Erenumab for migraine prevention in a patient with mitochondrial encephalopathy, lactate acidosis, and stroke‐like episodes syndrome: A case report

Naegel, Steffen; Burow, Philipp; Holle, Dagny; Stoevesandt, Dietrich; Heintz, Simon; Thaele, Annemarie; Zierz, Stephan; Kraya, Torsten

doi:10.1111/head.14101

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…Erenumab or galcanezumab were also effective on migraine with aura in two patients with a mitochondriopathy [ 140 , 141 ] and galcanezumab was found effective in a patient with nummular headache [ 142 ].…”

Section: Are They Effective In Other Headache Types?mentioning

confidence: 99%

Ten open questions in migraine prophylaxis with monoclonal antibodies blocking the calcitonin-gene related peptide pathway: a narrative review

et al. 2023

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The monoclonal antibodies (mAbs) blocking the calcitonin-gene related peptide (CGRP) pathway, collectively called here “anti-CGRP/rec mAbs”, have dramatically improved preventive migraine treatment. Although their efficacy and tolerability were proven in a number of randomized controlled trials (RCTs) and, maybe even more convincingly, in real world settings, a number of open questions remain. In this narrative review, we will analyze published data allowing insight in some of the uncertainties related to the use of anti-CGRP/rec mAbs in clinical practice: their differential efficacy in migraine subtypes, outcome predictors, switching between molecules, use in children and adolescents, long-term treatment adherence and persistence, effect persistence after discontinuation, combined treatment with botulinum toxin or gepants, added-value and cost effectiveness, effectiveness in other headache types, and potential contraindications based on known physiological effects of CGRP. While recent studies have already provided hints for some of these questions, many of them will not find reliable and definitive answers before larger studies, registries or dedicated RCTs are available.

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Section: Are They Effective In Other Headache Types?mentioning

confidence: 99%

Ten open questions in migraine prophylaxis with monoclonal antibodies blocking the calcitonin-gene related peptide pathway: a narrative review

et al. 2023

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“…The last search was conducted on June 1, 2022. The search allowed to retrieve 329 papers, of which only three papers resulted to be relevant to the topic [7][8][9] (Table 1). Notably, erenumab 70 mg was reported to be an effective migraine prophylaxis in a female patient with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS; m.3243A > G mutation) [9].…”

Section: Discussionmentioning

confidence: 99%

“…The search allowed to retrieve 329 papers, of which only three papers resulted to be relevant to the topic [7][8][9] (Table 1). Notably, erenumab 70 mg was reported to be an effective migraine prophylaxis in a female patient with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS; m.3243A > G mutation) [9]. This patient had been previously treated with topiramate and onabotulinumtoxinA, which were both discontinued due to inefficacy, and flunarizine which was not tolerated due to side effects.…”

Section: Discussionmentioning

confidence: 99%

Preventive migraine treatment in mitochondrial diseases: a case report of erenumab efficacy and literature review

et al. 2022

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Migraine is a common condition in mitochondrial diseases, with a higher prevalence than in the general population. Although several clinical studies support the hypothesis that mitochondrial dysfunction plays a central role in the pathophysiology of migraine, currently there are few data in the literature regarding the efficacy and safety of drugs for the treatment and prophylaxis for this condition in patients with primary mitochondrial disorders. We report a 37-year-old woman affected by mitochondrial disease with progressive external ophthalmoplegia phenotype (PEO) associated with POLG mutation effectively treated with erenumab, in the absence of side effects. Monoclonal antibodies against the calcitonin gene-related peptide (CGRP) or against its receptor are innovative and specific therapies for migraine prophylaxis. This class of drugs is particularly suitable for subjects, such as those suffering from genetically determined mitochondrial dysfunction, in which pharmacological management can represent a challenge due to the nature of these neurogenetic disorders and/or the frequently associated comorbidities.

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“…We present a patient with a genetically confirmed mitochondrial disorder [homozygous missense change in SSBP1; c.394A > G (p.I132V)] with episodic/chronic migraine with aura who received galcanezumab for preventive migraine treatment, after having failed two standard-of-care treatment approaches. Herein, we describe the second case of the successful and safe use of a monoclonal anti-CGRP-antibody in a patient with a mitochondrial disease ( 11 ), and we report for the first time a long-term follow-up of 3 years. Treatment with galcanezumab was well tolerated and showed adequate efficacy with a sustained > 50% reduction in monthly headache days.…”

Section: Discussionmentioning

confidence: 96%

“…The frequent use of acetaminophen as acute medication may deplete glutathione and cause hepatopathy ( 13 ). Triptans seem to be effective and well tolerated in such patients and therefore might be considered for the acute treatment of migraine attacks ( 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Monoclonal CGRP-antibody treatment in a migraine patient with a mutation in the mitochondrial single-strand binding protein (SSBP1)

et al. 2022

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BackgroundThere is a growing body of mitochondrial disorders that are associated with headaches, albeit only one of them is currently listed in the latest International Classification of Headache Disorders, 3rd edition (ICHD-3). Headache frequency and headache presentation can vary widely in this respective patient group. Acute and preventive migraine treatment can be quite challenging—the use of several established medications is often limited due to their side effects in the setting of mitochondrial dysfunction and multi-organ disease.Case presentationAlong with a review of the literature on treatment options in patients with mitochondrial disorders and migraine headaches, we present the case of a 23-year-old male with a homozygous mutation in the mitochondrial single-strand binding protein (SSBP1) with chronic migraine with aura. After failing several standard of care prophylactics due to either side effects or inefficacy, he was successfully treated with a monoclonal anti-CGRP-antibody as a preventive migraine treatment. The monoclonal antibody was well tolerated and showed adequate efficacy with a sustained > 50% reduction in monthly headache days after 3 years of treatment.ConclusionMigraine is often challenging to treat in patients with mitochondriopathy due to therapy-limiting comorbidities. Monoclonal CGRP-antibodies might be a safe treatment option in the prevention of migraine headaches in patients with a mitochondrial disorder.

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Erenumab for migraine prevention in a patient with mitochondrial encephalopathy, lactate acidosis, and stroke‐like episodes syndrome: A case report

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 8 publications

References 11 publications

Ten open questions in migraine prophylaxis with monoclonal antibodies blocking the calcitonin-gene related peptide pathway: a narrative review

Ten open questions in migraine prophylaxis with monoclonal antibodies blocking the calcitonin-gene related peptide pathway: a narrative review

Preventive migraine treatment in mitochondrial diseases: a case report of erenumab efficacy and literature review

Case report: Monoclonal CGRP-antibody treatment in a migraine patient with a mutation in the mitochondrial single-strand binding protein (SSBP1)

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