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Anti-CGRP Therapy Efficacious For Migraine in People With Fibromyalgia
A recent study reveals that anti-CGRP monoclonal antibodies effectively treat migraines in fibromyalgia patients, improving headache frequency and disability.
A new study has found that anti-CGRP monoclonal antibodies may be a good option for treating migraines in people with fibromyalgia (FM).1
“Migraine is a common comorbidity with FM and patients with fibromyalgia are frequently affected by chronic and disabling forms of headache.2 At present, there is little evidence of pharmacological treatment for fibromyalgia. Due to the lack of therapies that address the complex pathophysiologic basis of the disease, a non-pharmacologic approach is primarily recommended. CGRP is a potent inflammatory neuropeptide that may play a role in somatic and visceral inflammatory and neuropathic pain,” lead investigator Marina de Tommaso, Neurophysiopathology Unit, Headache Center, DiBrain Department, Bari Aldo Moro University, Policlinico General Hospital, Bari, Italy, and colleagues wrote.1
Tommaso and colleagues conducted a retrospective, observational, cross-sectional study, analyzing effects of anti-CGRP monoclonal antibody therapy in a subpopulation of migraineurs with FM compared to patients without this comorbidity by assessing the severity of FM via Fibromyalgia Impact Questionnaire (FIQ) as well as headache frequency and disability.
The study included 148 patients with migraine out of 1088 that came for the first visit to the Policlinico General Hospital’s headache Center between January 2021 and December 2022. Investigators measured 6-month outcomes with erenumab, galcanezumab, and fremanezumab. The final analysis included 122 patients, 26 of which had FM. De Tommaso and colleagues evaluated headache frequency and severity, number of days with symptomatic medication, and MIDAS score at baseline and after 6 months, as well as FIQ and the intensity of somatic pain using a numerical rating scale from 0 to 10 in patients that also had FM.1
The investigators found that FM and non-FM groups had a similar frequency of medication ineffectiveness at 3 months (chi-square with correction, 2.44; P = .11). Groups also had similar significant improvement in headache frequency and days of symptomatic medication use after 3 months (frequency: FM, 12.1 headache/days/month; not FM, 9.9; ANOVA FM vs no FM: F, 0.09; P = .8) and 6 months. The 2 migraine groups also had a similar proportion of patients in whom headache frequency decreased by at least 50% (FM, 46.2%; non-FM, 54.2; chi-square, 0.52; P = .46).1
Notably, improvements in fibromyalgia disability as measured by the FIQ were significantly correlated with the improvement in migraine-related disability as measured by MIDAS (Pearson correlation, 0.55; P = .0033). The relationship between FIQ and headache frequency showed a similar but insignificant trend (Pearson correlation, 0.34; P = .08). Comparing patients with episodic and chronic migraine patients with FM found no significant differences in percentage reduction of FIQ scores (ANOVA F, 3.59; P = .07).1
“In this monocentric retrospective study in a small group of migraine patients with a comorbidity for fibromyalgia, we found that monoclonal antibodies against CGRP had a beneficial effect on migraine, similar to that in non-fibromyalgia patients, and furthermore reduced somatic pain and global disability from the disease. We cannot currently assume that the anti-CGRP drugs act on somatic myofascial pain, nor do we know the possible mechanism of this effect,” de Tommaso and colleagues concluded.1
