Migraine: do comorbid anxiety or depression affect galcanezumab efficacy?

  • Smitherman TA & al.
  • Headache
  • 16 Oct 2020

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Comorbid anxiety or depression with chronic migraine (CM) is not linked to decreased benefit of high-dose galcanezumab, but efficacy of low-dose treatment may suffer.
  • Patients with episodic migraine (EM) and these conditions experience similar protective effects regardless of galcanezumab dosage.

Why this matters

  • People with a history of migraine are more than twice as likely to develop anxiety, depression, or other psychiatric disorders, with the highest prevalence found in those with chronic migraine.

Study design

  • Post hoc analysis of 3 randomized, double-blind, placebo-controlled, phase 3 studies.
  • 1773 patients with a history of EM and 1113 patients with CM.
  • Funding: None disclosed.

Key results

  • 26.0% of those with EM and 28.4% of those with CM had anxiety and/or depression, most often active at baseline.
  • Among patients with EM and anxiety and/or depression, 120 mg and 240 mg galcanezumab significantly decreased migraine headache days (MHD) compared with placebo (overall mean change from placebo, −2.07 MHD and −1.91 MHD, respectively; P<.001 for both>
  • Among patients with CM and anxiety and/or depression, only the 240-mg dose significantly decreased MHD (overall mean change from placebo, −1.92 MHD; P=.018).
  • Acute use of galcanezumab was associated with significant decreases in MHD at both dosages in patients with comorbid anxiety and/or depression with EM (P<.001 for both doses and cm mg p=".009">

Limitations

  • Studies not originally designed to compare efficacy in patients with/without comorbid anxiety/depression.