Migraine patients have a hard time: pain, nausea and sensitivity to light significantly limit their quality of life. Everyday and social life suffers – more than 8 days a month in chronic migraine. The aim of migraine prophylaxis is to reduce the number, duration and severity of migraine attacks. Current data now demonstrate that erenumab is effective and well tolerated in the long term.
Migraine is a highly disabling disease that has a profound and limiting impact on people’s lives – including the time they spend with family and friends or at work [1,2]. In chronic migraine, patients suffer from headaches 15 or more days per month, at least eight of which are migraines [3]. However, the risk of chronicity increases significantly from as few as four monthly migraine days. Therefore, to help sufferers efficiently, specific migraine prophylaxis should be considered at an early stage. Erenumab (Aimovig®) is a CGRP antibody that blocks the receptor of the increased neuropeptide calcitonin gene-related peptide (CGRP). CGRP is among the most potent vasodilators and plays an important role in the development of migraine. Migraine Prevention is self-administered once monthly via the SureClick® auto-injector, requires no starting dose, and is easy to use [4].
Study results support effectiveness
The exploratory interim results of the TELESCOPE-Real-World study also demonstrate the efficacy of the monoclonal antibody in everyday practice. A reduction in migraine intensity was noted in 80% of the 109 patients studied and treated prophylactically, and 92% reported a decrease in attacks. On average, monthly migraine days were reduced by 8 days. In 19,740 migraine patients with an average disease duration of 18 years, interim results show that 85% of erenumab patients (n=91) were able to better manage their daily lives. In addition, a reduction in migraine days was observed in 83%.
The positive effect of prophylaxis persists over time, as demonstrated by the interim analysis of the open-label phase II study in patients with episodic migraine after 4.5 years. Long-term treatment with Aimovig® resulted in a sustained decrease in monthly migraine days by an average of 5.8 days. In a separate subanalysis of patients with chronic migraine and acute medication overuse (AMO), prophylaxis reduced monthly migraine days by 8.9 days (70 mg) and 10 days (140 mg), respectively. Patients with chronic migraine without AMO benefited from a reduction of 8.2 days (70 mg) and 10.8 days (140 mg), respectively.
Combination with acute therapy possible
In the case of an acute migraine attack, prophylaxis can also be combined with specific medications (AMSM). Results of a post-hoc analysis of 428 patients with episodic migraine and 457 patients with chronic migraine taking AMSM for acute migraine showed that preventive treatment with erenumab plus AMSM significantly reduced monthly migraine days and AMSM requirements when needed, compared with AMSM alone. This effect was also observed in a retrospective cohort study: more than one third of the patients were able to reduce the amount of AMSM used by more than 80%.
Source: Novartis International AG
Literature:
- Lipton R, Bigal ME, Diamond M, et al: Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007; 68: 343-349.
- GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392: 1789-1858.
- Straube A, Gaul C, Förderreuther S, et al: Therapy and care for chronic migraine. Neurologist 2012; 83: 1600-1608.
- Novartis. Data on File. March 2019.
InFo NEUROLOGY & PSYCHIATRY 2020; 18(4): 34.
