Erenumab as a Therapy for Hard to Treat Episodic Migraine

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The most frequent treatment-emergent adverse event was injection site pain, which occurred in 6% of participants in both groups.
The most frequent treatment-emergent adverse event was injection site pain, which occurred in 6% of participants in both groups.

Erenumab may be an effective treatment option for individuals with episodic migraine who have not responded to or tolerated other therapies, according to a study published in The Lancet.

As part of this 12-week, double-blind, placebo-controlled, randomized study (LIBERTY; ClinicalTrials.gov identifier: NCT03096834), researchers enrolled 246 adult participants from 16 countries across Europe and Australia with migraine into 2 groups: 119 in the erenumab group and 124 in the placebo group. These participants had a history of episodic migraines with or without aura for at least 1 year, averaged between 4 and 14 migraines per month, and had between 2-4 unsuccessful treatment prior to the study. Definition of unsuccessful treatments included efficacy and tolerability with 2 to 4 previous therapies. The most common unsuccessful treatments were topiramate, amitriptyline, and propranolol. The primary cause of treatment failure was ineffectiveness, but topiramate was flagged for low tolerability.

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At 12 weeks, 36 of 119 individuals in the erenumab group had a 50% or greater reduction in the monthly number of migraine days. In the placebo group, this number was 17 of 124. A significantly higher number of patients in the erenumab group than in the placebo group had a 50% or greater reduction in the number of migraine days per month during weeks 0 to 4 and weeks 5 to 8. By study conclusion, 12% of participants in the erenumab group and 4% in the placebo group had a 75% or greater reduction in the number of migraine days per month (OR 3.2, 95% CI, 1.1–9.0; =.025).

"Erenumab might be an option for patients with difficult-to-treat migraine who have high unmet needs and few treatment options," researchers concluded. Authors counted the short duration of the trial as a limitation, but plan to address this in an open-label trial extension.

Disclosures: This study was funded by Novartis Pharma. Employees of the study funder had roles in the trial design: data collection, analysis, interpretation, and writing of the report.

Reference

Reuter U, Goadsby PJ, Lanteri-Minet M, et al. Efficacy and tolerability of erenumab in patients with episodic migraine in whom two-to-four previous preventive treatments were unsuccessful: a randomised, double-blind, placebo-controlled, phase 3b study [published October 22, 2018]. Lancet. doi: 10.1016/S0140-6736(18)32534-0

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