Treatment with the monoclonal calcitonin gene-related peptide receptor antibody erenumab: A real-life study

Simone de Vries Lentsch*, Iris E. Verhagen, Thomas C. van den Hoek, Antoinette MaassenVanDenBrink, Gisela M. Terwindt*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

37 Citations (Scopus)
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Abstract

Background and purpose: New prophylactics for migraine, targeting calcitonin gene-related peptide (CGRP), have recently emerged. Real-world data are important for a comprehensive understanding of treatment response. We assessed the consistency of response to erenumab, a monoclonal CGRP receptor antibody, in a real-world setting, in order to determine which patients may be considered responders in clinical practice. Methods: All erenumab-treated patients (n = 100) completed a time-locked daily electronic diary, and an automated algorithm was used to monitor treatment response. Monthly migraine days (MMD), non-migrainous headache days, days of acute medication use (MAMD), well-being and coping with pain were assessed for a 6-month period. The primary outcome was reduction in MMD compared to baseline. Results: The numbers of MMD and MAMD decreased in all months, in both episodic and chronic migraine patients, compared to baseline (p < 0.001), while general well-being (p < 0.001) and coping with pain (p < 0.001) also improved. Of all patients, 36% had an MMD reduction of ≥50% in ≥3/6 months, and 6% had such a reduction in all 6 months. For a ≥30% MMD reduction, the figures were 60% and 24%, respectively. Almost 90% of patients with an average MMD reduction of ≥30% over the first 3 months had a sustained response in the last 3 months. In addition, 20% of patients without an initial response (average <30%), had a delayed response (average ≥30%) in the last 3 months. Conclusion: Erenumab was effective in migraine patients who were highly refractory to previous prophylactics. As a practical guideline, we propose that treatment be continued for at least 6 months and that patients with a ≥30% MMD reduction in at least half of the treatment period should be considered to be responders.

Original languageEnglish
Pages (from-to)4194-4203
Number of pages10
JournalEuropean Journal of Neurology
Volume28
Issue number12
Early online date23 Aug 2021
DOIs
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
S.d.V.L. declares no competing interests relevant to the manuscript. G.M.T. reports consultancy support from Novartis, Allergan, Lilly, and Teva, and independent support from Dutch Organization for Scientific Research, the Dutch Heart and Brain Foundations, IRRF and Dioraphte. A.M.v.d.B. reports consultancy or industry support from Novartis, Lilly and Teva, and independent support from the Dutch Research Council (NWO) and the Dutch Heart and Brain Foundations. I.E.V. reports independent support from the Dutch Brain Council and the Dutch Brain Foundation. T.v.d.H. declares no competing interests relevant to the manuscript.

Publisher Copyright:
© 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology

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