BACKGROUND AND AIMS
Anti-calcitonin gene-related peptide (CGRP) therapies have demonstrated effectiveness and safety in patients with chronic1-3 and episodic4-10 migraine in several clinical trials. However, there is limited information regarding clinical characteristics, effectiveness, and safety in the elderly under CGRP therapies, which may prevent clinicians from using these treatments in older patients. Migraine tends to improve with age; however, a substantial proportion of older adults may still suffer from migraine. Besides that, these patients are more likely to have relevant comorbidities and polypharmacy, with potential drug–drug interactions, and are more vulnerable to adverse effects.11 This cohort could potentially benefit from therapies with a better tolerability profile. In addition, older adults may have tried multiple migraine-preventive drugs over their lives, reducing the therapeutic armamentarium.11
MATERIALS AND METHODS
To address this gap, the authors performed a retrospective multicentre study nested in a prospectively collected cohort of cases, in which patients were individuals over 65 years old with migraine, who were receiving anti-CGRP therapies. Sex- and age-matched controls under 55 years old were used. Demographics, effectiveness, and safety variables were collected. Effectiveness, defined by the reduction in the number of headache (HDM) and migraine days per month (MDM); and responder rate, defined as 30%, 50%, and 75% reduction in the number of HDM and MDM at 3-, 6-, and 12 months, were collected. Adverse events (AE) were also evaluated at each time point.
RESULTS
In this study, a total of 228 patients were included: 114 cases and 114 controls. Among these, 84% were female, mean age was 70.1 years (range: 66–86), and approximately 80% of cases had chronic migraine. The authors found a higher percentage of vascular risk factors among the elderly, such as hypertension and dyslipidaemia, and also migraine with aura; higher age of migraine onset; and higher prior number of prophylactic treatments and medication overuse rates in the elderly. However, there were no major differences regarding effectiveness. The authors found that, in these cases, a 50% response rate was achieved by 59% at 20–24 weeks. A lower reduction in HDM was observed in the elderly regarding number of headaches at 3 months, and MDM at 6- and 12 months. The percentage of AEs was similar in the two groups, without serious AEs. The most common AE was constipation, without differences between groups. In this series, independent characteristics associated with the elderly were age of migraine onset and number of prior preventive treatments.
CONCLUSION
This case-control study provides real-world evidence of effectiveness and safety of anti-CGRP therapies for patients with migraine over 65 years old compared with younger patients. These results highlight that anti-CGRP therapies are not only effective as in the elderly, but also have a good tolerability profile in this special population.
