PMID- 31758548
OWN - NLM
STAT- MEDLINE
DCOM- 20210729
LR  - 20210729
IS  - 1526-4610 (Electronic)
IS  - 0017-8748 (Linking)
VI  - 60
IP  - 2
DP  - 2020 Feb
TI  - Wearing Off Effect of OnabotulinumtoxinA Near the End of Treatment Cycle for 
      Chronic Migraine: A 4-Year Clinical Experience.
PG  - 430-440
LID - 10.1111/head.13713 [doi]
AB  - INTRODUCTION: The injection interval for onabotulinumtoxinA (BoNTA) in the 
      management of chronic migraine (CM) is 12 weeks (78-84 days). The aim of this 
      study was to review patient-reported wearing off effect (WOE) of the therapeutic 
      benefit of BoNTA near the end of the treatment cycle. We intended to describe the 
      demographics of patients at baseline and compare groups of patients with multiple 
      episodes of WOE. METHODS: We conducted a retrospective review of patients with CM 
      who received uninterrupted BoNTA therapy from January 2014 to March 2018. The 
      data from patient-reported WOE (worsening headache variables and neck pain) that 
      occurred during the 4 weeks (28 days) prior to the scheduled re-injection of 
      BoNTA for treatment cycles with injection interval </=13 weeks and without obvious 
      confounding factors were reviewed. RESULTS: We identified 98 eligible patients 
      and analyzed 471 treatment cycles. Forty-three unique patients reported at least 
      1 occurrence of WOE. About 24/43 patients reported 1 WOE event and 19/43 patients 
      reported >/=2 WOE events. Between the 2 groups, anxiety disorder and opioid use for 
      headache were statistically significantly different. In the former group, the 
      median interquartile range (IQR) dose of BoNTA was 165 (155, 175) units and the 
      median IQR duration of the antinociceptive effect of BoNTA was 66.5 (63, 71.5) 
      days. In the latter group, the median IQR dose of BoNTA was 167 (155, 173.3) 
      units and the median IQR duration of the antinociceptive effect of BoNTA was 65.3 
      (62.5, 68.8) days. Up to 32% of these patients reported an increase in the use of 
      abortive therapies to manage the symptoms of WOE. DISCUSSION: The primary goal of 
      BoNTA in the treatment of CM is to mitigate the development of central 
      sensitization. Since the 12-week injection paradigm may not provide sustained 
      antinociceptive effect in all patients, it may account for the failure of 
      response to BoNTA. Repeated occurrences of the WOE can potentially lead to 
      medication overuse and impact quality of life.
CI  - (c) 2019 American Headache Society.
FAU - Khan, Fawad A
AU  - Khan FA
AD  - McCasland Family Comprehensive Headache Center, Ochsner Neuroscience Institute, 
      Ochsner Clinic Foundation, New Orleans, LA, USA.
AD  - The University of Queensland School of Medicine, Ochsner Clinical School, New 
      Orleans, LA, USA.
AD  - Tulane University School of Medicine, New Orleans, LA, USA.
FAU - Mohammed, Alaa E
AU  - Mohammed AE
AD  - Center for Outcomes and Health Services Research, Ochsner Clinic Foundation, New 
      Orleans, LA, USA.
FAU - Poongkunran, Mugilan
AU  - Poongkunran M
AD  - McCasland Family Comprehensive Headache Center, Ochsner Neuroscience Institute, 
      Ochsner Clinic Foundation, New Orleans, LA, USA.
FAU - Chimakurthy, Anilkumar
AU  - Chimakurthy A
AD  - McCasland Family Comprehensive Headache Center, Ochsner Neuroscience Institute, 
      Ochsner Clinic Foundation, New Orleans, LA, USA.
FAU - Pepper, Michael
AU  - Pepper M
AD  - McCasland Family Comprehensive Headache Center, Ochsner Neuroscience Institute, 
      Ochsner Clinic Foundation, New Orleans, LA, USA.
AD  - The University of Queensland School of Medicine, Ochsner Clinical School, New 
      Orleans, LA, USA.
LA  - eng
PT  - Journal Article
DEP - 20191122
PL  - United States
TA  - Headache
JT  - Headache
JID - 2985091R
RN  - 0 (Analgesics)
RN  - EC 3.4.24.69 (Botulinum Toxins, Type A)
RN  - EC 3.4.24.69 (onabotulinum toxin A)
SB  - IM
MH  - Adult
MH  - Analgesics/administration & dosage/*pharmacology
MH  - Botulinum Toxins, Type A/administration & dosage/*pharmacology
MH  - Central Nervous System Sensitization/drug effects
MH  - Chronic Disease
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Migraine Disorders/*drug therapy/*prevention & control
MH  - *Patient Reported Outcome Measures
MH  - *Patient Satisfaction
MH  - Retrospective Studies
MH  - Tertiary Care Centers
MH  - Time Factors
OTO - NOTNLM
OT  - Botulinum Toxin
OT  - antinociceptive
OT  - injection paradigm
OT  - onabotulinumtoxinA
OT  - prophylaxis
OT  - wear off
EDAT- 2019/11/24 06:00
MHDA- 2021/07/30 06:00
CRDT- 2019/11/24 06:00
PHST- 2019/10/30 00:00 [accepted]
PHST- 2019/11/24 06:00 [pubmed]
PHST- 2021/07/30 06:00 [medline]
PHST- 2019/11/24 06:00 [entrez]
AID - 10.1111/head.13713 [doi]
PST - ppublish
SO  - Headache. 2020 Feb;60(2):430-440. doi: 10.1111/head.13713. Epub 2019 Nov 22.