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  1. Article ; Online: Twelve-month efficacy of CGRP monoclonal antibodies and predictive value of short-term response: results of an Australian multicentre study.

    Ray, Jason Charles / Dalic, Linda / Baker, Josephine / Cheng, Shuli / Hutton, Elspeth Jane / Matharu, Manjit

    BMJ neurology open

    2024  Volume 6, Issue 1, Page(s) e000547

    Abstract: Introduction: Clinical trials show that calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are effective preventative treatments for chronic migraine. Their efficacy over longer time periods and in cohorts originally excluded from trials ... ...

    Abstract Introduction: Clinical trials show that calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are effective preventative treatments for chronic migraine. Their efficacy over longer time periods and in cohorts originally excluded from trials remains uncertain. This study aims to explore the impact of CGRP mAbs in an Australian real-life setting.
    Methods: A multicentre cohort study was performed in the tertiary headache clinics of the Alfred and Austin Hospitals, Melbourne, Australia. Patients were commenced on a CGRP mAb for chronic migraine and asked to keep a headache diary, recorded at 3 monthly appointments for 12 months. Primary outcome was a ≥50% reduction in monthly headache days (MHD).
    Results: From a population of 105 patients, 90 patients commenced galcanezumab and 15 commenced fremanezumab. The ≥50% responder rate of the cohort was 52.4% after 3 months. Over 12 months follow-up, 25.7% of the cohort ceased due to a lack of efficacy and 16.2% ceased due to an adverse event. There was no difference in response or cessation between medications. There was poor agreement in 3-month and 12-month response rates (Cohen's κ=0.130; p=0.171). On subgroup analysis, continuous headache at baseline and number of trialled preventative treatments were the only factors associated with efficacy.
    Conclusion: CGRP mAbs were associated with sustained reductions in MHD over 12-month follow-up in patients with resistant migraine in Australia. Further studies are required to determine treatment options for patients with continuous headache. Poor agreement between outcomes at 3 and 12 months highlights the need to assess some patients at later timepoints.
    Language English
    Publishing date 2024-01-10
    Publishing country England
    Document type Journal Article
    ISSN 2632-6140
    ISSN (online) 2632-6140
    DOI 10.1136/bmjno-2023-000547
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Calcitonin gene related peptide in migraine: current therapeutics, future implications and potential off-target effects.

    Ray, Jason Charles / Kapoor, Mahima / Stark, Richard J / Wang, Shuu-Jiun / Bendtsen, Lars / Matharu, Manjit / Hutton, Elspeth Jane

    Journal of neurology, neurosurgery, and psychiatry

    2021  Volume 92, Issue 12, Page(s) 1325–1334

    Abstract: Migraine is the second largest cause of years lost to disability globally among all diseases, with a worldwide prevalence over 1 billion. Despite the global burden of migraine, few classes of therapeutics have been specifically developed to combat ... ...

    Abstract Migraine is the second largest cause of years lost to disability globally among all diseases, with a worldwide prevalence over 1 billion. Despite the global burden of migraine, few classes of therapeutics have been specifically developed to combat migraine. After 30 years of translational research, calcitonin gene-related peptide (CGRP) inhibitors have emerged as a promising new tool in the prevention of migraine. Like all new therapeutics; however, we have limited real-world experience and CGRP has several known systemic actions that warrant consideration. This article provides a narrative review of the evidence for CGRP antagonists and summarises the known and potential side effects that should be considered.
    MeSH term(s) Calcitonin Gene-Related Peptide Receptor Antagonists/adverse effects ; Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use ; Humans ; Migraine Disorders/drug therapy ; Treatment Outcome
    Chemical Substances Calcitonin Gene-Related Peptide Receptor Antagonists
    Language English
    Publishing date 2021-01-25
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 3087-9
    ISSN 1468-330X ; 0022-3050
    ISSN (online) 1468-330X
    ISSN 0022-3050
    DOI 10.1136/jnnp-2020-324674
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: IVIg-exposure and thromboembolic event risk: findings from the UK Biobank.

    Kapoor, Mahima / Hunt, Ian / Spillane, Jennifer / Bonnett, Laura Jayne / Hutton, Elspeth Jane / McFadyen, James / Westwood, John-Paul / Lunn, Michael P / Carr, Aisling S / Reilly, Mary M

    Journal of neurology, neurosurgery, and psychiatry

    2022  Volume 93, Issue 8, Page(s) 876–885

    Abstract: Background: Arterial and venous thromboembolic events (TEEs) have been associated with intravenous Ig use, but the risk has been poorly quantified. We aimed to calculate the risk of TEEs associated with exposure to intravenous Ig.: Methods: We ... ...

    Abstract Background: Arterial and venous thromboembolic events (TEEs) have been associated with intravenous Ig use, but the risk has been poorly quantified. We aimed to calculate the risk of TEEs associated with exposure to intravenous Ig.
    Methods: We included participants from UK Biobank recruited over 3 years, data extracted September 2020.The study endpoints were incidence of myocardial infarction, other acute ischaemic heart disease, stroke, pulmonary embolism and other venous embolism and thrombosis.Predictors included known TEE risk factors: age, sex, hypertension, smoking status, type 2 diabetes mellitus, hypercholesterolaemia, cancer and past history of TEE. Intravenous Ig and six other predictors were added in the sensitivity analysis.Information from participants was collected prospectively, while data from linked resources, including death, cancer, hospital admissions and primary care records were collected retrospectively and prospectively.  FINDINGS: 14 794 of 502 492 individuals had an incident TEE during the study period. The rate of incident events was threefold higher in those with prior history of TEE (8 .7%) than those without previous history of TEE (3.0%).In the prior TEE category, intravenous Ig exposure was independently associated with increased risk of incident TEE (OR=3.69 (95% CI 1.15 to 11.92), p=0.03) on multivariate analysis. The number needed to harm by exposure to intravenous Ig in those with a history of TEE was 5.8 (95% CI 2.3 to 88.3).Intravenous Ig exposure did not increase risk of TEE in those with no previous history of TEE.
    Interpretation: Intravenous Ig is associated with increased risk of further TEE in individuals with prior history of an event with one further TEE for every six people exposed. In practice, this will influence how clinicians consent for and manage overall TEE risk on intravenous Ig exposure.
    MeSH term(s) Biological Specimen Banks ; Diabetes Mellitus, Type 2/complications ; Humans ; Immunoglobulins, Intravenous/adverse effects ; Retrospective Studies ; Risk Factors ; United Kingdom/epidemiology ; Venous Thromboembolism
    Chemical Substances Immunoglobulins, Intravenous
    Language English
    Publishing date 2022-06-10
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 3087-9
    ISSN 1468-330X ; 0022-3050
    ISSN (online) 1468-330X
    ISSN 0022-3050
    DOI 10.1136/jnnp-2022-328881
    Database MEDical Literature Analysis and Retrieval System OnLINE

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