Erenumab in Chronic Migraine Patients Who Previously Failed Five First-Line Oral Prophylactics and OnabotulinumtoxinA: A Dual-Center Retrospective Observational Study

Abstract

Background: German authorities reimburse migraine prevention with erenumab only in patients who previously did not have therapeutic success with at least five oral prophylactics or have contraindications to such. In this real-world analysis, we assessed treatment response to erenumab in patients with chronic migraine (CM) who failed five oral prophylactics and, in addition, onabotulinumtoxinA (BoNTA).Methods: We analyzed retrospective data of 139 CM patients with at least one injection of erenumab from two German headache centers. Patients previously did not respond sufficiently or had contraindications to β-blockers, flunarizine, topiramate, amitriptyline, valproate, and BoNTA. Primary endpoint of this analysis was the mean change in monthly headache days from the 4-weeks baseline period over the course of a 12-weeks erenumab therapy. Secondary endpoints were changes in monthly migraine days, days with severe headache, days with acute headache medication, and triptan intake in the treatment period.Results: Erenumab (starting dose 70 mg) led to a reduction of −3.7 (95% CI 2.4-5.1) monthly headache days after the first treatment and −4.7 (95% CI 2.9-6.5) after three treatment cycles (p < 0.001 for both). All secondary endpoint parameters were reduced over time. Half of patients (51.11%) had a >30% reduction of monthly headache days in weeks 9-12. Only 4.3% of the patients terminated erenumab treatment due to side effects. Conclusion:In this treatment-refractory CM population, erenumab showed efficacy in a real-world setting similar to data from clinical trials. Tolerability was good, and no safety issues emerged. Erenumabis is a treatment option for CM patients who failed all first-line preventives in addition to BoNTA.

Conversion From Chronic to Episodic Migraine in Patients Treated With Erenumab: Real-life Data From an Italian Region

“…All converters withhold medication overuse. The high rate of conversion to EM in our population of di cult-to-treat patients with a long history of CM and multiple prior preventive treatment failures, including botulinum toxin in ≥ 40% of cases, supports the e cacy of erenumab for the preventive treatment of patients with CM, as shown in randomized controlled trials [13][14][15][16][17][18] and real-life studies [7][8][9][10]. We also found that at Months 4-6 16.5% of patients achieved a status of LFEM, while 28.6% achieved a status of MFEM, which indicates a high treatment bene t and a substantial improvement in the patients' quality of life.…”

“…Monoclonal antibodies directed against the calcitonin gene-related peptide (CGRP) or its receptor (CGRPr) are migraine-speci c treatments whose e cacy and safety were proven in both EM and CM [2][3][4][5]. However, the available real-life studies show that most patients treated in common clinical practice have CM [6][7][8][9][10]. In the present real-life, multicenter study, we assessed the rate and possible predictors of conversion from CM to EM in patients treated with erenumab.…”

Association between response to triptans and response to erenumab: real-life data

“…A previous real-life study found a trend toward better response to erenumab in triptan responders compared with non-responders [11], being however underpowered to draw de nite conclusions. The remaining available real-life studies on the safety and e cacy of erenumab [12][13][14][15][16][17] did not assess triptan response. Our nding is in line with a previous report which found an association between response to triptans and response to onabotulinumtoxin A [18]; however, the association found by this early study was not con rmed in a further study [19].…”

Conversion from chronic to episodic migraine in patients treated with erenumab: real-life data from an Italian region

“…Monoclonal antibodies directed against the calcitonin gene-related peptide (CGRP) or its receptor (CGRPr) are migraine-specific treatments whose efficacy and safety were proven in both EM and CM [5][6][7][8]. However, the available real-life studies show that most patients treated in common clinical practice have CM [9][10][11][12][13]. In the present real-life, multicenter study, we assessed the rate and possible predictors of conversion from CM to EM in patients treated with erenumab.…”