13 Oct Anti-CGRP Migraine Drugs in Pregnancy And Risk of Spontaneous Abortion
MedicalResearch.com Interview with:
Professor Anick Bérard PhD FCAHS FISPE
Canada Research Chair Tier 1 on Medications and Pregnancy
Faculty of Medicine, Université Paris Cité, France
Faculty of Pharmacy, University of Montreal
Adjunct Professor, Faculty of Pharmacy, Université Claude Bernard Lyon 1, France
Principal Investigator: Canadian Mother-Child Initiative on Drug Safety in Pregnancy (CAMCCO – Research, Training, Knowledge-Dissemination); CONCEPTION study – COVID-19 and Pregnancy; AMerican PREGNANcy-Mother-Child CohorT (AM-PREGNANT)
Director, Research Unit on Medications and Pregnancy, Research Center – CHU Sainte-Justine
Editor in Chief, Frontiers in Pharmacology – Pharmacoepidemiology
Medication and Pregnancy Notice: Migraine preventive medications, including anti-CGRP therapies and propranolol, should only be prescribed and monitored by your healthcare provider. If you are pregnant, planning a pregnancy, or think you may be pregnant, do not stop, start, or change any medication on your own. Talk with your healthcare provider about the risks and benefits for your individual situation.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response:
- Migraine is very prevalent in pregnancy – 20%.
- It usually improves in the 2nd/3rd trimester – especially for migraine without aura.
- Anti-CGRPs are effective therapies for the prevention of migraine but their safety in pregnancy is unknown. Guidelines do not recommend use during pregnancy except in very few cases. Women with chronic migraine are usually switched to safer alternatives 5-6 months before pregnancy (because of the 30-day half-life – 5 times the half-life). But inadvertent exposures occur.
- Our study is the first large scale study looking at the safety of anti-CGRP during pregnancy for the prevention of chronic migraine. Using data from US pregnant women with chronic migraine, anti-CGRP use increased the risk of spontaneous abortion by 42% (baseline risk of clinically detected spontaneous abortions is 6-8%; the absolute risk on anti-CGRP becomes 8-11%); but propranolol use did not. Our findings are in line with the current guidelines on migraine preventive therapies which recommend discontinuation of anti-CGRP at least 5 months before conception and switch to established migraine preventive therapies such as propranolol.
Dr. Don Kikkawa[/caption]
Dr. Leo Miller[/caption]
Dr. Tatum[/caption]
Kristina L. Tatum, PsyD, MS
Instructor
Department of Social and Behavioral Sciences
School of Public Health
A large population-based analysis of more than 841,000 breast cancer patients across the United States examines whether GLP-1 receptor agonist use is associated with improved survival and lower recurrence risk — with findings that researchers describe as very promising.
Dr. Serena Guo[/caption]
Serena Jingchuan Guo, MD PhD
Assistant Professor
Department of Pharmaceutical Outcomes and Policy
University of Florida College of Pharmacy
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Dr. Hao Dai[/caption]
Hao Dai, PhD
Postdoctoral Fellow
Department of Biostatistics & Health Data Science
Indiana University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obesity and type 2 diabetes are both known to increase the risk of several cancers. Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have become very popular for both glycemic control and weight loss, but their long-term effects on cancer risk are still unclear. Using a large real-world dataset, we emulated a target trial comparing more than 43,000 GLP-1RA users to matched non-users.
We found that GLP-1RA use was associated with a significantly lower overall cancer risk.
Dr. Jiyoung Ahn[/caption]
MedicalResearch.com Interview with:
Jiyoung Ahn, PhD
Dr. King[/caption]
Brett King, MD, PHD
Dr. King was named an American Academy of Dermatology (AAD) “Patient Care Hero”
for his work treating patients with severe alopecia areata
Dermatology Physicians of Connecticut
Fairfield, Connecticut
MedicalResearch.com: What is the background for this study? Would you briefly explain the condition of Alopecia Areata?
Response: Alopecia Areata (AA), an autoimmune form of hair loss, is common and its treatment has been revolutionized in the past ~3 years with approvals of 3 JAK inhibitors, bariticinib, ritlecitinib and deuruxolitinib. Prior to these approvals, off label treatments included the JAK inhibitors tofacitinib and ruxolitinib.
Dr. Ådén[/caption]
Ulrika Ådén PhD
Professor of Neonatology
Department of Women's and
Children's Health Karolinska
MedicalResearch.com: What is the background for this study?
Response: Children born preterm are at higher risk of cognitive impairment during childhood and later in life. However, an important unresolved question is whether these impairments primarily reflect genetic susceptibility or are driven by the biological consequences of being born too early. Cognitive development is known to have a strong heritable component (~70 %), and previous studies have attempted to disentangle genetic and environmental contributions, for example through sibling comparison designs. Although informative, such approaches have inherent limitations.
In this study, we aimed to investigate long-term cognitive outcomes across a range of gestational age groups including very preterm, moderately preterm, late preterm, and early term, compared to children born full term. Importantly, we accounted for genetic influences as well as a range of potential confounding factors, including prenatal risks and child-specific factors. This approach provides a more nuanced understanding of the extent to which cognitive outcomes associated with preterm birth reflect biological versus inherited risk.
