Utility of Anti-CGRP Antibody Erenumab in Patients with Chronic Migraine with Medication Overuse

Authors:  Tepper SJ et al. 

Neurology 2019 Apr 17

Chronic migraine (CM) — defined as 15 or more headache days per month — can be difficult to treat. It is often accompanied by medication overuse (MO), which is the excessive use of acute medications. MO is distinct from medication-overuse headache (MOH), a secondary headache disorder that can result from MO. Cessation of the implicated acute treatments, initiation of preventive treatment, or both are debated treatment options for CM with MO. Three antibodies to calcitonin gene-related peptide (anti-CGRP), including erenumab, have been FDA-approved for preventive treatment of migraine. Can a preventive therapy, such as erenumab, show benefit in patients with CM and MO?

Investigators conducted a preplanned subgroup analysis of the double-blind, placebo-controlled phase 2 trial of erenumab (70 or 140 mg) in patients with CM to assess efficacy based on the presence or absence of MO. 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.