Erenumab for Migraine: Real-World, Patient-Reported Outcomes

In a real-world setting, patients with migraine who received erenumab treatment reported high satisfaction and reduced migraine frequency, according to a 6-month analysis of the Swiss QUality of life and healthcare impact Assessment in a Real‑world Erenumab treated migraine population (SQUARE) study published in The Journal of Headache and Pain.

Patients (N=172) with chronic (n=79) or episodic (n=92) migraine who had experienced failure of prior prophylactic treatment received erenumab every 4 weeks at 19 sites in Switzerland and were asked to keep a diary about symptoms. After 6 months of treatment, Headache Impact Test (HIT-6™), modified Migraine Disability Assessment (mMIDAS), Impact of Migraine on Partners and Adolescent Children (IMPAC), and Treatment Satisfaction Questionnaire for Medication (TSQM-9) scores were compared with baseline.

The mean age of study participants was 44.2 (standard deviation [SD], 13.9) years, 84.9% were women, 16.4% had experienced failure of 6 or more prior prophylactic treatments, the number of monthly migraine days (MMD) was 16.6 (SD, 7.2), and the number of monthly acute medication days was 11.6 (SD, 7.0).

At 6 months, HIT-6™ scores decreased by an average of 7.7 points (P <.001) overall —  8.2 points among the episodic and 7.1 points among the chronic migraine cohorts — compared with baseline.

Similarly, mMIDAS scores were found to be decreased at 6 months compared with baseline among patients with episodic (mean, 23.8 vs 14.1; P <.001) and chronic (mean, 39.6 vs 23.6; P <.001) migraine.

The mean change in MMD was -5.1 days for patients with episodic migraine and -10.7 days for patients with chronic migraine (both P <.001); 4.6% and 2.8% of patients with episodic and chronic migraine experienced a 100% decrease in MMD, 24.1% and 26.8% experienced a 75% or greater decrease in MMD, and 57.5% and 54.9% experienced at least a 50% decrease in MMD, respectively. Similarly, the proportion of patients who used migraine-specific medications on 10 or more days per month decreased from 55.9% to 23.9% at 6 months.

The effect of migraine on spouses and children was also reported to be improved at 6 months (P <.001), with the proportion of patients with a grade I score increasing from 3.7% to 19.7% and the proportion of patients with a grade IV score decreasing from 54.3% to 37.4% (P <.001).

Using the TSQM-9 to assess treatment satisfaction, patients graded the effectiveness of erenumab as 67.1 points, its convenience as 82.4 points, and global satisfaction as 72.4 points. In general, patients with episodic migraine reported higher TSQM-9 effectiveness scores than patients with chronic migraine (P =.011).

A total of 99 adverse events were reported by 62 patients. The most common event was constipation (n=21). Twelve events were serious, including 2 patients receiving in-hospital headache treatment and 1 medication overuse headache requiring withdrawal in the hospital setting.

This study may have been limited, as enrollment was terminated early due to the COVID-19 pandemic; however, the number of recruited patients was sufficient to test for significant differences.

These data indicate that erenumab improved patient-reported outcomes and was well tolerated in the real-world setting for the treatment of chronic or episodic migraine. According to the study authors, “Patients treated with erenumab reported fewer migraine days per month, a lower impairment by their migraine symptoms and a reduction of the impact not only on themselves, but also on their social environment.”

Disclosure: This study was funded by Novartis Pharma Schweiz AG, of which 1 study author is an employee. The other study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.