Background This meta-analysis evaluated the real-world effectiveness of onabotulinumtoxinA (BOTOX®), the first preventive treatment FDA-approved specifically for chronic migraine in 2010. Methods We systematically reviewed onabotulinumtoxinA observational data in chronic migraine published between 1 January 2010 and 31 March 2021. Random-effects models evaluated available data for primary and secondary endpoints defined in onabotulinumtoxinA pivotal trials at approximately 24 weeks and 52 weeks. Results Of the 44 full-text eligible studies (29 prospective; 13 retrospective; 2 other), seven evaluated change from baseline (mean[confidence interval]) at ∼24 weeks and ∼52 weeks, respectively, for onabotulinumtoxinA in: number of headache days/month: (–10.64 [–12.31, –8.97]; –10.32 [−14.92, –5.73]); number of days of acute headache pain medication intake per month (–7.40 [–13.04, –1.77]; overlapping CIs at 52 weeks); total Headache Impact Test-6 score (–11.70 [–13.86, –9.54]); –11.80 [14.70, –8.90]); and Migraine-Specific Quality-of-Life v2.1 score (MSQ; 23.60 [CI: 21.56, 25.64]; 30.90 [CI: 28.29, 33.51]). At ∼24 weeks onabotulinumtoxinA showed total Migraine Disability Assessment score of 44.74 [28.50, 60.99] and ≥50% reduction in migraine days response rate of 46.57% [29.50%, 63.65%]. A sensitivity analysis at study-end suggested durability of onabotulinumtoxinA effectiveness on MSQ. Conclusion The meta-analysis reflecting real-world practice broadly corroborated with evidence from pivotal and long-term open-label studies of onabotulinumtoxinA in chronic migraine preventive treatment.
EML) of 2017 was analyzed. List of medicines registered in Armenia (2018) was analyzed to identify authorized tracer medicines. Data on availability and prices were collected from pricelists of 5 main wholesalers, 3 pharmacy chains and 10 independent pharmacies. Affordability was calculated using methodology developed by WHO and Health Action International; it was expressed as the number of days needed by a person who earns the minimum wage that was set by legislation, to purchase a course of treatment. RESULTS: Only 72.5% of 51 antineoplastics and immunosuppressives and 65.0% of 103 formulations of these medicines listed in WHO EML are included in the new Armenian EML (72.3% and 54.3%, correspondingly, in Armenian EML of 2013); 68.6% of tracer medicines and 44.7% of their formulations are authorized. 49.0% of medicines and 25.2% of formulations were found in wholesalers' pricelists. Only 19.4% of formulations were available in different pharmacy outlets; the most of chain and all independent pharmacies did not have any tracer medicine. Only 16 of 86 formulations of cytotoxic and adjuvant medicines listed in WHO EML were available on the market; and cost of treatment only for 3 of them was less than 1 day wage. CONCLUSIONS: Only less than half of essential antineoplastics and immunosuppressives and less than one quarter of their formulations recommended by WHO are available on the pharmaceutical market of Armenia. Cost of treatment for the great majority of these essential medicines is unaffordable for those patients who are not covered by the reimbursement system.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.