by Viktoria Papp
Each month the EANpages editorial team reviews the scientific press for recently published papers of outstanding interest to neurologists. Below we present our selection for January 2024 (for our Paper of the Month for January, see here).
1. Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users’ Self-Reported Records From a Smartphone Application
This retrospective multinational study presented Class IV evidence for acute migraine treatment. Patient-reported data were collected in real-world settings on the effectiveness of different acute migraine treatments by using a smartphone headache diary applicationcalled Migraine Buddy™. From the 10,842,795 migraine attacks recorded in the database between 30 June 2014 and 2 July 2020, 3,119,517 migraine attacks from 278,006 users fulfilled the inclusion criteria and were analysed. The primary endpoint was the user-reported treatment effectiveness. The authors compared 25 medications used in acute migraine with ibuprofen as a reference drug. They found that the most used medications were ibuprofen (usage count 682,539), followed by sumatriptan (673,581), acetaminophen (419,363), acetaminophen/acetylsalicylic acid/caffeine (381,618), and rizatriptan (359,158). The majority of migraine attacks were treated with one (65.5%) or two (23.3%) medications. More than half (54.5%) of the treatments were reported as “helpful”. The highest effectiveness was reported with triptans (mean odd ratio [OR] 4.8), ergots (mean OR 3.02), and anti-emetics (mean OR 2.67) compared to ibuprofen. These results from head-to-head comparisons and real-world data support the guideline recommendations that triptans, ergots, and anti-emetics are the most effective treatment options for acute migraine.
2. Neurological adverse events related to immune-checkpoint inhibitors in Spain: a retrospective cohort study
This retrospective multicenter Spanish cohort study included patients who were treated with immune-checkpoint inhibitors against their cancer disease but developed secondary immune reactions leading to neurological syndromes as an adverse event. The study reported on clinical features, antibody findings, treatment approaches, longitudinal follow-up, and prognostic factors of treatment response and survival. Sixty-four patients were included between 1 Jan 2018, and 1 Feb 2023. Most patients had pulmonary cancer (47%), melanoma (21%), or renal cell carcinoma (11%). Eighty-one percent of the patients had CNS involvement and 78% had no detectable neural antibodies. Despite 91% of the patients being treated with steroids and 48% of them also received additional treatment, 28% showed no improvement in the first month after an adverse event, and 11 out of 18 patients died. At the last follow-up (median six months), 38% of the patients had a poor outcome (modified Rankin Scale score <2). The risk of mortality was higher in patients with pulmonary cancer compared to other cancer types and in patients with encephalopathy without signs of CNS inflammation or combined myocarditis, myasthenia, and myositis. These findings may suggest that these patients need prompt and intensive treatment since most deaths occurred within the first month after onset.
3. Ubrogepant for the treatment of migraine attacks during the prodrome: a phase 3, multicentre, randomised, double-blind, placebo-controlled, crossover trial in the USA
The PRODROME trial is a phase 3, multicentre, randomised (1:1), double-blind, placebo-controlled, crossover study that included 75 sites and 518 patients. The study drug, ubrogepant (100 mg) is a calcitonin gene-related peptide (CGRP) receptor antagonist and is approved to treat migraine attacks. The main goal of the study was to evaluate the efficacy, safety, and tolerability of the drug when it was administered in the migraine prodromal phase compared to placebo. The primary outcome was the absence of moderate or severe headaches within 24 hours after receiving the treatment. The modified intention-to-treat (mITT) population was used to assess efficacy. Eighty-eight percent of the participants were female. When ubrogepant was given in the prodrome, 46% of the prodromes were not followed by moderate or severe headache compared to 29% in the placebo-treated arm (odds ratio 2.09, 95% CI: 1.63–2.69; p<0∙0001). Side effects were reported after 17% of the ubrogepant treated prodrome and 12% of the placebo-treated prodrome. No serious side effects were observed, the most frequent side effects were nausea, dizziness, fatigue, and somnolence. The results showed that ubrogepant can prevent the occurrence of headaches after migraine prodrome when taking it during the prodromal phase and it is well-tolerated.
