Abstract text (incl. figure legends and references)

QUESTION: At 2018 European Medicines Agency authorized CGRP inhibitors as a treatment for episodic and chronic migraine. Erenumab and Galcanezumab included in its clinical essays patients until 65 years old. Fremanezumab included patients until 70 years old, but did not specify the percentage of older patients or their comorbidities. There are few data of this group who usually has other comorbidities and vascular risk factors. Our objective is to describe the efficacy and security of CGRP inhibitors in clinical practice.

METHODS: We have retrospectively reviewed 32 patients with ages between 55 and 77 years old treated with CGRP inhibitors. We included patients who began CGRP inhibitors between 2019 and 2022. We considered CGRP inhibitors were effective if patients achieved a decrease of 50% of monthly migraine days or a decrease higher than 5 points in MIDAS or HIT-6 scales.

RESULTS: 3 patients were male and 25 female. 4 patients had episodic migraine and 28 chronic migraine with an average MIDAS of 106.5 and HIT-6 of 67.5. Patients had tried an average of 6 preventive medications, including botulinum toxin 31 of them. 15 patients had vascular risk factors, 6 had high blood pressure, 11 hypercholesterolemia, 1 diabetes. Efficacy was of 40.6%, 12/24 patients responded to erenumab, 1/4 to galcanezumab and 0/4 to fremanezumab. 11 patients who did not respond to a first CGRP inhibitor switched to another and 7/11 responded. Adverse effects appeared in 46.9% of the patients. The most common was constipation in 9 patients, followed by articular pain and local erythema in 2 patients. There were 3 significant adverse effects: a paralytic ileus, hypertensive emergency and a patient who reported worsening of her inflammatory arthritis.

CONCLUSIONS: In our series the efficacy of CGRP inhibitors in older patients were similar to the efficacy reported in clinical essays. Most adverse effects were minor, only 3 leaded to discontinuation of the treatment.