Fremanezumab Effective for Chronic Migraine
In a double-blind, placebo-controlled trial in patients with chronic migraine, 1121 patients were randomized into 3 groups (1:1:1), as follows:
* Treatment with fremanezumab quarterly (675 mg at baseline, placebo at weeks 4 and 8);
* Fremanezumab monthly (225 mg at baseline, weeks 4 and 8); or
* Placebo
The authors looked at the effect of treatment with fremanezumab on health-related quality of life and productivity. They used the Migraine-Specific Quality of Life (MSQoL) questionnaire at baseline and weeks 4, 8, and 12; Patient Global Impression of Change (PGIC) questionnaire at weeks 4, 8, and 12; and EuroQoL 5-dimension, 5-response level (EQ-5D-5L) questionnaire and Work Productivity and Activity Impairment: General Health (WPAI:GH) questionnaire at baseline and week 12.
Of the patients studied, 375 had quarterly dosing, 375 monthly dosing, and 371 were given placebo. Significant improvement over placebo was found in those receiving fremanezumab quarterly and monthly in change from baseline mean scores in MSQoL domains (all, P < 0.05) to week 12. At week 12, fremanezumab also showed significant improvements in EQ-5D-5L visual analog scale (P < 0.05) and PGIC scores (P < 0.0001) and significant reductions from baseline in WPAI:GH scores (P < 0.01) and presenteeism (impairment while working; P < 0.05) versus placebo.
In this study, Class II evidence was demonstrated that fremanezumab-whether administered quarterly or monthly-was associated with improvement over placebo in migraine-specific quality of life, overall health status, patients' global impression of change with treatment, and productivity in patients with chronic migraine. (See Lipton RB, Cohen JM, Gandhi SK, et al. Effect of fremanezumab on quality of life and productivity in patients with chronic migraine. Neurology. 2020;95(7):e878-e888. doi:10.1212/WNL.0000000000010000.) Clinicaltrialsgov Identifier: NCT02621931.
Electromagnetic-Focused Extracorporeal Shockwave Treatment for Greater Trochanteric Pain Syndrome
Electromagnetic-focused extracorporeal shockwave treatment (F-ESWT) was found to be safe and effective in patients with greater trochanteric pain syndrome (GTPS) in a randomized controlled trial using sham treatment as placebo.
GTPS is characterized by lateral hip pain. Both the physiopathology and treatment consensus remain unclear.
In a multicenter clinical trial, 103 patients with chronic GTPS were randomly assigned to receive electromagnetic F-ESWT and a specific exercise protocol or to the control group. The control group participants were given sham F-ESWT and the same exercise protocol.
Although both groups were treated with 3 weekly sessions, the F-ESWT group received an energy flux density of 0.20 mJ/mm, and the control group received 0.01 mJ/mm. Assessment was made at baseline and 1, 2, 3, and 6 months after treatment.
The primary outcome was a visual analog scale (VAS) score for pain at 2 months. The Harris hip score (HHS), Lower Extremity Functional Scale (LEFS), EuroQoL-5 Dimensions Questionnaire (EQ-5D), and Roles and Maudsley score were used as secondary outcomes.
The mean VAS score decreased from 6.3 at baseline in both groups to 2.0 in the F-ESWT group versus 4.7 in the control group at 2 months (P < 0.001). All secondary outcomes at all follow-up intervals were significantly better in the F-ESWT group, except for the LEFS score at 1 month after treatment (P = 0.25). No complications were reported.
The authors concluded that F-ESWT in association with a specific exercise program is safe and effective for GTPS, with a success rate of 86.8% at 2 months, maintained until the end of follow-up. (See Ramon S, Russo S, Santoboni F, et al. Focused shockwave treatment for greater trochanteric pain syndrome: a multicenter, randomized, controlled clinical trial. J Bone Joint Surg Am. 2020;102(15):1305-1311. doi:10.2106/JBJS.20.00093.)