Randomized studies have reported a positive effect of candesartan, an angiotensin II receptor antagonist, in migraine prevention. The aim of our study was to explore patient subjective efficacy of candesartan in a real-world sample of migraine patients and try to identify predictors of candesartan response. We audited the clinical records of 253 patients who attended the King’s College Hospital, London, from February 2015 to December 2017, looking specifically at their response to candesartan. Univariate and multivariate logistic regression models were used to identify predictors of headache benefit. Odds ratios (OR) with confidence intervals (CI) 95% were calculated. Eighty-one patients (chronic migraine, n = 68) were included in the final analysis. Thirty-eight patients reported a positive response to candesartan, while 43 patients did not have a meaningful therapeutic effect. The median dose of candesartan was 8 mg and the median treatment period was 6 months. In a univariate logistic regression model, the presence of daily headache was associated with reduced odds of headache benefit (OR 0.39, 95% CI 0.16–0.96, p = 0.04). In multivariate logistic regression model, younger age (OR 0.92, 95% CI 0.87–0.98, p = 0.006) and longer disease duration (OR 1.06, 95% CI 1.01–1.12, p = 0.03) were associated with a good response to candesartan, while the presence of daily headache was associated with reduced odds of headache benefit (OR 0.16, 95% CI 0.04–0.71, p = 0.01). Having failed up to nine preventives in patients did not predict a treatment failure with candesartan as well. Candesartan yields clinical benefits in difficult-to-treat migraine patients, irrespective of previous failed preventives.
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Conflicts of interest
R. Messina declares, unrelated to this work, compensation for speaking activities from Novartis, Eli Lilly and Teva Pharmaceutical Industries. C. P. Lastarria Pèrez have no conflict of interest related to the publication of this manuscript. M. Filippi declares, unrelated to this work, compensation for consulting services and/or speaking activities from Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). Prof. Filippi is Editor-in-Chief of the Journal of Neurology. P. J. Goadsby reports unrelated to the work, over the last 36 months, grants and personal fees from Amgen and Eli-Lilly and Company, grant from Celgene, and personal fees from Aeon Biopharma, Alder Biopharmaceuticals, Allergan, Autonomic Technologies Inc., Biohaven Pharmaceuticals Inc., Clexio, Electrocore LLC, Epalex, eNeura, Impel Neuropharma, MundiPharma, Novartis, Santara Therapeutics, Teva Pharmaceuticals, Trigemina Inc., WL Gore, and personal fees from MedicoLegal work, Massachusetts Medical Society, Up-to-Date, Oxford University Press, and Wolters Kluwer; and a patent magnetic stimulation for headache assigned to eNeura without fee.
Ethics approval and consent to participate
The audit was registered with the King’s College Hospital Neurology Department Audit Committee.
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The data that support the findings of this study are available upon reasonable request from the corresponding author.
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Messina, R., Lastarria Perez, C.P., Filippi, M. et al. Candesartan in migraine prevention: results from a retrospective real-world study. J Neurol (2020). https://doi.org/10.1007/s00415-020-09989-9
- Treatment response
- Challenging migraine patients