@article{10902/36841,
year = {2025},
url = {https://hdl.handle.net/10902/36841},
abstract = {Introducción: Los anticuerpos monoclonales contra el péptido relacionado con el gen de la calcitonina (CGRP) han supuesto una revolución en el tratamiento de la migraña, aunque un tercio de los pacientes no responden a estos fármacos. Una de las causas emergentes de no respuesta aparente podría ser la pérdida del efecto fin de dosis, como demuestra el caso de nuestra paciente.
Caso Clínico: Mujer de 36 años con diagnóstico de migraña con aura desde la infancia y evolución a migraña crónica con cefalea diaria en los últimos 5 años asociando abuso de medicación y múltiples fallos a preventivos orales, toxina botulínica y dos anticuerpos contra el CGRP (erenumab y galcanezumab). Tras el inicio de eptinezumab trimestral, presenta una importante mejoría en el número de días de cefalea al mes durante las primeras 8 semanas, pero experimenta un claro deterioro fin de dosis en el tercer mes durante los dos primeros ciclos de tratamiento. Por ello, se ajusta su administración a cada 8 semanas con un excelente control de la frecuencia de su migraña.
Conclusión: Los anticuerpos anti-CGRP pueden presentar pérdida de efecto fin de dosis, siendo necesaria su identificación para realizar ajuste posológico individualizado y evitar así, de manera errónea, etiquetarlo como un fracaso terapéutico. Nuestro caso demuestra, además, que los pacientes con migraña crónica refractaria a dos anticuerpos pueden responder a un tercer fármaco, en este caso a eptinezumab por vía intravenosa.},
abstract = {Background/Objectives: Retinal vein occlusion (RVO) represents a common
ophthalmological disorder that, if untreated, often leads to severely impaired vision. The
classic vascular risk factors, aging and glaucoma, represent the core pathogenic factors for
RVO. However, antiphospholipid syndrome (APS) has been involved in a non-negligible
number of patients with RVO. The main objective of the present study was to assess the performance
of the new 2023 ACR/EULAR classification criteria for APS in a cohort of patients
with RVO fulfilling the Sydney classification criteria. Methods: A prospective study of
consecutive patients with RVO diagnosed with APS in a third-level university hospital. The
new 2023 ACR/EULAR classification criteria for APS were applied to all patients. Vascular
risk factors, the antiphospholipid antibody (aPL) profile, clinical management, and clinical
outcomes were assessed and compared between those fulfilling the Sydney and the 2023
ACR/EULAR criteria. Results: Sixty-nine RVO-APS patients were included in the study.
After applying the new classification criteria, 18 patients (26.1%) did not fulfill the new
criteria for APS. Specifically, 17 (24.6%) were excluded due to the new Domain 8 (p < 0.001)
as they presented only aPL IgM serology, and 1 patient (1.4%) was excluded due to having
high venous thromboembolic risk (VTE) with a clinical domain score < 3. Interestingly
enough, the presence of high arterial risk (45.1% vs. 50%; p = 0.72) was greater than the
presence of high VTE (3.9% vs. 5.6%; p = 0.99); in both cases, the 51 RVO-APS patients were
classified with the 2023 ACR/EULAR criteria, and the 18 cases were excluded according to
the new classification criteria. Except for the expected differences in serological domains
(Domain 7, p < 0.001, and Domain 8, p < 0.001), we did not find other significant differences
in terms of prognosis or risk of recurrence between both groups of patients. Conclusions:
The implementation of the new ACR/EULAR 2023 classification criteria for APS resulted
in the exclusion of about one out of four previously diagnosed RVO-APS patients. The
higher prevalence of manifestations of high arterial risk compared with high VTE among both newly classified and excluded APS patients highlights the importance of monitoring
cardiovascular risk factors for both the prevention and the management of potential retinal
and cardiovascular events.},
publisher = {Viguera Editores},
publisher = {Revista de Neurología, 2025, 80(2), 38974},
title = {Manejo exitoso de la pérdida de efecto fin de dosis con eptinezumab: enseñanzas de un caso de migraña crónica refractaria a dos anticuerpos anti-CGRP subcutáneos},
author = {Polanco Fernández, Marcos and Gangas Barranquero, Lara and González Quintanilla, Vicente and Madera Fernández, Jorge and Pascual Gómez, Julio},
}