in the treatment of migraine in elderly patients: A single center experience. Presented at: American Headache Society Annual Meeting; June 15-30, 2020 (virtual meeting).

Aimovig (erenumab-aooe, Amgen), Emgality (galcanezumab-gnlm, Eli Lilly and Co.) and Ajovy (fremanezumab-vfrm, Teva) were approved by the FDA for migraine prevention in 2018.

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.”

Payal Soni
Payal Patel Soni

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.