KMITL

Permanent URI for this communityhttps://dspace.kmitl.ac.th/handle/123456789/1

Browse

Settings

Author: search.filters.author.Rattanawong, WanakornSubject: search.filters.subject.CGRP-targeted therapy

Search Results

Now showing 1 - 2 of 2
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Item,
    Diagnosis challenges and accessibility barriers to migraine management in Southeast Asia: results from the South-East Asia Local breAch on MigraiNe Treatment (SEALANT) study
    (2026-12-01)
    Rattanawong, Wanakorn
    ;
    Hiransuthikul, Akarin
    ;
    Anukoolwittaya, Prakit
    ;
    Pongpitakmetha, Thanakit
    ;
    Thanprasertsuk, Sekh
    Background: Migraine is one of the leading causes of disability among all neurological diseases, yet major gaps persist in diagnosis and access to effective treatment, particularly in low- and middle-income regions. Southeast Asia and East Asia are characterised by marked socioeconomic diversity, variable healthcare infrastructure, and limited availability of migraine-specific therapies. We aimed to assess physician-reported barriers to migraine diagnosis and management across Southeast Asian and East Asian countries. Methods: The South-East Asia Local breAch on MigraiNe Treatment (SEALANT) study was a multinational, cross-sectional, web-based survey conducted between Nov 1, 2024, and Aug 31, 2025. Physicians involved in migraine care from Laos, Indonesia, Malaysia, the Philippines, Singapore, Taiwan, and Thailand were eligible. Survey domains included diagnostic barriers, clinic accessibility, acute and preventive treatment practices, awareness of medication overuse headache, access to calcitonin gene-related peptide (CGRP)–targeted therapies, and migraine-related stigma. Countries were categorised by World Bank income classification. Data were analysed descriptively, and comparisons were made across income groups. All results are based on physicians’ perceptions of routine clinical practice rather than objectively verified patient-level data. Results: A total of 686 physicians participated (mean age 39.0 years [SD 9.9]), of whom 79.8% were neurologists. Overall, 70.0% of respondents reported an insufficient number of neurology/headache clinics, increasing to 87.2% in lower-middle-income countries. Physicians reported that approximately 60.0% of patients were correctly diagnosed with migraine before specialist consultation, while 44.9% were perceived to experience diagnostic delays exceeding one year. According to physician reports, acute migraine management relied predominantly on non-specific analgesics, with opioids remaining widely available and prescribed across all income settings. Reported use of migraine-specific acute therapies and preventive treatments was limited. Although CGRP-targeted preventive therapies were widely regarded by physicians as effective (77.1%), many perceived that these treatments should not yet be reimbursed. Conclusion: Substantial and inequitable gaps persist in migraine diagnosis and management across Southeast Asia and East Asia, as perceived by physicians, driven by shortages of specialist services, delayed diagnosis, reliance on non-specific treatments, and restricted access to migraine-specific therapies. Addressing migraine as a public health priority through health-system strengthening, education, and equitable access to evidence-based treatments is essential to reduce disability in the region.
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Item,
    CGRP-targeted therapy fulfilling the treatment gap in medication-underuse setting: a retrospective cohort study at a tertiary headache center in Thailand, a lower-middle-income country
    (2025-12-01)
    Roongrojwittayakul, Sirawit
    ;
    Anukoolwittaya, Prakit
    ;
    Hiransuthikul, Akarin
    ;
    Pongpitakmetha, Thanakit
    ;
    Thanprasertsuk, Sekh
    Background: Migraine preventive treatment is essential to reducing the burden of disease. However, discontinuation of oral migraine preventive medications (OMPMs) remains common due to suboptimal efficacy and tolerability, especially in lower-middle-income countries, which may contribute to migraine progression—a situation that has led to the introduction of the concept of “Medication Underuse Headache”. The calcitonin gene-related peptide monoclonal antibody (CGRP mAbs) might close the gap in this situation. This study aimed to investigate the treatment patterns of migraine preventive medications over six months at a tertiary headache center in Thailand and to explore the association between each preventive medication class and discontinuation rates. Methods: A single-center retrospective cohort study was conducted between 2021 and 2023. Adult patients who were diagnosed with migraine and received at least one preventive medication at their first visit to the Headache Clinic at King Chulalongkorn Memorial Hospital were included, with a minimum follow-up period of six months. The primary outcome was the discontinuation of any migraine preventive medication from the baseline regimen during follow-up visits. A multivariable Cox regression model, adjusted for sex, age, and diagnosis, was used to explore baseline factors associated with the discontinuation of preventive migraine medications. Results: Among the 100 eligible patients (mean age [SD]: 39.6 [14.4] years; 87.0% female), 41.0% (41/100) discontinued at least one preventive medication, most commonly due to intolerance to side effects (53.7%, 22/41) and lack of treatment effectiveness (34.1%, 14/41). The highest discontinuation rates were observed with serotonin norepinephrine reuptake inhibitors at 53.8% (7/13), calcium channel blockers at 37.5% (6/16), and beta-blockers at 25.6% (11/43). Notably, no patients discontinued CGRP mAbs. Patients using CGRP mAbs at baseline had a significantly higher rate of discontinuing at least one other oral preventive medication compared to those who did not use CGRP mAbs: 31.7% vs. 25.4% at month 3, and 55.4% vs. 33.4% at month 6 (p = 0.04). After adjustment, baseline use of CGRP mAbs was significantly associated with an increased risk of discontinuing at least one medication in the regimen (adjusted odds ratio 2.16; 95% CI: 1.16 to 4.03, p = 0.02). Conclusion: Discontinuation of preventive migraine treatment remains a significant issue in Thailand. CGRP mAbs were associated with higher treatment persistence and may help reduce polypharmacy in migraine management.