• Peter J Goadsby, Uwe Reuter, Yngve Hallström, Gregor Broessner, Jo H Bonner, Feng Zhang, Sandhya Sapra, Hernan Picard, Daniel D Mikol, and Robert A Lenz.
• From the National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London (P.J.G.); the Department of Neurology, Charité Universitätsmedizin Berlin, Berlin (U.R.); the Neuro Center, St. Göran Hospital, Stockholm (Y.H.); the Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria (G.B.); Mercy Research, St. Louis (J.H.B.); and the Departments of Global Biostatistical Science (F.Z.), Global Health Economics (S.S.), and Global Development (H.P., D.D.M., R.A.L.), Amgen, Thousand Oaks, CA.
• N. Engl. J. Med. 2017 Nov 30; 377 (22): 2123-2132.

BackgroundWe tested erenumab, a fully human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor, for the prevention of episodic migraine.MethodsWe randomly assigned patients to receive a subcutaneous injection of either erenumab, at a dose of 70 mg or 140 mg, or placebo monthly for 6 months. The primary end point was the change from baseline to months 4 through 6 in the mean number of migraine days per month. Secondary end points were a 50% or greater reduction in mean migraine days per month, change in the number of days of use of acute migraine-specific medication, and change in scores on the physical-impairment and everyday-activities domains of the Migraine Physical Function Impact Diary (scale transformed to 0 to 100, with higher scores representing greater migraine burden on functioning).ResultsA total of 955 patients underwent randomization: 317 were assigned to the 70-mg erenumab group, 319 to the 140-mg erenumab group, and 319 to the placebo group. The mean number of migraine days per month at baseline was 8.3 in the overall population; by months 4 through 6, the number of days was reduced by 3.2 in the 70-mg erenumab group and by 3.7 in the 140-mg erenumab group, as compared with 1.8 days in the placebo group (P<0.001 for each dose vs. placebo). A 50% or greater reduction in the mean number of migraine days per month was achieved for 43.3% of patients in the 70-mg erenumab group and 50.0% of patients in the 140-mg erenumab group, as compared with 26.6% in the placebo group (P<0.001 for each dose vs. placebo), and the number of days of use of acute migraine-specific medication was reduced by 1.1 days in the 70-mg erenumab group and by 1.6 days in the 140-mg erenumab group, as compared with 0.2 days in the placebo group (P<0.001 for each dose vs. placebo). Physical-impairment scores improved by 4.2 and 4.8 points in the 70-mg and 140-mg erenumab groups, respectively, as compared with 2.4 points in the placebo group (P<0.001 for each dose vs. placebo), and everyday-activities scores improved by 5.5 and 5.9 points in the 70-mg and 140-mg erenumab groups, respectively, as compared with 3.3 points in the placebo group (P<0.001 for each dose vs. placebo). The rates of adverse events were similar between erenumab and placebo.ConclusionsErenumab administered subcutaneously at a monthly dose of 70 mg or 140 mg significantly reduced migraine frequency, the effects of migraines on daily activities, and the use of acute migraine-specific medication over a period of 6 months. The long-term safety and durability of the effect of erenumab require further study. (Funded by Amgen and Novartis; STRIVE ClinicalTrials.gov number, NCT02456740 .).

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