Evaluation of the effectiveness and safety of anti-CGRP monoclonal antibodies in patients with migraine and autoimmune diseases: IMMUNO-CGRP study.
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García-Castillo María Clara, Sierra-Mencía Álvaro, Caronna Edoardo, Toledo-Alfocea Daniel, Jaimes Alex, Urtiaga Sarai, Casas-Limón Javier, Muñoz-Vendrell Albert, Santos-Lasaosa Sonia, García Martín Valvanuz, Martín Ávila Guillermo, Polanco Marcos, Villar-Martínez Maria Dolores, Trevino-Peinado Cristina, Rubio-Flores Laura, Sánchez-Soblechero Antonio, Portocarrero Sánchez Leonardo, Luque-Buzo Elisa, Lozano-Ros Alberto, Gago-Veiga Ana Beatriz, Díaz-De-Terán Javier, Recio García Andrea, Canales Rodríguez Javiera, Gómez García Andrea, González Salaices Marta, Campoy Sergio, Mínguez-Olaondo Ane, Maniataki Stefania, González-Quintanilla Vicente, Porta-Etessam Jesús, Cuadrado María-Luz, Guerrero Peral Ángel Luis, Pozo-Rosich Patricia, Rodríguez-Vico Jaime, Huerta-Villanueva Mariano, Pascual Julio, Goadsby Peter J, Gonzalez-Martinez Alicia
Аннотация
BACKGROUND: CGRP has an important role in migraine pathophysiology through neuronal modulation in the trigeminovascular nociceptive system and activation of neuro-inflammatory cascades. We hypothesized that autoimmune diseases may influence treatment response and safety profiles in patients with migraine treated with anti-CGRP treatments.
METHODS: This was a retrospective multicenter, age- and sex-matched cohort study in headache units/headache clinics in Spain and United Kingdom between May 2024 and May 2025 including patients treated with CGRP monoclonal antibodies from prospectively collected cohorts. Patients were assessed for demographics, migraine-related characteristics, treatment effectiveness (monthly migraine days [MMD] and/or monthly headache days [MHD]), and safety outcomes. The main outcome was the effectiveness measured by ≥50% response rate in MMD between the two groups. Secondary outcomes included other effectiveness measurements regarding the number of MMD and MHD and treatment emerging adverse events.
RESULTS: A total of 388 patients with migraine under anti-CGRP treatments (194 with autoimmune diseases and 194 age- and sex-matched controls without autoimmune diseases) were included. The proportion of patients achieving a ≥50% response rate in MMD was higher in patients without autoimmune diseases at 6 (69% vs. 53%; p = 0.006) and 9 months (74% vs. 52%; p = 0.006). Treatment emerging adverse events were comparable between the two groups (35% vs. 38%; p = 0.575). Patients with autoimmune disease had a significantly lower likelihood of achieving a ≥50% response in MMD compared with those without autoimmune disease (adjusted odds ratio, 0.61; 95% confidence interval, 0.44-0.85; p = 0.006), independent of comorbid depression and medication overuse.
CONCLUSIONS: Our study shows that anti-CGRP treatments are effective and safe for patients with migraine regardless the presence of autoimmune diseases, although an increased treatment response in patient without autoimmune disorders compared to patients with autoimmune disorders was observed. These findings highlight the need for early intervention, tailored strategies, and vigilant monitoring in patients with migraine and autoimmune disorders. Further research should explore immunomodulatory approaches to enhance outcomes.