The human anti-CGRP receptor monoclonal antibody erenumab is approved for the prevention of migraine. However, research suggests these medications may not be as effective in migraine with a history of aura.
In a post-hoc analysis, researchers found that erenumab significantly reduced the number of monthly migraine days (MMDs) and the use of acute migraine-specific medication (AMSM) in episodic or chronic migraine, regardless of aura status.
“These findings suggest that erenumab may be safe and effective for this patient population,” the authors wrote.
The study was published online today in JAMA Neurology.
Researchers analyzed data from four randomized controlled trials of 2682 patients with migraine with and without aura who received placebo (n = 1043) or erenumab (n = 1400) at a dose of 70 mg or 140 mg. A history of aura was reported in 46.7% of those receiving erenumab.
Among patients with episodic migraine and a history of aura, MMD decreased by –1.1 days (95% CI, –1.7 to –0.6) in those who received 70 mg and –0.9 days (95% CI, –1.6 to –0.2) in those who received 140 mg, compared to placebo.
Among patients with chronic migraine and a history of aura, MMD decreased –2.1 days (95% CI, –3.8 to –0.5) in those who received 70mg of erenumab and –3.1 days (95% CI, –4.8 to –1.4) in those who received 140 mg.
In those who used AMSMs, the number of days the rescue medications were needed was significantly lower with erenumab. In those with episodic migraine and a history of aura, the difference in AMSM days from baseline was –0.9 (95% CI, –1.4 to –0.3) in those who received 70 mg of erenumab and −1.3 (95% CI, −2.0 to −0.5) in those who received 140 mg.
In those with chronic migraine, the difference was –2.4 (95% CI, –3.9 to –1.0) in those who received 70 mg of erenumab and −3.7 (95% CI, −5.0 to −2.3) in those who received 140 mg.
Safety profiles were similar across all subgroups and decreases in MMD and AMSM with erenumab were sustained throughout long-term analysis regardless of aura status.
The study was funded by Amgen Inc. Lead author Messoud Ashina, MD, PhD, DMSc, is a consultant or scientific advisor for AbbVie, Allergan, Amgen, Eli Lilly, Lundbeck, Novartis, and Teva Pharmaceuticals. Full disclosures for Ashina and other authors can be found in the original article.
JAMA Neurol. Published online December 20, 2021. Full text