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Erenumab for Preventive Treatment of Migraine: A Systematic Review and Meta-Analysis of Efficacy and Safety

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Abstract

Background

Novel therapeutic options with improved efficacy and safety profiles are needed for the prophylaxis of migraine. In recent years, the inhibition of calcitonin gene-related peptide (CGRP) signaling has attracted growing interest in the pharmacological research on migraine. Erenumab is the first fully human monoclonal antibody directed against the CGRP receptor to be approved for use in migraineurs.

Objective

To evaluate the efficacy and safety of erenumab as preventive treatment in patients with migraine using meta-analytical techniques.

Methods

Randomized, placebo-controlled, single- or double-blinded trials were identified through a systematic literature search (October week 4, 2018). Main outcomes included the changes from baseline in monthly migraine days (MMD) and monthly acute migraine-specific medication days (MSMD) at week 12, and the incidence of adverse events (AEs), severe AEs (SAEs) and treatment withdrawal due to AEs. Mean difference (MD) and risk ratio (RR) with 95% confidence intervals (95% CIs) were estimated.

Results

Across the five included trials, erenumab given as a subcutaneous injection at a monthly dosage of 70 mg and 140 mg was associated with a significantly greater reduction in baseline MMD (70 mg: MD − 1.3, 95% CI − 1.7 to − 1.0, p < 0.001; 140 mg: MD − 1.9, 95% CI − 2.3 to − 1.4, p < 0.001) and MSMD (70 mg: MD − 1.0, 95% CI − 1.6 to − 0.4, p < 0.001; 140 mg: MD − 1.8, 95% CI − 2.5 to − 1.1, p < 0.001) than placebo. There were no differences in the occurrence of AEs, SAEs, and drug withdrawal due to AEs between the erenumab and placebo groups.

Conclusions

Erenumab is an efficacious and well tolerated preventive treatment in adult patients with episodic and chronic migraine.

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Authors and Affiliations

  1. Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy

    Simona Lattanzi, Tommaso Corradetti & Mauro Silvestrini

  2. Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy

    Francesco Brigo

  3. Division of Neurology, “Franz Tappeiner” Hospital, Merano, BZ, Italy

    Francesco Brigo

  4. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria

    Eugen Trinka

  5. Center for Cognitive Neuroscience, Salzburg, Austria

    Eugen Trinka

  6. Public Health, Health Services Research and HTA, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria

    Eugen Trinka

  7. Neurology Unit, Campus Bio-Medico University, Rome, Italy

    Fabrizio Vernieri

  8. Clinic of Neurosurgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy

    Mauro Dobran

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  1. Simona Lattanzi
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Corresponding author

Correspondence to Simona Lattanzi.

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Funding

No funding was received for the conduct of this study.

Conflict of interest

Simona Lattanzi, Fabrizio Vernieri, Tommaso Corradetti, Mauro Dobran, and Mauro Silvestrini have no conflicts of interest directly relevant to the content of this study. Francesco Brigo has acted as a consultant for Eisai. Eugen Trinka has received speaker’s honoraria from UCB, Biogen, Gerot-Lannach, Bial, Eisai, Takeda, Newbridge, Sunovion Pharmaceuticals Inc., LivaNova and Novartis; consultancy funds from UCB, Biogen, Gerot-Lannach, Bial, Eisai, Takeda, Newbridge, GW Pharmaceuticals, Sunovion Pharmaceuticals Inc., and Novartis; directorship funds from Neuroconsult GmbH. E. Trinka’s Institution received grants from Biogen, Red Bull, Merck, UCB, European Union, FWF Österreichischer Fond zur Wissenschaftsförderung, and Bundesministerium für Wissenschaft und Forschung.

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Lattanzi, S., Brigo, F., Trinka, E. et al. Erenumab for Preventive Treatment of Migraine: A Systematic Review and Meta-Analysis of Efficacy and Safety. Drugs 79, 417–431 (2019). https://doi.org/10.1007/s40265-019-01069-1

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