A real‐world, observational study of erenumab for migraine prevention in Canadian patients

Abstract

Objectives To assess real‐world effectiveness, safety, and usage of erenumab in Canadian patients with episodic and chronic migraine with prior ineffective prophylactic treatments. Background In randomized controlled trials, erenumab demonstrated efficacy for migraine prevention in patients with ≤4 prior ineffective prophylactic migraine therapies. The “Migraine prevention with AimoviG: Informative Canadian real‐world study” (MAGIC) assessed real‐world effectiveness of erenumab in Canadian patients with migraine. Methods MAGIC was a prospective open‐label, observational study conducted in Canadian patients with chronic migraine (CM) and episodic migraine (EM) with two to six categories of prior ineffective prophylactic therapies. Participants were administered 70 mg or 140 mg erenumab monthly based on physician’s assessment. Migraine attacks were self‐assessed using an electronic diary and patient‐reported outcome questionnaires. The primary outcome was the proportion of subjects achieving ≥50% reduction in monthly migraine days (MMD) after the 3‐month treatment period. Results Among the 95 participants who mostly experienced two (54.7%) or three (32.6%) prior categories of ineffective prophylactic therapies and who initiated erenumab, treatment was generally safe and well tolerated; 89/95 (93.7%) participants initiated treatment with 140 mg erenumab. At week 12, 32/95 (33.7%) participants including 17/64 (26.6%) CM and 15/32 (48.4%) EM achieved ≥50% reduction in MMD while 30/86 (34.9%) participants including 19/55 (34.5%) CM and 11/31 (35.5%) EM achieved ≥50% reduction in MMD at week 24. Through patient‐reported outcome questionnaires, 62/95 (65.3%) and 45/86 (52.3%) participants reported improvement of their condition at weeks 12 and 24, respectively. Physicians observed improvement in the condition of 78/95 (82.1%) and 67/86 (77.9%) participants at weeks 12 and 24, respectively. Conclusion One‐third of patients with EM and CM achieved ≥50% MMD reduction after 3 months of erenumab treatment. This study provides real‐world evidence of erenumab effectiveness, safety, and usage for migraine prevention in adult Canadian patients with multiple prior ineffective prophylactic treatments.

Efficacy and safety of fremanezumab for migraine prophylaxis in patients with at least three previous preventive failures: Prospective, multicenter, real‐world data from a Greek registry

“…Nonetheless, although our findings are overall in agreement with the results reported in the FRIEND study, a direct comparison cannot be done because of significant differences in the number of patients studied (67 vs. 204 in our study) and different medical histories and comorbidities. Moreover, we report similar findings to those recently published for erenumab [19][20][21] and galcanezumab [22,23] in real-world studies in both the EM and CM settings, although again methodological differences exist between studies, including the evaluation of changes in monthly migraine days (MMD) rather than MHD and the definition of the cut-off for treatment response at the level of 30% rather than 50% reduction in MHD. TA B L E 3 Changes in efficacy, disability, and quality of life outcomes at baseline (T0-trimester before initiation of therapy) and after fremanezumab treatment in patients with chronic migraine (n = 107).…”

Does MIDAS reduction at 3 months predict the outcome of erenumab treatment? A real-world, open-label trial

“…In the subsequent 52-week open-label, MMDs decreased by 9.3 from baseline, and the percentage of patients qualifying as 50% responders was 59% [31]. In the real-world setting, the percentage of 50% responders for CM ranged between 34 and 75%, while the reduction in MMDs varied from 9.3 to 12.8, a quite ample heterogeneity that can be explained by differences in study design, duration of follow-up, and inclusion/exclusion criteria [9,10,32,33].…”

Open-label trials for CGRP-targeted drugs in migraine prevention: A narrative review

“…In CM, real-world studies proved a reduction in MMD from 8.2 to 13.9, while the 50% responder rate was between 34 and 75% (42–45). Noteworthy, erenumab proved effective in refractory CM patients as well (46).…”

“…Real-world studies including EM patients suggested a reduction in MMD between 2.9 to 6.4; the 50% responder rate ranged between 35-76.5% (42–44).…”

“…In the real-world setting, at least one AE was reported by 19% to 48% of patients, with constipation, nausea, flu-like symptoms, and site injection reaction being the most prevalent (>2%) and consistently reported (42)(43)(44)(45).…”