Erenumab effective for migraine with medication overuse

  • Tepper SJ & al.
  • Neurology
  • 17 Apr 2019

  • International Clinical Digest
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Takeaway

  • The 41% of patients with chronic migraine who overused medications to treat their acute symptoms derived similar benefits from erenumab (Aimovig).

Why this matters

Key results

  • Erenumab 70 or 140 mg vs placebo netted greater 3-month reductions:
    • Monthly migraine days: mean, –6.6 (95% CI, –8.0 to –5.3) and –6.6 (95% CI, –8.0 to –5.3) vs –3.5 (95% CI, –4.6 to –2.4).
    • Acute migraine-specific medication treatment days: mean, –5.4 (95% CI, –6.5 to –4.4) and –4.9 (95% CI, –6.0 to –3.8) vs –2.1 (95% CI, –3.0 to –1.2).
  • Proportion achieving ≥50% reductions in monthly migraine days:
    • Placebo: 18%.
    • 70 mg: 36% (OR, 2.67; 95% CI, 1.36-5.22).
    • 140 mg: 35% (OR, 2.51; 95% CI, 1.28-4.94).
  • Concomitant improvements in disability, health-related QoL.
  • 140-mg dose increased likelihood of transition to nonmedication overuse (OR, 1.9-3.3).
  • Treatment effects similar to those in patients without medication overuse.

Study design

  • Planned subgroup analysis, phase 2, double-blind, randomized, controlled trial: 667 patients with chronic migraine (274 medication overusers).
  • Randomization: erenumab (70 or 140 mg) vs placebo.
  • Main outcome: migraine reduction.
  • Funding: Amgen.

Limitations

  • Smaller sample size.
  • Limited follow-up.

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