Real-World Erenumab Data Shows High Use in Chronic Migraine and Persistence to Therapy

Christine Szekely, PhD, epidemiologist, Amgen

Christine Szekely, PhD

After its FDA approval in May 2018, erenumab (Aimovig, Amgen/Novartis) has been utilized by a number of migraine specialists in real-world clinical practice, and a recent assessment of prescription trends has revealed that approximately 40% of those prescribed the therapy had a diagnosis of chronic migraine, suggesting its use has been largely in a severe patient population.

Additionally, the data revealed that the majority of the prescriptions came from neurologists at a dose of 70 mg, with infrequent alterations in dose or change to another anti-calcitonin gene-related peptide (CGRP) therapies. Most of these patients were persistent to the therapy after 3 months.

Led by Christine Szekely, PhD, epidemiologist, Amgen, the investigators presented their data in a poster at the 2019 American Headache Society Annual Meeting, July 11-14, in Philadelphia, Pennsylvania. The group sought to describe the real-world patient demographics, clinical characteristics, and patterns of treatment with erenumab, using data from the Practice Fusion ambulatory Electronic Health Record (PF EHR) database (n = 2476).

“Despite lifestyle modifications and the availability of acute and preventive pharmacotherapies, migraine remains inadequately treated in a significant number of patients,” Szekely and colleagues wrote. “Recently, a new class of migraine-specific preventive treatment became available in the US market that targets the CGRP pathway.”

Of the total cohort, 69.6% (n = 1724) of patients were initiated on the 70-mg dose, primarily by a neurologist or pain specialist (66.6%). The patients were an average of 49 years of age, and 86.3% were women. Additionally, a number of patients had common comorbidities of migraine, most notably anxiety (24.7%), depression (18.1%), hypertension (15.5%), osteoarthritis (12.0%), and epilepsy/seizure (6.3%), among others.

All told, 42.4% (n = 1050) of those prescribed the CGRP inhibitor were diagnosed with chronic migraine. Migraine Disability Assessment (MIDAS) scores were available for 6% (n = 149) of the cohort, with 49.7% (n = 74) of that subgroup reporting a score ≥21, indicating severe disability. Moderate disability was indicated by 22.1% (n = 33) of patients, while 10.7% (n = 16) and 17.4% (n = 26) indicated mild and little/no disability, respectively.

Prior to beginning treatment with erenumab, the majority of patients (72.5%; n = 1796) were prescribed or had a documented acute migraine therapy, including triptans (55.3%), nonsteroidal anti-inflammatories (NSAIDS; 24.8%), opioids (18.7%), and ergotamines (2.7%). Furthermore, 74.3% (n = 1839) of patients were prescribed treatments for migraine prevention—mostly anticonvulsants (58.4%), though anti-hypertensives, botulinum toxin, antidepressants, and others were also utilized. Of those patients, 29.9% (n = 740) had been on 1 preventive, 23.3% (n = 577) had 2, and 21.1% (n = 533) had ≥3.

“Most patients who initiated erenumab did not change their dose. However, 4.3% switched from 70 mg to 140 mg and 0.7% switched from 140 mg to 70 mg,” Szekely et al wrote, noting that 95% (n = 1293) remained on their dose. Additionally, 93.5% of those who initiated therapy with erenumab did not switch to another therapy within 3 months, though a small number—13 total—switched to another anti-CGRP medication, either fremanezumab (n = 10) or galcanezumab (n = 3).

As for persistence, 58.8% (n = 1455) of patients reached the 3-monht follow-up time point, and 84.6% of those (n = 1231) were adherent to the CGRP inhibitor 3 months post-index.

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REFERENCE

Szekely C, Fischer L, Rasmussen S, Bensink ME, Kallenbach L. Early use of erenumab in US real-world practice. Presented at: 2019 American Headache Society Annual Meeting. July 11-14, 2019; Philadelphia, PA. Poster P286LB.