Abstract: PUB682
Improvement in Cervical Radiculopathy by Erenumab During the Preventive Treatment of Migraine in a Patient with CKD
Session Information
Category: Trainee Case Report
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Swan, Jr., Alexander Myint, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Aung, Htun M., Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Kyaw, Htet Htet, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Swan, Tracy T., Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Tun, May T., Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Thida, Aye M., Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Swan, Alexander M., Rutgers New Jersey Medical School, Newark, New Jersey, United States
Introduction
Pain control of chronic kidney disease (CKD) patient can be challenging especially in those with multiple comorbidities. We present the incidental finding of improvement in cervical radiculopathy in a CKD patient receiving erenumab for the preventive treatment of migraine.
Case Description
A 75-year-old lady with HTN, DM2, CKD, CHF, peripheral vascular disease, osteoarthritis, osteoporosis and migraine presented with a sharp, intermittent, shooting neck pain, which was 7/10 in intensity, radiating to both arms, aggravated by movement of the neck, without a motor deficit. She was taking pantoprazole, sacubitril/valsartan, metoprolol, clonidine, aspirin, linagliptin, pravastatin, alirocumab, denosumab, gabapentin, pentoxifylline, calcitriol, erythropoietin, sevelamer and pain medications including narcotics. Physical exam revealed severe paresthesia from neck to arms, significant neck spasms, loss of cervical lordosis and reduced deep tendon reflexes. MRI of the cervical spine revealed mild nerve root impingement. Appropriate pain medications with gabapentin, non-narcotic and narcotic medications were used without success. The pain progressively worsened within 3 weeks, the intensity being 9/10. Surgery was considered high-risk due to multiple comorbidities. Meanwhile, erenumab was initiated for the preventive treatment of migraine. Neuropathic neck pain intensity concomitantly decreased from 10/10 to 3/10 within a week of erenumab treatment without administering any pain medications, resulting in improvement in her quality of life.
Discussion
Erenumab, a human immunoglobulin G2 (IgG2) monoclonal antibody and a calcitonin gene-related peptide (CGRP) receptor antagonist, has been indicated for the preventive treatment of migraine in adults. CGRP mediates the trigeminovascular pain transmission from intracranial blood vessels to the central nervous system, as well as the vasodilatory component of neurogenic inflammation. Improvement in her cervical radiculopathy during preventive treatment of migraine may be due to inhibition of CGRP, a major mediator of neurogenic inflammation and vasodilation. This incidental finding may suggest additional use of CGRP-inhibitor for the treatment of radiculopathy. Therefore, further researches are necessary to prove this hypothesis.