OnabotulinumtoxinA decreases interictal CGRP plasma levels in patients with chronic migraine
OnabotulinumtoxinA decreases interictal CGRP plasma levels in patients with chronic migraine
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DOI：
10.1097/j.pain.0000000000000119
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发表时间：
2015-05-01
期刊：
影响因子：
7.4
通讯作者：
Pascual, Julio
中科院分区：
文献类型：
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作者：
Cernuda-Morollon, Eva;Ramon, Cesar;Pascual, Julio
OnabotinumoxinA(OnabotA)已显示出对慢性偏头痛(CM)的疗效。然而，它的作用机制仍然不清楚。我们已经分析了使用onabotA治疗是否能够引起发作间期血浆降钙素基因相关肽(CGRP)浓度的变化，这已被证明在CM患者中是升高的。采用双抗体夹心法测定83例(平均年龄44岁，女性占94%)偏头痛发作前及治疗后1个月(平均年龄44岁，女性占94%)偏头痛发作前及治疗后1个月的降钙素基因相关肽水平。治疗后降钙素基因相关肽水平(中位数51.89pg/mL；范围199.4~10.2)显著低于治疗前(中位数74.09pg/ml；范围241.0~11.4pg/ml；P=0.001)。治疗前有效组降钙素基因相关肽水平(76.85pg/m L)显著高于无效组(50.45pg/m L；P=0.001)。治疗1个月后，无效组降钙素基因相关肽水平无明显变化(51.89pg/m L，P>0.05)，有效组降钙素基因相关肽水平显著降低(52.48pg/m L，P=0.003)。与无应答者相比，应答者的一些人口统计学因素、临床特征和合并症没有什么不同。这些结果证实，发作间期CGRP水平有助于预测对onabotA的反应，提示onabotA在CM中的作用机制是通过抑制CGRP的释放而逆转致敏作用。
OnabotulinumtoxinA (onabotA) has shown efficacy in chronic migraine (CM). Its mechanism of action, however, remains obscure. We have analysed whether treatment with onabotA is able to induce changes in interictal plasma calcitonin gene-related peptide (CGRP) concentrations, which have been shown to be increased in patients with CM. Calcitonin gene-related peptide levels were determined in samples obtained from the right antecubital vein using ELISA, outside a migraine attack and having taken no symptomatic medication in the previous 24 hours, in 83 patients with CM (average age 44 years; 94% females) before and 1 month after treatment with 155 to 195 U of onabotA. CGRP levels after onabotA treatment (median, 51.89 pg/mL; range, 199.4-10.2) were significantly lower as compared with CGRP levels obtained before onabotA treatment (median, 74.09 pg/mL; range, 241.0-11.4; P = 0.001). Pretreatment CGRP levels in responders (76.85 pg/mL) were significantly higher than those seen in nonresponders (50.45 pg/mL; P = 0.001). One month after treatment, the CGRP levels did not change in nonresponders (51.89 pg/mL; P not significant), but significantly decreased in responders (52.48 pg/mL; P = 0.003). A number of demographic factors, clinical features, and comorbidities were not different in responders as compared with those of nonresponders. These results confirm that interictal CGRP levels can be of help in predicting the response to onabotA and suggest that the mechanism of action of onabotA in CM is the reversal of sensitization as a result of the inhibition of CGRP release.