Erenumab Reduces Migraine Frequency in Chronic Migraine With Medication Overuse

man with headache
man with headache
In patients with chronic migraine (CM) and medication overuse, erenumab reduces migraine frequency.

In patients with chronic migraine (CM) and medication overuse, erenumab reduces migraine frequency and acute migraine-specific medication treatment days, improving disability and quality of life, according to the results of a randomized double-blind placebo-controlled study published in Neurology.

Patients with CM represent a population with a significant unmet need as they are difficult to treat and commonly overuse acute medications, including simple and combination analgesics, triptans, and opioids.2-4 Overuse of these medications may increase the risk for secondary headache disorder as a result of such medication overuse.5

Related Articles

Erenumab is a fully human anti-calcitonin gene-related peptide (CGRP) receptor monoclonal antibody that is approved for migraine prevention6 and has demonstrated efficacy in CM.7 The study investigators conducted a 3-month randomized trial focusing on CM prevention with 70 and 140 mg erenumab (n=667) and found reduced monthly migraine days and acute medication use.8 The researchers analyzed data from a a planned subgroup of the randomly assigned patients who met the criteria for medication overuse (n=247).  The study investigators found that individuals in both the erenumab 70-mg and 140-mg subgroup had greater reductions in monthly migraine days and acute migraine-specific medication treatment days at month 3 compared with the placebo subgroup. Clinical responses paralleled improvements in patient-reported outcomes with a consistent benefit of erenumab across measures of impact, disability, and health-related quality of life. The non-medication overuse subgroup was found to have similar treatment effects.

The study investigators concluded,”[t]his study provides Class II evidence that erenumab reduces monthly migraine days at 3 months in patients with chronic migraine and medication overuse.”

References

1. Tepper SJ, Diener HC, Ashina M, et al. Erenumab in chronic migraine with medication overuse: Subgroup analysis of a randomized trial [published online April 17, 2019]. Neurology.  doi:10.1212/WNL.0000000000007497.

2. Silberstein S, Diener HC, Lipton R, et al. Epidemiology, risk factors, and treatment of chronic migraine: a focus on topiramate. Headache. 2008;48:1087–1095.

3. Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB. Transformed migraine and medication overuse in a tertiary headache centre: clinical characteristics andtreatment outcomes. Cephalalgia. 2004;24:483–490.

4. Mathew NT. Chronic refractory headache. Neurology. 1993;43:S26–S33.

5. Headache Classification Committee of the International Headache Society. International Classification of Headache Disorders, 3rd Edition (Beta Version). Cephalalgia. 2013;33:629-808.

6. Aimovig (erenumab-aooe) [US package insert]. Thousand Oaks, CA: Amgen Inc; 2018.

7. Xu C, Shi L, Rao S, et al. AMG 334, the first potent and selective human monoclonal antibody antagonist against the CGRP receptor. J Headache Pain. 2014;15(suppl 1):G43.

8. Tepper S, Ashina M, Reuter U, et al. Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase2 trial. Lancet Neurol. 2017;16:425–34.