Migraine prophylaxis with CGRP antibodies is characterized above all by a rapid onset of action and good tolerability. A phase IV comparative study evaluated erenumab against the anticonvulsant topiramate in patients with episodic and chronic migraine. The results confirm the value of the antibody against the CGRP receptor as a safe and effective treatment.
The CGRP receptor antibody erenumab (Aimovig®) is used for the prophylaxis of episodic and chronic migraine. Whether this protects better against migraine attacks than agents previously prescribed for prophylaxis was analyzed in a post-approval study. The study included 777 subjects who received either erenumab subcutaneously at a dose of 70 mg or 140 mg (given every four weeks) or topiramate orally at 50 to 100 mg/day. Patients who were treatment-naïve and patients who had already failed up to three prophylactic migraine therapies suffering from ≥4 monthly migraine days (MMDs) were included. The primary study endpoint was treatment discontinuation due to adverse events. The secondary endpoint was defined as the proportion of patients with a 50% reduction in monthly migraine days. During the 24-week treatment period, the CGRP receptor antibody was found to be better tolerated and more effective than topiramate and resulted in fewer treatment discontinuations. This was also reflected in the reduction of MMDs. Here, a greater proportion of patients achieved at least a 50% reduction in their MMDs.
Calcitonin gene-related peptide (CGRP) is a messenger substance that is released in increased amounts during a migraine attack and plays a central role as an inflammatory protein in migraine. The proinflammatory neuropeptide is responsible for vasodilatation. The monoclonal antibody now specifically targets the CGRP receptor and can thus inhibit the process.
Source: “HER-MES CLINICAL TRIAL. HER-MES is the first randomized, double blind, head-to-head study of Aimovig® (erenumab) against topiramate in patients with episodic and chronic migraine”.
– Novartis
Further reading:
- ClinicalTrials.gov. Head-to-head study of Erenumab against topiRamate- Migraine study to assess tolerability and efficacy in a patiEnt-centered setting (HER-MES). https://clinicaltrials.gov/ct2/show/NCT03828539
- Bigal ME, Walter S, Rapoport AM: Calcitonin gene-related peptide (CGRP) and migraine current understanding and state of development. Headache. 2013; 53(8): 1230-1244.
- Lassen LH, Haderslev PA, Jacobsen VB, et al: CGRP may play a causative role in migraine. Cephalalgia. 2002; 22(1): 54-61.
- de Vries T, Villalón CM, MaassenVanDenBrink A: Pharmacological treatment of migraine: CGRP and 5-HT beyond the triptans. Pharmacol Ther. 2020; 211: 107528
- Faught E: Topiramate in the treatment of partial and generalized epilepsy. Neuropsychiatr Dis Treat. 2007; 3(6): 811-821. doi:10.2147/ndt.s512
InFo NEUROLOGY & PSYCHIATRY 2020; 18(6): 46.
