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Objective: To evaluate the real‐world effectiveness of eptinezumab for migraine prevention in Asian patients. Background: Eptinezumab is a monoclonal antibody that targets calcitonin gene‐related peptide (CGRP), a potent vasodilator with an important role in migraine pathophysiology. Although there is robust clinical evidence from pivotal Phase 3 placebo‐controlled trials of the efficacy of eptinezumab for migraine prevention, there are limited data on the real‐world effectiveness of eptinezumab in Asian patient cohorts. Methods: This was a non‐interventional, prospective, multisite cohort study of adults with migraine (International Classification of Headache Disorders, 3rd edition criteria) in Singapore who were prescribed eptinezumab (100 mg at baseline and Month 3, administered intravenously) and were followed until Month 6. The primary endpoint was change from baseline in monthly migraine days (MMDs) at Month 3 and Month 6. Secondary endpoints were ≥30% and ≥50% responder rates, and change from baseline in the Headache Impact Test‐6 (HIT‐6), Migraine Disability Assessment (MIDAS), Migraine‐Specific Quality of Life (MSQ), patient‐identified most bothersome symptom (PI‐MBS), acute medication use at Month 3 and Month 6, and safety. Results: Enrolled patients (completed = 29/30) had on average 3.4 (SD 2.9) previous preventive treatments; 29/30 of the patients had trialed at least one previous preventive treatment without benefit. Most had previously trialed oral preventives (87%, 26/30) and anti‐CGRP (70%, 21/30). Relative to baseline, mean MMDs decreased by 4.3 days (95% CI 2.1–6.4; p < 0.001) at Month 3 and 4.9 days (95% CI 2.1–7.7; p < 0.001) at Month 6. At Month 3 and Month 6, 14/30 (47%) and 15/29 (52%) of the patients were ≥30% responders, and 6/30 (20%) and 8/29 (28%) patients were ≥50% responders, respectively. The number of patients with severe life impairment based on the HIT‐6 score (total score 60–78) decreased from 24/30 (80%) at baseline to 19/30 (63%) at Month 3 and 19/29 (66%) at Month 6. The mean MIDAS score decreased by 24.6 points (95% CI 2.82–46.38; p = 0.028) at Month 6, and the mean MSQ score increased by 12.2 points (95% CI 5.18–19.20; p = 0.001) at Month 3 and 13.6 points (95% CI 4.58–22.66; p = 0.004) at Month 6. Most patients reported improvement in the PI‐MBS at Month 3 (73%, 22/30) and Month 6 (55%, 16/29). Acute medication use for headache relief decreased by 3.3 days/month (95% CI 1.0–5.6; p = 0.007) at Month 3 and 4.7 days/month (95% CI 1.7–7.7; p = 0.003) at Month 6. Treatment‐emergent adverse events (TEAEs) were reported in 16/30 (54%) patients, mostly mild/moderate in severity. No serious TEAEs led to treatment discontinuation. Conclusion: Quarterly eptinezumab administration was effective and well‐tolerated in Asian patients with chronic migraine. Plain Language Summary: Numerous studies have shown that eptinezumab is effective for migraine prevention, but there have been limited studies in Asian patients. In this six‐month real‐world study of eptinezumab treatment in 30 Asian patients with chronic migraine (CM), patients were treated with eptinezumab (one dose each at Months 1 and 3) and they reported fewer migraine days per month and improvement in their symptoms, lessened impact of migraine on daily life, and reduced use of medication for acute headache relief after 6 months. These findings support eptinezumab's potential effectiveness as a preventive treatment option in Asian patients with CM. [ABSTRACT FROM AUTHOR]

Background: Pathogenesis and diagnostic biomarkers for diseases can be discovered by metabolomic profiling of human fluids. If the various types of coronary artery disease (CAD) can be accurately characterized by metabolomics, effective treatment may be targeted without using unnecessary therapies and resources.Objectives: The authors studied disturbed metabolic pathways to assess the diagnostic value of metabolomics-based biomarkers in different types of CAD.Methods: A cohort of 2,324 patients from 4 independent centers was studied. Patients underwent coronary angiography for suspected CAD. Groups were divided as follows: normal coronary artery (NCA), nonobstructive coronary atherosclerosis (NOCA), stable angina (SA), unstable angina (UA), and acute myocardial infarction (AMI). Plasma metabolomic profiles were determined by liquid chromatography-quadrupole time-of-flight mass spectrometry and were analyzed by multivariate statistics.Results: We made 12 cross-comparisons to and within CAD to characterize metabolic disturbances. We focused on comparisons of NOCA versus NCA, SA versus NOCA, UA versus SA, and AMI versus UA. Other comparisons were made, including SA versus NCA, UA versus NCA, AMI versus NCA, UA versus NOCA, AMI versus NOCA, AMI versus SA, significant CAD (SA/UA/AMI) versus nonsignificant CAD (NCA/NOCA), and acute coronary syndrome (UA/AMI) versus SA. A total of 89 differential metabolites were identified. The altered metabolic pathways included reduced phospholipid catabolism, increased amino acid metabolism, increased short-chain acylcarnitines, decrease in tricarboxylic acid cycle, and less biosynthesis of primary bile acid. For differential diagnosis, 12 panels of specific metabolomics-based biomarkers provided areas under the curve of 0.938 to 0.996 in the discovery phase (n = 1,086), predictive values of 89.2% to 96.0% in the test phase (n = 933), and 85.3% to 96.4% in the 3-center external sets (n = 305).Conclusions: Plasma metabolomics are powerful for characterizing metabolic disturbances. Differences in small-molecule metabolites may reflect underlying CAD and serve as biomarkers for CAD progression. [ABSTRACT FROM AUTHOR]