Assessment of Bone Mineral Density Over 1 Year in a Cross-Sectional Cohort of Migraine Patients Receiving Anti-CGRP Monoclonal Antibodies.
Journal
CNS drugs
ISSN: 1179-1934
Titre abrégé: CNS Drugs
Pays: New Zealand
ID NLM: 9431220
Informations de publication
Date de publication:
22 Aug 2024
22 Aug 2024
Historique:
accepted:
18
06
2024
medline:
23
8
2024
pubmed:
23
8
2024
entrez:
22
8
2024
Statut:
aheadofprint
Résumé
Calcitonin gene-related peptide (CGRP), implicated in migraine pain, also possesses bone anabolic properties, which leads to the possibility that monoclonal antibodies targeting CGRP (anti-CGRPs) might increase the risk of bone density abnormalities. The objective of this study was to explore bone mineral density abnormalities in a cohort of migraine patients treated with anti-CGRPs. This was a single-center, cross-sectional, cohort study including migraine patients who underwent a densitometry assessment during anti-CGRP treatment. We assessed the frequency of osteopenia or osteoporosis (OSTEO+ status), defined as a bone mineral density T-score of -1 to -2.5, and <-2.5 standard deviations from the young female adult mean, respectively. Additionally, the association of OSTEO+ status with anti-CGRP treatment duration and primary osteoporosis' risk factors was investigated using logistic regression models. Data from 51 patients (43 female, mean age 46 ± 13.9 years) were evaluated. The mean duration of anti-CGRP treatment was 15.7 (±11.8) months. Twenty-seven patients (53%) were OSTEO+ (n = 22 osteopenia; n = 5 osteoporosis). In the final model, menopause [odds ratio 11.641 (95% confidence interval 1.486-91.197), p = 0.019] and anti-seizure drug use [odds ratio 12.825 (95% confidence interval 1.162-141.569), p = 0.037] were associated with OSTEO+ status. In our cohort of migraine patients, no evidence of an association between anti-CGRP treatment duration and an increasing risk of bone mineral density abnormalities was found. However, these findings are preliminary and necessitate further longitudinal research with larger cohorts and extended follow-up to be validated.
Sections du résumé
BACKGROUND
BACKGROUND
Calcitonin gene-related peptide (CGRP), implicated in migraine pain, also possesses bone anabolic properties, which leads to the possibility that monoclonal antibodies targeting CGRP (anti-CGRPs) might increase the risk of bone density abnormalities.
OBJECTIVE
OBJECTIVE
The objective of this study was to explore bone mineral density abnormalities in a cohort of migraine patients treated with anti-CGRPs.
METHODS
METHODS
This was a single-center, cross-sectional, cohort study including migraine patients who underwent a densitometry assessment during anti-CGRP treatment. We assessed the frequency of osteopenia or osteoporosis (OSTEO+ status), defined as a bone mineral density T-score of -1 to -2.5, and <-2.5 standard deviations from the young female adult mean, respectively. Additionally, the association of OSTEO+ status with anti-CGRP treatment duration and primary osteoporosis' risk factors was investigated using logistic regression models.
RESULTS
RESULTS
Data from 51 patients (43 female, mean age 46 ± 13.9 years) were evaluated. The mean duration of anti-CGRP treatment was 15.7 (±11.8) months. Twenty-seven patients (53%) were OSTEO+ (n = 22 osteopenia; n = 5 osteoporosis). In the final model, menopause [odds ratio 11.641 (95% confidence interval 1.486-91.197), p = 0.019] and anti-seizure drug use [odds ratio 12.825 (95% confidence interval 1.162-141.569), p = 0.037] were associated with OSTEO+ status.
CONCLUSIONS
CONCLUSIONS
In our cohort of migraine patients, no evidence of an association between anti-CGRP treatment duration and an increasing risk of bone mineral density abnormalities was found. However, these findings are preliminary and necessitate further longitudinal research with larger cohorts and extended follow-up to be validated.
Identifiants
pubmed: 39174745
doi: 10.1007/s40263-024-01104-0
pii: 10.1007/s40263-024-01104-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Ashina M, Katsarava Z, Do TP, Buse DC, Pozo-Rosich P, Özge A, et al. Migraine: epidemiology and systems of care. Lancet. 2021;397(10283):1485–95.
doi: 10.1016/S0140-6736(20)32160-7
pubmed: 33773613
Ashina M, Buse DC, Ashina H, Pozo-Rosich P, Peres MFP, Lee MJ, et al. Migraine: integrated approaches to clinical management and emerging treatments. Lancet. 2021 Apr 17;397(10283):1505-18
Berger A, Bloudek LM, Varon SF, Oster G. Adherence with migraine prophylaxis in clinical practice. Pain Pract. 2012;12(7):541–9.
doi: 10.1111/j.1533-2500.2012.00530.x
pubmed: 22300068
Deligianni CI, Mitsikostas DD, Ashina M. Safety and tolerability evaluation of erenumab for the preventive treatment of migraine. Expert Opin Drug Saf. 2021;20(8):867–76.
doi: 10.1080/14740338.2021.1933941
pubmed: 34037500
Rivera-Mancilla E, Villalón CM, MaassenVanDenBrink A. CGRP inhibitors for migraine prophylaxis: a safety review. Expert Opin Drug Saf. 2020;19(10):1237–50.
doi: 10.1080/14740338.2020.1811229
pubmed: 32811190
Edvinsson L, Goadsby PJ. Neuropeptides in headache. Eur J Neurol. 1998;5(4):329–41.
doi: 10.1046/j.1468-1331.1998.540329.x
Lassen LH, Haderslev PA, Jacobsen VB, Iversen HK, Sperling B, Olesen J. CGRP may play a causative role in migraine. Cephalalgia. 2002;22(1):54–61.
doi: 10.1046/j.1468-2982.2002.00310.x
pubmed: 11993614
McCulloch J, Uddman R, Kingman TA, Edvinsson L. Calcitonin gene-related peptide: functional role in cerebrovascular regulation. Proc Natl Acad Sci U S A. 1986;83(15):5731–5.
doi: 10.1073/pnas.83.15.5731
pubmed: 3488550
pmcid: 386363
Vignery A, McCarthy TL. The neuropeptide calcitonin gene-related peptide stimulates insulin-like growth factor I production by primary fetal rat osteoblasts. Bone. 1996;18(4):331–5.
doi: 10.1016/8756-3282(96)00017-8
pubmed: 8726390
Kacena MA, White FA. No pain, no gain: will migraine therapies increase bone loss and impair fracture healing? EBioMedicine. 2020;60:103025.
doi: 10.1016/j.ebiom.2020.103025
pubmed: 32971471
pmcid: 7516061
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. https://doi.org/10.1177/0333102413485658 . PMID: 23771276.
Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364–76.
doi: 10.1016/S0140-6736(18)32112-3
pubmed: 30696576
Varacallo M, Seaman TJ, Jandu JS, Pizzutillo P. Osteopenia. Treasure Island: StatPearls Publishing LLC; 2023.
R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing. 2021; version 4.1.2. Available from: https://www.R-project.org/ . Accessed 29 Jun 2024.
Sample SJ, Heaton CM, Behan M, Bleedorn JA, Racette MA, Hao Z, et al. Role of calcitonin gene-related peptide in functional adaptation of the skeleton. PLoS ONE. 2014;9(12): e113959.
doi: 10.1371/journal.pone.0113959
pubmed: 25536054
pmcid: 4275203
Ji MX, Yu Q. Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med. 2015;1(1):9–13.
pubmed: 29062981
pmcid: 5643776
AA.VV. Management of osteoporosis in postmenopausal women: the 2021 position statement of the North American Menopause Society. Menopause. 2021;28(9):973–97.
van der Burgh AC, de Keyser CE, Zillikens MC, Stricker BH. The effects of osteoporotic and non-osteoporotic medications on fracture risk and bone mineral density. Drugs. 2021;81(16):1831–58.
doi: 10.1007/s40265-021-01625-8
pubmed: 34724173
pmcid: 8578161
Ashina M, Saper J, Cady R, Schaeffler BA, Biondi DM, Hirman J, et al. Eptinezumab in episodic migraine: a randomized, double-blind, placebo-controlled study (PROMISE-1). Cephalalgia. 2020;40(3):241–54.
doi: 10.1177/0333102420905132
pubmed: 32075406
pmcid: 7066477
Detke HC, Goadsby PJ, Wang S, Friedman DI, Selzler KJ, Aurora SK. Galcanezumab in chronic migraine: the randomized, double-blind, placebo-controlled REGAIN study. Neurology. 2018;91(24):e2211–21.
doi: 10.1212/WNL.0000000000006640
pubmed: 30446596
pmcid: 6329331
Dodick DW, Ashina M, Brandes JL, Kudrow D, Lanteri-Minet M, Osipova V, et al. ARISE: a phase 3 randomized trial of erenumab for episodic migraine. Cephalalgia. 2018;38(6):1026–37.
doi: 10.1177/0333102418759786
pubmed: 29471679
Dodick DW, Silberstein SD, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T, et al. Effect of fremanezumab compared with placebo for prevention of episodic migraine: a randomized clinical trial. JAMA. 2018;319(19):1999–2008.
doi: 10.1001/jama.2018.4853
pubmed: 29800211
Goadsby PJ, Reuter U, Hallström Y, Broessner G, Bonner JH, Zhang F, et al. A controlled trial of erenumab for episodic migraine. N Engl J Med. 2017;377(22):2123–32.
doi: 10.1056/NEJMoa1705848
pubmed: 29171821
Lipton RB, Goadsby PJ, Smith J, Schaeffler BA, Biondi DM, Hirman J, et al. Efficacy and safety of eptinezumab in patients with chronic migraine: PROMISE-2. Neurology. 2020;94(13):e1365–77.
doi: 10.1212/WNL.0000000000009169
pubmed: 32209650
pmcid: 7274916
Silberstein SD, Dodick DW, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T, et al. Fremanezumab for the preventive treatment of chronic migraine. N Engl J Med. 2017;377(22):2113–22.
doi: 10.1056/NEJMoa1709038
pubmed: 29171818
Skljarevski V, Matharu M, Millen BA, Ossipov MH, Kim BK, Yang JY. Efficacy and safety of galcanezumab for the prevention of episodic migraine: results of the EVOLVE-2 Phase 3 randomized controlled clinical trial. Cephalalgia. 2018;38(8):1442–54.
doi: 10.1177/0333102418779543
pubmed: 29848108
Stauffer VL, Dodick DW, Zhang Q, Carter JN, Ailani J, Conley RR. Evaluation of galcanezumab for the prevention of episodic migraine: the EVOLVE-1 randomized clinical trial. JAMA Neurol. 2018;75(9):1080–8.
doi: 10.1001/jamaneurol.2018.1212
pubmed: 29813147
pmcid: 6143119
Tepper S, Ashina M, Reuter U, Brandes JL, Doležil D, Silberstein S, et al. Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Neurol. 2017;16(6):425–34.
doi: 10.1016/S1474-4422(17)30083-2
pubmed: 28460892
Ashina M, Goadsby PJ, Reuter U, Silberstein S, Dodick DW, Xue F, et al. Long-term efficacy and safety of erenumab in migraine prevention: results from a 5-year, open-label treatment phase of a randomized clinical trial. Eur J Neurol. 2021;28(5):1716–25.
doi: 10.1111/ene.14715
pubmed: 33400330
Sacco S, Amin FM, Ashina M, Bendtsen L, Deligianni CI, Gil-Gouveia R, et al. European Headache Federation guideline on the use of monoclonal antibodies targeting the calcitonin gene related peptide pathway for migraine prevention: 2022 update. J Headache Pain. 2022;23(1):67.
doi: 10.1186/s10194-022-01431-x
pubmed: 35690723
pmcid: 9188162
Arora E, Singh H, Gupta YK. Impact of antiepileptic drugs on bone health: need for monitoring, treatment, and prevention strategies. J Family Med Prim Care. 2016;5(2):248–53.
doi: 10.4103/2249-4863.192338
pubmed: 27843822
pmcid: 5084542
Fan HC, Lee HS, Chang KP, Lee YY, Lai HC, Hung PL, et al. The impact of anti-epileptic drugs on growth and bone metabolism. Int J Mol Sci. 2016;17(8):1242.
doi: 10.3390/ijms17081242
pubmed: 27490534
pmcid: 5000640
Jetté N, Lix LM, Metge CJ, Prior HJ, McChesney J, Leslie WD. Association of antiepileptic drugs with nontraumatic fractures: a population-based analysis. Arch Neurol. 2011;68(1):107–12.
doi: 10.1001/archneurol.2010.341
pubmed: 21220681
Kim SH, Lee JW, Choi KG, Chung HW, Lee HW. A 6-month longitudinal study of bone mineral density with antiepileptic drug monotherapy. Epilepsy Behav. 2007;10(2):291–5.
doi: 10.1016/j.yebeh.2006.11.007
pubmed: 17224308