Patients With Episodic Migraine 6 Time More Likely to Reduce Monthly Migraine Days With Erenumab
In episodic migraine, patients treated with erenumab were 6 times more likely to achieve 50% or greater reduction in monthly migraine days, compared to ongoing treatment with nonspecific oral migraine preventive medications (OMPMs). Results from the APPRAISE randomized clinical trial were published in JAMA Neurology.
“Our results suggest that physicians should not prolong the treatment with nonspecific oral preventives because earlier initiation of erenumab provides a better long-term efficacy, tolerability, and adherence,” noted Patricia Pozo-Rosich, MD, PhD, and coauthors.
Patients experiencing migraine frequently fail initial preventative treatment efforts due to poor tolerability as well as insufficient response, which leads to low medication adherence and increased disease burden. The study thus sought to compare the efficacy, tolerability, patient adherence, and patient satisfaction between erenumab and OMPMs in patients with episodic migraine (EM) who had previously failed 1 or 2 preventative treatments.
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The 12-month open-label multicenter, active-controlled, phase 4 randomized clinical trial included 621 patients from 84 centers across 17 countries. Participants were randomized 2:1 to receive erenumab or OMPMs. Upon final analysis, “significantly” more patients receiving erenumab versus OMPM achieved the primary endpoint, defined as completing 1 year of the initially assigned treatment and reaching a reduction of 50% or greater from baseline monthly migraine days (232 of 413 [56.2%] vs 35 of 208 [16.8%]; odds ratio [OR], 6.48; 95% CI, 4.28-9.82; P <.001).
Further, compared to OMPMs, treatment with erenumab showed a higher responder rate (314 of 413 [76.0%] vs 39 of 208 [18.8%]; OR, 13.75; 95% CI, 9.08-20.83; P <.001) on the Patients’ Global Impression of Change (PGIC) scale (≥5 at month 12). Significant reduction in cumulative average MMDs was reported with erenumab treatment versus OMPM treatment (−4.32 vs −2.65; treatment difference [SE]: −1.67 [0.35] days; P < .001). Finally, substantially fewer patients in the erenumab arm compared with the OMPM arm switched medication (9 of 413 [2.2%] vs 72 of 208 [34.6%]) and discontinued treatment due to adverse events (12 of 408 [2.9%] vs 48 of 206 [23.3%]).
“Earlier initiation of erenumab may ultimately lead to fewer patients discontinuing or switching medication in a real-world clinical practice. Moreover, these findings may help reduce health care resource utilization, decrease disability, and increase better quality of life,” the study authors concluded.
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