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Abstract Details

OnabotulinumtoxinA wear-off phenomenon in the treatment of chronic migraine
Headache
P4 - Poster Session 4 (5:30 PM-6:30 PM)
13-006
To evaluate the prevalence, features, associations and treatment of onabotA wear-off in chronic migraine (CM).
Clinical experience suggests patients with CM frequently experience a shorter treatment duration of onabotA than 12 weeks, but this phenomenon has not been systematically reported in this population.
We retrospectively reviewed patients with CM initiated on onabotA at the Montefiore Headache Center in 2015 and 2016. Wear-off was considered present if the phrase was documented, a quantitative headache day increase was present, or if there was increased use of abortive medications, bridging therapies and ED visits/hospitalizations in the 6 weeks preceding the subsequent onabotA administration.
Wear-off was present in 62.9%. Mean age at first injection, prevalence of women, menstrual-related migraine, medication overuse headache and psychiatric comorbidity did not differ between the wear-off and no wear-off groups. Mean units injected per session in the wear-off group until first documented wear-off were significantly less vs. no wear-off group (166.0 ± 13.1 vs. 173.4 ± 10.3, p=0.0005). The attending physician injector rate (51.5% ± 23.8% vs. 50.9% ± 23.9%, p=0.88) and mean days between injection sessions (91.0 ± 3.6 vs. 91.2 ± 3.4, p=0.78) did not differ between the two groups. Wear-off most commonly occurred during the final 2-4 weeks before the next injection session (43.3%) and after the very first injection session (40.0%). Intramuscular ketorolac injections (33.3%) and peripheral nerve blocks (25.6%) were the most common transitional therapies to be implemented in the wear-off period.
The majority of patients with CM treated with onabotA perceive wear-off.  Until daily diary studies from onabotA clinical trials are available for analysis, clinicians may consider increasing the units used per session from treatment onset to reduce the frequent need for bridging therapies.
Authors/Disclosures
Alina Masters-Israilov, MD (Weill Cornell Medical College, Department of Neurology)
PRESENTER 		Dr. Masters-Israilov has received publishing royalties from a publication relating to health care.
Matthew S. Robbins, MD, FAAN (Weill Cornell Medicine) Dr. Robbins has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Robbins has received publishing royalties from a publication relating to health care. Dr. Robbins has a non-compensated relationship as a Board of Directors member, 好色先生 Program speaker with American Headache Society that is relevant to AAN interests or activities. Dr. Robbins has a non-compensated relationship as a Board of Directors member, 好色先生 Program speaker with New York State Neurological Society that is relevant to AAN interests or activities. Dr. Robbins has a non-compensated relationship as a Editorial Board Member with Continuum, 好色先生 that is relevant to AAN interests or activities.