Applying Data on CGRP, OnabotulinumtoxinA Combination to Clinical Practice: Andrew Blumenfeld, MD


The director of the Headache Center of Southern California provided insight on how a layered treatment approach to chronic migraine can be directly implemented into clinical care.

"If you had 4 bad days a month, you’re missing 6 weeks of productive activity in a year. If you got up to 8, you’re missing 12 weeks out of the year. That’s a lot of time. There’s a cost that comes with that.”

Andrew Blumenfeld, MD, and colleagues recently conducted research that evaluated the real-world safety and potential benefits of adding a calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) to onabotulinumtoxinA (Botox; Allergan/AbbVie) treatment in patients with chronic migraine. All patients included were aligned with the American Headache Society’s (AHS) position statement released in 2019, which states that a CGRP mAb may be added to 1 or more established treatments based on clinical judgement.

The data, presented at the 2021 Virtual AHS 63rd Annual Scientific Meeting, June 3-6, showed that the combination of treatments is safe and well-tolerated, and was associated with clinically meaningful improvements in headache frequency and migraine-related disability. Blumenfeld, director of the Headache Center of Southern California, said that clinicians should feel comfortable directly applying this data into their own clinical care, considering the safety of the drugs observed have already been FDA-cleared.

In an interview with NeurologyLive, Blumenfeld expressed his optimism in implementing the research into clinical care but noted that insurance companies oftentimes disrupt the process of allowing patients to receive a layered treatment approach to which they claim is experimental due to the “lack of data.”

For more coverage of AHS 2021, click here.

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