Factores predisponentes al abandono del tratamiento preventivo en una serie de pacientes con migraña / Predisposing factors affecting drop-out rates in preventive treatment in a series of patients with migraine

Introducción. Más de un 30% de pacientes abandona el tratamiento preventivo de la migraña. Esta situación es poco conocida y los factores de riesgo que llevan al abandono del tratamiento tampoco están identificados. Objetivo. Valorar alguno de los factores que pueden predisponer al abandono de un tratamiento preventivo. Pacientes y métodos. Es un estudio prospectivo de pacientes con migraña que precisaron tratamiento preventivo por primera vez con uno de tres fármacos considerados de primera línea: un betabloqueante (nadolol), un neuromodulador (topiramato) o un antagonista del calcio (flunaricina). Se establecieron dos grupos según se produjese abandono o no del tratamiento. Se analizaron y compararon diferentes variables demográficas y clínicas en ambos grupos. Resultados. En un total de 800 pacientes con migraña que precisaron tratamiento preventivo por primera vez, hubo un 19,7% de abandonos. En el grupo que abandonó, las variables ‘edad’, ‘número de crisis previas al tratamiento preventivo’ y ‘efectos adversos’ mostraron diferencias significativas con las del grupo de pacientes que no suspendieron el tratamiento preventivo. Conclusiones. El fármaco utilizado como tratamiento preventivo, los efectos adversos, la edad más joven y el menor número de crisis antes de iniciar el tratamiento preventivo favorecieron su abandono. El tipo de migraña episódica o crónica, la presencia de abuso de fármacos y los fármacos utilizados para el tratamiento de las crisis no guardaron relación con la suspensión del tratamiento preventivo (AU)

Introduction. The drop-out rate among patients receiving preventive treatment for migraine is higher than 30%. This situation is not very widely known and the risk factors that lead patients to drop out from treatment have yet to be identified. Aim. To evaluate some of the factors that can predispose patients to drop out of preventive treatment. Patients and methods. We conducted a prospective study of patients suffering from migraine who required preventive treatment for the first time with one of what are considered the top three first-choice drugs, i.e. a beta-blocker (nadolol a neuromodulator (topiramate) or a calcium antagonist (flunarizine). Two groups were established according to whether patients dropped out of treatment or not. Different demographic and clinical variables were analysed and compared in the two groups. esults. Of 800 patients with migraine who required preventive treatment for the first time, the drop-out rate was 19.7%. In the drop-out group, the variables ‘age’, ‘number of seizures’, ‘number of seizures prior to preventive treatment’ and ‘side effects’ showed significant differences with those from the group of patients who did not drop out of preventive treatment. Conclusions. The drug used as preventive treatment, the side effects, a younger age and a lower number of seizures before starting the preventive treatment favoured higher drop-out rates. Whether the migraine was episodic or chronic, the presence of medication abuse and the drugs used to treat the seizures were not related with dropping out of preventive treatmen (AU)

[Predisposing factors affecting drop-out rates in preventive treatment in a series of patients with migraine]. / Factores predisponentes al abandono del tratamiento preventivo en una serie de pacientes con migraña.

INTRODUCTION: The drop-out rate among patients receiving preventive treatment for migraine is higher than 30%. This situation is not very widely known and the risk factors that lead patients to drop out from treatment have yet to be identified. AIM: To evaluate some of the factors that can predispose patients to drop out of preventive treatment. PATIENTS AND METHODS: We conducted a prospective study of patients suffering from migraine who required preventive treatment for the first time with one of what are considered the top three first-choice drugs, i.e. a beta-blocker (nadolol), a neuromodulator (topiramate) or a calcium antagonist (flunarizine). Two groups were established according to whether patients dropped out of treatment or not. Different demographic and clinical variables were analysed and compared in the two groups. RESULTS: Of 800 patients with migraine who required preventive treatment for the first time, the drop-out rate was 19.7%. In the drop-out group, the variables 'age', 'number of seizures', 'number of seizures prior to preventive treatment' and 'side effects' showed significant differences with those from the group of patients who did not drop out of preventive treatment. CONCLUSIONS: The drug used as preventive treatment, the side effects, a younger age and a lower number of seizures before starting the preventive treatment favoured higher drop-out rates. Whether the migraine was episodic or chronic, the presence of medication abuse and the drugs used to treat the seizures were not related with dropping out of preventive treatment.

[Comparative study of the effectiveness of topiramate and nadolol in the preventive treatment of episodic migraine in independent series of patients]. / Estudio comparativo de la efectividad del topiramato y del nadolol en el tratamiento preventivo de la migraña episodica en series independientes de pacientes.

INTRODUCTION: Topiramate and nadolol with levels A and C of scientific evidence, respectively, would be indicated as preventive treatments of migraine. To date only one study of satisfaction has been carried out to compare the two pharmaceuticals. AIM: To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study. PATIENTS AND METHODS: From a database of 700 patients with migraine, those with episodic migraine and who had followed a course of preventive treatment, for the first time, with topiramate or nadolol were selected for the study. The effectiveness variables (reduction in the number of crises at four months of preventive treatment and responder rates) were analysed. RESULTS: Altogether 208 patients with were included for treatment: 140 with topiramate (77.8% females; mean age, 37.9) and 68 with nadolol (69% females; mean age, 36.9). The mean number of crises in the month prior to treatment was: topiramate group, 6.3 +/- 2.6; nadolol group 5.3 +/- 2.0 (p = 0.0066). At four months after starting treatment: topiramate group, 2.69 +/- 2.6; nadolol group 2.6 +/- 2.2 (NS). The percentage of reduction in the number of migraines was 56.6% with topiramate and 51.6% with nadolol (NS). The responder rate (reduction in the frequency of crises by at least 50%) was 71.3% with topiramate versus 69% with nadolol (NS). The excellent response rate (reduction in crises by at least 75%) was 53.3% with topiramate versus 32.2% with nadolol (p = 0.0077). Adverse side effects were reported by 54% of patients treated with topiramate versus 30.8% of those treated with nadolol (p = 0.0015). The rate of satisfaction was 61% for the topiramate group and 71% for the group with nadolol (NS). CONCLUSIONS: Both topiramate and nadolol proved to be effective in the preventive treatment of episodic migraine. Topiramate was found to be more effective than nadolol, although it was used in patients with a higher frequency of crises, and was not tolerated so well.

Estudio comparativo de la efectividad del topiramato y del nadolol en el tratamiento preventivo de la migraña episódica en series independientes de pacientes / Comparative study of the effectiveness of topiramate and nadolol in the preventive treatment of episodic migraine in independent series of patients

Introducción. El topiramato con nivel A y el nadolol con nivel C de evidencia científica estarían indicados como tratamientos preventivos de la migraña. Sólo existe un estudio de satisfacción que compare ambos fármacos. Objetivo. Comparar los parámetros de efectividad en grupos independientes de pacientes tratados preventivamente con uno de los fármacos del estudio. Pacientes y métodos. De una base de datos de 700 pacientes con migraña, se seleccionaron aquéllos con migraña episódica y que habían llevado tratamiento preventivo, por primera vez, con topiramato o nadolol. Se analizaron las variables de efectividad (reducción del número de crisis al cuarto mes de tratamiento preventivo y tasa de respondedores). Resultados. Fueron incluidos 208 pacientes con intención de tratar; 140 con topiramato (77,8% mujeres; edad media: 37,9 años) y 68 con nadolol (69% mujeres; edad media: 36,9 años). La media de crisis en el mes previo al tratamiento fue: grupo con topiramato, 6,3 ± 2,6; grupo con nadolol, 5,3 ± 2,0 (p = 0,0066). Al cuarto mes de tratamiento: grupo con topiramato, 2,69 ± 2,6; grupo con nadolol, 2,6 ± 2,2 (NS). El porcentaje de reducción de migrañas fue del 56,6% con topiramato y del 51,6% con nadolol (NS). La tasa de respondedores (reducción en la frecuencia de crisis al menos del 50%) fue del 71,3% con topiramato y del 69% con nadolol (NS). La tasa de respuesta excelente (reducción de las crisis al menos un 75%) fue del 53,3% con topiramato y del 32,2% con nadolol (p = 0,0077). El 54% de los pacientes tratados con topiramato y el 30,8% de los pacientes tratados con nadolol presentaron efectos adversos (p = 0,0015). La tasa de satisfacción fue del 61% en el grupo de topiramato y del 71% en el grupo de nadolol (NS). Conclusión. El topiramato y el nadolol mostraron ser efectivos en el tratamiento preventivo de la migraña episódica. El topiramato mostró mayor efectividad y se utilizó en pacientes con mayor frecuencia de crisis, pero se toleró peor que el nadolol (AU)

Introduction. Topiramate and nadolol with levels A and C of scientific evidence, respectively, would be indicated as preventive treatments of migraine. To date only one study of satisfaction has been carried out to compare the two pharmaceuticals. Aim. To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study. Patients and methods. From a database of 700 patients with migraine, those with episodic migraine and who had followed a course of preventive treatment, for the first time, with topiramate or nadolol were selected for the study. The effectiveness variables (reduction in the number of crises at four months of preventive treatment and responder rates) were analysed. Results. Altogether 208 patients with were included for treatment: 140 with topiramate (77.8% females; mean age, 37.9) and 68 with nadolol (69% females; mean age, 36.9). The mean number of crises in the month prior to treatment was: topiramate group, 6.3 ± 2.6; nadolol group 5.3 ± 2.0 (p = 0.0066). At four months after starting treatment: topiramate group, 2.69 ± 2.6; nadolol group 2.6 ± 2.2 (NS). The percentage of reduction in the number of migraines was 56.6% with topiramate and 51.6% with nadolol (NS). The responder rate (reduction in the frequency of crises by at least 50%) was 71.3% with topiramate versus 69% with nadolol (NS). The excellent response rate (reduction in crises by at least 75%) was 53.3% with topiramate versus 32.2% with nadolol (p = 0.0077). Adverse side effects were reported by 54% of patients treated with topiramate versus 30.8% of those treated with nadolol (p = 0.0015). The rate of satisfaction was 61% for the topiramate group and 71% for the group with nadolol (NS). Conclusions. Both topiramate and nadolol proved to be effective in the preventive treatment of episodic migraine. Topiramate was found to be more effective than nadolol, although it was used in patients with a higher frequency of crises, and was not tolerated so well (AU)