For people with episodic migraine whose previous prophylactic treatments have failed, erenumab may represent an efficacious and tolerable treatment, according to a study recently published in the journal Cephalalgia. Placebo response rate was found to be lower among those with previous treatment failure.
This international, double-blind study included 955 individuals with episodic migraine, 42.4% (n=405) of whom reported at least 1 previous migraine preventative treatment. Participants were treated for 6 months with monthly erenumab infusions of 70 mg or 140 mg, during which time they recorded a daily diary on headache. Primary study end points included change from baseline in monthly migraine days, decreases in monthly migraine days of ≥50% and ≥75%, and change in days of acute migraine medication at 4 to 6 months. A linear mixed-effects model was used to examine baseline change in monthly migraine days.
Both 70- and 140-mg doses of erenumab were associated with decreases in monthly migraine days at months 4 to 6 compared with placebo, with reductions of -0.9 (-1.5 to -0.3; 70 mg; P <.05) and -1.3 (-1.9 to -0.7; 140 mg; P <.001) among those whose treatment had never failed, -2.0 (-2.8 to -1.2; 70 mg; P <.001) and -2.5 (-3.4 to -1.7; 140 mg; P <.001) for those whose treatment had failed at least 1 medication, and -1.3 (-2.6 to 0.0; 70 mg; P <.001) and -2.7 (-4.0 to -1.4; 140 mg; P <.001) for those who experienced failed treatment at least twice. Acute migraine-specific medication days had similar decreases, as did decreases in monthly migraine of ≥50% and ≥75%. Among those achieving ≥50% monthly migraine day reduction, placebo response in those with no previous medication failures was 32.6%; in those with ≥1 previous medication failure, 17.5%; and in those with ≥2 previous medication failures, 11.1%.
Limitations to this study included a potential lack of real-world generalizability in the results, as well as a post hoc component in the research.
The study researchers conclude that “erenumab at both 70 mg and 140 mg doses demonstrated consistently greater efficacy than placebo in patients with prior treatment failures (1 and 2 categories). Our prespecified and post hoc analyses support the utility of erenumab as a new and safe migraine preventive therapy for patients who have failed other preventive therapies. Moreover, the data contribute to a growing evidence base suggesting patients who have failed previous preventive medications have lower placebo responses, with important implications for clinical trial design in the future.”
Several authors report financial association with pharmaceutical companies. Please see the original reference for authors’ disclosures.
Goadsby PJ, Paemeleire K, Broessner G, et al. Efficacy and safety of erenumab (AMG334) in episodic migraine patients with prior preventive treatment failure: a subgroup analysis of a randomized, double-blind, placebo-controlled study [published online April 13, 2019]. Cephalalgia. doi: 10.1177/0333102419835459