Combining CGRP Inhibitors with – Botox
Now that some of the new CGRP inhibitors have hit the market, studies are beginning to see how they might work with together with other treatments. At the University of Utah, the treatment includes Botox (onabotulinumtoxinA or ONA) and Aimovig (erenumab).
The patients trying the combination treatment, in this case, had already tried 3, 4, 5, or more treatments without success. Many also suffered from depression, anxiety, insomnia, and other co-morbid disorders. Most, though not all, were women.
Both ONA and the CGRP inhibitors such as Aimovig are given by injection. Botox every 12 weeks, Aimovig every 4. (The upcoming drug eptinezumab is meant to be given every 12 weeks, so it would be interesting to see how that works with ONA as well.)
The benefits of ONA are known to be inconsistent over the 12 weeks between treatments. In other words, there may be days, especially near the end, when it’s not helping the way it did at its peak. So combining it with another medication may help the situation.
In this study, which is small but ongoing, the results were not spectacular but they were promising for some patients. Slightly more than half of the patients did see significant improvement with the combination. The bulk of the rest found no improvement, although 18% found that their “headache burden” actually got worse.
So once again this is a treatment that may be a tremendous benefit to some patients. And remember, these were generally patients who have tried several other treatments without success.
One of the biggest challenges when it comes to combination treatment, and combination treatments that work with many but not all patients, is insurance coverage. It is in the best interest of insurance companies in many cases to see stable improvement of migraine symptoms. But convincing them that this is the way to go may take time.
We would be interested to hear your comments if you have tried any of the new CGRP inhibitors in combination with Botox treatment. Leave a comment!
To read more, see Concurrent CGRP Inhibitor and OnabotulinumtoxinA Therapy Boosts Relief in Severe Chronic Migraine
25 April 2020 @ 4:19 pm
When Aimovig first came out, I was still using Botox. Ive been using Botox every 3 months since 2004…. Anyway, the combination of the two was very successful for me. I felt like SuperWoman…anything that would normally cause a migraine (like more than 1 alcoholic beverage), I could do without repercussion. Unfortunately, that was short lived. After 3-4 months, my Neurologist told me I had to choose between Botox and Aimovig, as my insurance company would not pay for both. So I chose Aimovig 150mg, and am doing fine. I know my limitations, and life is so much better with this new CGRP medication. I do wish I could do both, but I completely understand why my insurance company won’t pay for both. Hang in there, and I highly recommend doing both if feasible, and if not, try the CGRPs.
7 August 2020 @ 1:31 pm
I’m currently on both Aimovig and ONA. Just ran out of fills on my Aimovig access card and have to pay full price for Aimovig now if I continue with Botox as my neuro thinks is best. Over the years I’ve tried multiple preventatives and treatments. Aimovig has been a life saver. If I use my retirement savings I can probably afford it. Doesn’t seem ethical to develop a life saving drug and only offer it to those who can afford it when Amgen CEOs make multiples of millions.