Erenumab as a Promising Treatment for Episodic Migraine

In a novel trial, researchers have found that erenumab may be a more effective and tolerable option for patients with episodic migraine who have not responded well to previous oral migraine preventive medications (OMPMs). The findings, published in a recent issue of a prestigious medical journal, shed light on the potential benefits of early intervention with erenumab for individuals who have previously failed one or two preventive treatments.

The trial results were published in the journal JAMA Neurology.

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Individuals suffering from migraines frequently find themselves navigating a challenging cycle of trying out various nonspecific preventive medications. This cycle is often driven by two primary factors: poor tolerability and inadequate efficacy. As a result, many patients experience low adherence to their prescribed treatments, ultimately leading to an increased burden of disease. Hence researchers conducted a 12-month prospective, multicenter, randomized clinical trial, known as the APPRAISE trial, involving 621 adult participants from 17 countries.

These individuals, aged 18 years or older, had a history of migraine lasting 12 months or longer and experienced between 4 and fewer than 15 monthly migraine days (MMDs). Patients were randomly assigned to receive either erenumab or OMPMs, with dose adjustments permitted according to label recommendations. The primary endpoint of the study was the proportion of patients who completed one year of treatment and achieved a reduction of 50% or more in MMDs compared to baseline at month 12. Additional measures assessed in the study encompassed two secondary endpoints: the cumulative mean change from baseline in monthly migraine days (MMDs) throughout the treatment duration and the proportion of responders as per the Patients' Global Impression of Change (PGIC) scale at the 12-month mark for patients adhering to their initially assigned treatment.

Findings

The results of the study were striking.

• Significantly more patients treated with erenumab reached the primary endpoint compared to those on OMPMs.
• Specifically, 56.2% of patients in the erenumab group achieved the desired reduction in MMDs, while only 16.8% of patients in the OMPM group reached the same milestone.
• Furthermore, erenumab demonstrated higher responder rates on the Patients' Global Impression of Change (PGIC) scale, indicating greater overall satisfaction with treatment.
• In addition to improved efficacy, erenumab also exhibited superior tolerability and adherence compared to OMPMs.

The study findings revealed a noteworthy reduction in the cumulative average monthly migraine days (MMDs) among patients receiving erenumab compared to those treated with nonspecific oral migraine preventive medications (OMPMs). Fewer patients in the erenumab group switched medications or discontinued treatment due to adverse events, highlighting the potential for better patient outcomes with this specific preventive medication.

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The study's implications extend beyond clinical practice, offering hope to millions of individuals worldwide who suffer from episodic migraine. By identifying a specific medication that demonstrates superior efficacy, tolerability, and adherence, researchers have paved the way for more targeted and personalized treatment approaches in the management of this debilitating condition. As further research continues to unfold, the potential for erenumab to revolutionize the treatment landscape for episodic migraine appears increasingly promising. With continued advancements in medical science, individuals affected by this condition can look forward to a future marked by improved symptom management and enhanced quality of life.

Further reading: Pozo-Rosich P, Dolezil D, Paemeleire K, et al. Early Use of Erenumab vs Nonspecific Oral Migraine Preventives: The APPRAISE Randomized Clinical Trial. JAMA Neurol. Published online March 25, 2024. doi:10.1001/jamaneurol.2024.0368.