Monthly Erenumab May Be Effective for Treatment-Resistant Chronic Migraine

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Participants were randomly assigned to receive erenumab 70 mg, erenumab 140 mg, or placebo.
Participants were randomly assigned to receive erenumab 70 mg, erenumab 140 mg, or placebo.

Erenumab 70 mg or 140 mg once monthly may be effective for patients with chronic migraine in whom prior preventive treatments have failed, according to a study published in Cephalagia.

The study included 498 participants with chronic migraine (defined as ≥15 headache days/month; ≥8 migraine days/month). Study participants had not responded to 0, 1 to 3, or 2 to 3 prior preventive treatments (eg, sodium valproate, botulinum toxin, topiramate), as indicated by insufficient efficacy and/or lack of tolerability. Participants were randomly assigned to receive erenumab 70 mg (n=138), erenumab 140 mg (n=136), or placebo (n=218). The primary end point was change in monthly migraine days from baseline to month 3.

Participants who were treated with either dose of erenumab reported greater reductions in monthly migraine days at month 3 compared with those who received placebo. The reduction in monthly migraine days was greater in participants treated with erenumab vs placebo: never-failed group: -2.2 days (95% CI, 4.1, 0.3) for erenumab 70 mg and -0.5 day (95% CI, 2.4, 1.5) for erenumab 140 mg; for the ≥1 prior treatment failure group: 2.5 days (95% CI, 3.8, 1.2) for erenumab 70 mg and 3.3 days (95% CI, 4.6,  2.1) for erenumab 140 mg; for the ≥2 prior treatment failures group: -2.7 days (95% CI, 4.2, 1.2) for erenumab 70 mg and -4.3 days (95% CI, 5.8, 2.8) for erenumab 140 mg.

The percentage of participants who reached ≥50% and ≥75% reduction from baseline in monthly migraine days was greater in all erenumab groups compared with the placebo group. The researchers found that participants with prior treatment failure had a lower placebo response.

“The results of this analysis should help to inform clinical decision-making for physicians treating patients who have failed one or more preventive treatments for migraine,” the researchers wrote. “Further studies will be required to determine whether erenumab can provide relief in patients who have exhibited no therapeutic response to more than 3 classes of preventive treatment.”

Disclosures

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Amgen, Thousand Oaks, CA, USA, and Novartis Pharma AG, Basel, Switzerland. Employees of the sponsors were involved in study design, data collection, analysis, and interpretation. All authors, including those who are employees of the study sponsors, drafted and/or revised the manuscript and approved the final version for submission.

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Reference

Ashina M, Tepper S, Brandes JL, et al. Efficacy and safety of erenumab (AMG334) in chronic migraine patients with prior preventive treatment failure: a subgroup analysis of a randomized, double-blind, placebo-controlled study. [published July 8, 2018]. Cephalagia. doi:10.1177/0333102418788347

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