Erenumab Benefits Adults With Migraine With Multiple Prophylactic Treatment Failures

Werner J. Becker, MD, FRCPC

Real-world data from the MAGIC study suggest that, when administered in patients with chronic (CM) and episodic (EM) migraine who experienced repeated ineffective prophylactic migraine therapy, erenumab (Aimovig; Amgen) treatment was safe and resulted in at least 50% reduction in monthly migraine days (MMD) in more than one-third of the cohort.

MAGIC was a prospective, open-label, observational study that assessed the real-world effectiveness of erenumab, a calcitonin gene-related peptide (CGRP) targeting therapy, in Canadian patients with migraine. In the study, participants received 70 mg or 140 mg of erenumab monthly based on physicians’ assessment and recorded migraine attacks using an electronic diary. In total, 89 individuals (93.7%) initiated erenumab at 140 mg.

Lead investigator Werner J. Becker, MD, FRCPC, professor emeritus, University of Calgary, and colleagues assessed 95 patients who received erenumab therapy, 86 of whom continued treatment beyond week 12. At baseline, most participants had previously experienced inadequate efficacy with 2 (54.7%) or 3 (32.6%) categories of prophylactic migraine therapies, and 1 participant (1.1%) had a similar experience with more than 4.

In the primary outcome analysis, 32 participants (33.7%) experienced a reduction of at least 50% in MMD at the end of the 12-week treatment period. This reduction was similar to other randomized controlled trials, including the STR1VE trial (NCT0245670; 70 mg: 41.3%; 140 mg: 48.1%) and was higher than that reported in the LIBERTY trial (NCT03096834; 140 mg: 30.0%).

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Erenumab was proven to be safe and well-tolerated, with most (88.2%) of the 34 adverse events (AEs) considered mild in nature. Notably, no action was taken for 67.7% of AEs. Eight AEs related to constipation and an additional mild case of rectal hemorrhage, which was classified as a serious AE, were considered to have a suspected causal relationship with erenumab. Investigators found no AEs related to cardiac or vascular disorders even though 7.0% of patients enrolled had preexisting cardiovascular comorbidities, such as atrial fibrillation, supraventricular tachycardia, and hypertension.

At weeks 12 and 24, 65.3% and 52.3% of patients, respectively, reported improvements on Patient Global Impression of Change (P-GIC), an assessment of patients’ condition. Similarly, scores on Migraine-Specific Quality of Life Questionnaire (MSQ) aligned with these observations; however, missing patient-reported outcome responses increased at follow-up time points.

At baseline, physicians assessed 50 subjects (52.6%) as moderately to extremely ill. At week 12, 82.1% of the 28 participants assessed had physician-perceived improvement on Clinical Global Impressions-Severity (CGI-S) scale. Results remained somewhat similar after 24 months, with 77.9% of the 19 participants reporting improvement following erenumab treatment.

On secondary outcome analyses, 26.6% of those with CM (n = 17) and 48.4% of those with EM (n = 15) achieved at least 50% reduction in MMD following erenumab. At week 24, 34.5% of participants with CM (n = 19) and 35.5% of those with EM (n = 11) achieved the same reductions. Those included in the study showed a mean migraine headache day reduction of 4.9 (SD, 5.8) and 6.1 (SD, 6.1) at weeks 12 and 24, respectively. Despite 71.6% of the cohort meeting eligibility criteria for medication overuse at baseline, monthly acute migraine-specific medication treatment days decreased on average by 2.7 days (SD, 4.0) and 2.7 days (SD, 4.6) during the same time points.

REFERENCE
1. Becker WJ, Spacey S, Leroux E, et al. A real-world observational study of erenumab for migraine prevention in Canadian patients. Headache. Published online April 10, 2022. doi:10.1111/head.14291