Cladribine Shows No Increased COVID-19 Risks, Migraine Preventative Preferences, Benefits of Mobile Stroke Units

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This week Neurology News Network covered a study from ACTRIMS Forum 2022 on lack of severe outcomes while on cladribine, the treatment preferences of patients with migraine on a preventative, and the continued benefits of mobile stroke units on functional outcomes.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio.

Patients with relapsing multiple sclerosis (MS) treated with 10-mg cladribine (Mavenclad; EMD Serono) tablets were not found to be at greater risk of serious disease and/or severe outcomes when compared with the general population and the MS population. According to findings presented at the ACTRIMS Forum 2022, the postapproval safety profile of cladribine tablets is consistent with previously published findings from the clinical development program. Data were collected as of July 15, 2021, with 316 COVID-19 cases confirmed by tests and 51 cases designated as serious. An additional 6 patients had symptoms consistent with COVID-19 but were not further evaluated following reports of negative PCR tests. Of the 503 patients that were eligible to be evaluated, a total of 259 (51.5%) had recovered or were recovering at the time of reporting, and 3 patients with suspected COVID-19 had died. Median time to onset of COVID-19 infection from most recent cladribine tablet treatment course was 169 days for 314 evaluable patients.

A recently published study looking at patient preference for early onset of preventive migraine treatments showed that both patients with chronic (CM) and episodic migraine (EM) treated with eptinezumab (Vyepti; Lundbeck) consider the likelihood of reduction of migraine on day 1 post dose to be as important as their overall reductions in the first month of treatment. Primary investigator Jessica Ailani, MD, FAHS, FAAN, director, MedStar Georgetown Headache Center, and colleagues analyzed a cohort of 101 patients who completed an online preference-elicitation thresholding exercise. Based on responses to choice frame 1, 58% of participants with CM considered a 14% point-reduction in the likelihood of having a migraine on day 1 postdosing to have equivalent or greater value as a reduction of 2 migraine days during the first month post-dosing. Furthermore, for these patients, a median reduction of 9.0% (IQR, 13.0%) in the chance of migraine on day 1 postdosing was also considered just as valuable as a reduction of 2 migraine days in the first month postdosing. In the EM group, 51% of participants that responded to choice frame 1 considered an 8% point-reduction in the likelihood of migraine on day 1 postdosing to have equivalent or greater value than reductions of 1 monthly migraine day.

Although the benefits of mobile stroke units (MSUs) have been previously reported, a newly published, large-scale meta-analysis showed that MSU use was associated with a 65% increase in the odds of excellent outcome, a higher proportion of treatment with intravenous thrombolysis (IVT), and a 30-minute reduction in onset-to-IVT times, without safety concerns. Studies from MEDLINE, Cochrane Library, and Embase from 1960 to 2021 that compared MSU deployment and usual care for patients with suspected stroke were eligible for analysis. Pooling 5 studies (n = 3228), including the notable B_PROUD and BEST-MSU trials, the meta-analysis suggested that MSU was superior to usual care regarding excellent outcome in adjusted and crude analyses. Furthermore, the pooled OR for reduced disability was 1.39 in adjusted analysis (3 studies; n = 1563) and 1.30 in unadjusted analysis (5 studies; n = 3228). "The main strength of this review is the use of all published data with consistent findings across studies,” the study authors wrote.

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