Understanding the Impact of Data Analysis on Preventive Migraine Treatment: Jessica Ailani, MD

WATCH TIME: 5 minutes

"I think understanding where the person is coming from is first and foremost, even in our busy days, even when we're like 30 patients in and you're like 'I don't have time for this.' Take that moment, take that deep breath, and realize that a lot of the anger comes from their frustration with the disease process, and reflect that back to them."

Patients with migraine, one of the most disabling neurological conditions globally, may often experience a substantial impairment of their daily activities and quality of life.¹ In addition, those with difficult-to-treat migraine may often cycle through different preventive therapies. According to recent cross-sectional analysis published in The Journal of Headache and Pain, investigators observed an existence of increased burden, quality-of-life impairment, and functional impairment among patients with migraine who experienced at least 4 monthly headache days and more treatment failures.² These results suggest the need for effective preventive migraine treatments, despite not being able to determine the cause and directionality.

DELIVER is a multi-site, randomized, parallel-group, double-blinded, placebo-controlled trial (NCT04418765) assessing eptinezumab (Vyepti; Lundbeck) as a preventive treatment for patients who have failed between 2 and 4 preventive migraine therapies. A recent analysis of the trial revealed that a clinical response to eptinezumab was maintained in most patients if they reported an at least a 50% migraine response following 1–2 doses of the treatment. For at least 50% responders in the first dose, 61% and 74% maintained an at least 50% response to eptinezumab 100 mg (n = 113) and eptinezumab 300 mg (n = 126), respectively, for 18 months. For those who responded to the first 2 doses of eptinezumab, the percent of patients who maintained a 50% responder status over the remaining 4 doses was 69% (100 mg, n = 128) and 82% (300 mg, n = 131).³

Lead author Jessica Ailani, MD, director of the MedStar Georgetown Headache Center, presented these recent findings at the 2024 American Academy of Neurology (AAN) Annual Meeting, held April 13-18, in Denver, Colorado. Ailani sat down with NeurologyLive^® at the meeting to discuss how data analysis helps to contribute to shaping treatment approaches for patients with migraine. She also talked about strategies that clinicians can employ to effectively address patients' frustrations and help to maintain hope during the patients’ treatment journey. Additionally, Ailani spoke about how the healthcare system can better support patients with migraine who have experienced disappointment and a sense of failure in their treatment attempts.

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REFERENCES
1. Pozo-Rosich P, Lucas C, Watson DPB, et al. Burden of Migraine in Patients With Preventive Treatment Failure Attending European Headache Specialist Centers: Real-World Evidence From the BECOME Study. Pain Ther. 2021;10(2):1691-1708. doi:10.1007/s40122-021-00331-3
2. Buse DC, Pozo-Rosich P, Dupont-Benjamin L, et al. Impact of headache frequency and preventive medication failure on quality of life, functioning, and costs among individuals with migraine across several European countries: need for effective preventive treatment. J Headache Pain. 2023;24(1):115. Published 2023 Aug 24. doi:10.1186/s10194-023-01655-5
3. Ailani J, Soni-Brahmbhatt S, Awad S, et al. Long-term Maintenance of ≥50% Migraine Response with Eptinezumab Treatment in Patients with 2–4 Prior Preventive Migraine Treatment Failures. Presented at: 2024 AAN Annual Meeting; April 13-18; Denver, CO.