Background and importance After the appearance of migraine biological drugs, some criteria have been established for their rational use and efficiency. There are many drugs for migraine prophylaxis but there are very few for which clear evidence has been presented, so we will try to provide data in this regard.
Aim and objectives To determine the adequacy of prophylactic treatment and compliance with the financing conditions for antimigraine monoclonal antibodies in our hospital.
Material and methods Retrospective observational study involving all the patients that had started treatment in our hospital with any of the monoclonal antibodies: erenumab, fremanezumab and galcanezumab. The duration and tolerance of all migraine prophylaxis treatments were recorded. Prophylactic treatments were considered adequate according to whether or not they had a therapeutic indication in the technical sheet in Spain. Being consider as low evidence drugs the rest of them. Finally, compliance with the funding criteria set by the Health Ministry to start monoclonal antibody treatment was determined: having 8 or more days of migraine/month and having failed at least three prophylactic treatments for at least 3 months, one of them being botulinum toxin in the case of chronic migraine.
Results A total of 38 patients (79% women) started treatment with antimigraine biologics. The average number of prophylactic treatments was 3.9 and only one patient did not receive the minus 3. 10.5% reported some type of intolerance with any of the treatments. The duration of treatment reached at least 3 months in 78% of the patients and exceeded 6 months in 48%. 43% of the drugs used in prophylaxis had an indication. In the 57% of patients that received drugs without indication, the following were used: pregabalin (5), valproic acid (4), diazepam (2), candesartan (1), levetirazetam (1), citalopram (1), zonisamide (1), tizanidine (1) and Lisinopril (1). 14 patients (37%) did not meet the funding criteria: 8 for not having reached 3 months of treatment, 3 for presenting less than 8 MMD and 2 for presenting chronic migraine and not having received botulinum toxin A.
Conclusion and relevance More than half of the patients (57%) received drugs without indication for migraine prophylaxis and more than a third (37%) did not meet the funding criteria for these biological drugs. The work of the hospital pharmacist could improve the adequacy of treatment.
Conflict of interest No conflict of interest
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