Excellent Response to OnabotulinumtoxinA: Different Definitions, Different Predictors

Abstract

The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineurs treated with onabotulinumtoxinA and followed-up for, at least, 9 months was performed. Excellent responders were defined either as patients with a ≥75% decrease in monthly headache days (percent-based excellent responders) or as patients with <4 monthly headache days (frequency-based excellent responders). The characteristics of excellent responders at the baseline were compared with the ones of patients with a <30% decrease in monthly headache days. Percent-based excellent responders represented about 10% of the sample, whilst frequency-based excellent responders were about 5% of the sample. Compared with non-responders, percent-based excellent responders had a higher prevalence of medication overuse and a higher excellent response rate even after the 1st and the 2nd injection. Females were less like to be frequency-based excellent responders. Chronic migraine sufferers without medication overuse and of female sex may find fewer benefits with onabotulinumtoxinA. Additionally, the excellent response status is identifiable after the first cycle.

OnabotulinumtoxinA Treatment in Chronic Migraine: Investigation of Its Effects on Disability, Headache and Neck Pain Intensity

“…The decrease of more than 30% in the number of days with headache after the first month with ONA treatment indicates that ONA treatment can be successful [ 27 ]. The decrease in monthly headache days in ONA treatment is more than 75% between the beginning and the next application shows that the response to the treatment is excellent [ 52 ]. Ornello et al reported those who responded to a reduction in headache days after ONA application at 3, 6 and 9 months [ 52 ].…”

“…The decrease in monthly headache days in ONA treatment is more than 75% between the beginning and the next application shows that the response to the treatment is excellent [ 52 ]. Ornello et al reported those who responded to a reduction in headache days after ONA application at 3, 6 and 9 months [ 52 ]. In the results at 3 months, the rate of excellent responders to ONA treatment was 8.6% ( n = 248/2879).…”

OnabotulinumtoxinA: Still the Present for Chronic Migraine

“…Several real-world studies have been published, with findings consistent with PREEMPT studies in CM patients with and without MOH [ 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 ]. Real-world studies primarily exploring the effectiveness and safety of BT-A compared to the baseline are summarized in Table 2 .…”

“…Gender does not influence patients’ response to BT-A [ 124 ]. Additionally, BT-A may also be a safe and valuable tool to treat CM in the elderly, when many treatments are not indicated [ 126 ].…”

“…Adverse events (AEs) associated with BT-A are mainly local and transitory [ 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 ]. Muscular weakness, especially in the trapezius muscle, is one of the most common [ 116 ].…”