Abstract text (incl. figure legends and references)

QUESTION

An important percentage of our patients are using monoclonal antibodies against CGRP or its receptor (a-CGRP) concomitantly with botulinum toxin. It is important to analyze how these patients evolve with both treatments.

METHODS

We investigate patients with resistant migraine treated with a-CGRP and botulinum toxin ant compare with patients with a-CGRP only. We analyzed: days of migraine (MHD), headache (HHD) and triptanes per month (MtuD) as well as scales (HIT-6, MIDAS, and quality of life (MsQol)). We compared the data at 3 and 6 months. We analyzed the wearing off from botulinum toxin in patients who are with this treatment and how many of them stopped the treatment with toxin after initiated a-CGRP.

RESULTS

336 patients were included, 215 with both treatments (64%), 121 patients with a-CGRP but without toxin (36%). Comparing results, in the group with toxin, at baseline 19 MHD with reduction of 7 MHD at 3 months and 8,3 MHD at 6 months. In the group without toxin, they had 20,3 MHD at baseline with reduction of 8,5 MHD at 3 months and 11,8 MHD at 6 months.

In the group with toxin, HIT-6 was reduced an average of 6,3 points at 6 months and MIDAS 40,2 points at 6 months. In the group with toxin, HIT-6 was reduced 12,9 points and MIDAS 58,8 points at 6 months.

At 6 months, 119 patients are with both treatments (botulinum toxin and a-CGRP). 79 of them (66%) presented wearing off from the toxin: 32 patients had more frequent migraines, 13 more intense them, and 24 patients both things.

45 patients (20,9%) stopped the treatment with botulinum toxin after 3-6 months after initiating the a-CGRP.

CONCLUSIONS

Although both groups have a significant response, the group without botulinum toxin presents better results. However, the wearing off in the group with botulinum toxin supports the use of both treatments in these patients to optimize their therapy.