Erenumab - a promising drug for chronic migraine associated with medication overuse

USA: A phase 2 trial showed Erenumab to be a promising drug for patients with chronic migraine (CM) and medication overuse. Erenumab is a fully human anti-calcitonin gene-related peptide (CGRP) receptor monoclonal antibody approved for migraine prevention with demonstrated clinically relevant efficacy in CM.

The study, published in the journal Neurology, found that in patients with chronic migraine and medication overuse, erenumab reduced acute migraine-specific medication treatment days and migraine frequency, improving quality of life and disability.

Chronic migraine is defined as more than fifteen headache days per month over a three month period. It is difficult to treat and is often accompanied by excessive use of acute medications -- medication overuse (MO) in an attempt to manage their symptoms. Initiating a preventive treatment and cessation of acute treatments are two debatable options for treatment of patients with CM and MO.

Stewart J. Tepper, Geisel School of Medicine at Dartmouth, Hanover, NH, and colleagues set to determine whether erenumab is beneficial in patients with chronic migraine and medication overuse.

For the purpose, the researchers conducted a preplanned subgroup analysis of the double-blind, placebo-controlled phase 2 trial. 667 adults with CM were randomized (3:2:2) to placebo or erenumab (70 or 140 mg), stratified by region and medication overuse status.

Data from patients with baseline medication overuse at baseline were used to assess changes in monthly migraine days, acute migraine-specific medication treatment days, and proportion of patients achieving ≥50% reduction from baseline in monthly migraine days.

Also Read: Cognitive‐behavioral therapy reduces headache frequency in chronic migraine

They found that:

• Of the 667 patients randomized, 41% met criteria for MO.


• Compared with the non-MO subgroup, the MO subgroup had a higher percentage with prior treatment failure with at least one preventive treatment (75% vs. 63%) and higher mean baseline monthly migraine days (19.0 days vs. 17.3 days).


• At month 3, patients in the MO subgroup experienced reduced mean monthly migraine days with erenumab versus placebo (140 mg: −6.6 days; 70 mg: −6.6 days placebo: −3.5 days) and acute migraine-specific medication treatment days (140 mg: −4.9 days; 70 mg: −5.4 days; placebo: −2.1 days).


• The observed treatment effects were similar in the non-MO subgroup.

Also Read: Vagus Nerve Stimulation device approved by FDA for prevention of Chronic Migraine

Previous studies, along with the current study of erenumab, support that, contrary to previous suggestions, headache preventive medications are not necessarily limited by acute headache medication overuse.

"Overall, these results demonstrate that erenumab is effective in patients with CM and medication overuse with clinical improvements in reduction of the frequency of migraines and with improvements in patient-reported outcomes (PROs) across multiple measures of health-related quality of life (HRQOL), social and psychological impact, and disability in patients with CM," concluded the authors.

For detailed study follow the link: https://doi.org/10.1212/WNL.0000000000007497