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

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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.