Monthly Erenumab may induce Remission of Medication-Overuse Headache in Chronic Migraine Patients: Study

A new study by Stewart Tepper and team showed that monthly 140 mg erenumab injections in individuals with non-opioid chronic migraine and drug overuse headaches resulted in medication overuse headache remission safely and effectively within 6 months.

Acute drug misuse is prevalent in migraine patients, which includes triptans, opioids, and both combination and basic analgesics. Medication overuse headache (MOH) is a recognized secondary headache disorder according to the International Classification of Headache Disorders (ICHD-3). It is characterized by prolonged overuse of acute headache medication(s) and a clinical observation of a significant worsening of an existing headache or the emergence of a new headache type in relation to the medication overuse.

The anticalcitonin gene-related peptide (CGRP) receptor monoclonal antibody erenumab-aooe was created for adult migraine prevention and has been effective in lowering monthly migraine days. This trial was set out to evaluate the safety and effectiveness of erenumab in patients with nonopioid CM-MOH.

This randomized, parallel-group, double-blind, placebo-controlled study lasted from October 7, 2019 to November 2, 2022, at 67 centers in North America, Europe, and Australia. Adults with CM-MOH who had failed at least one preventative therapy were eligible to participate. There were 992 individuals screened, with 620 enrolled. The main endpoint was MOH remission at month 6. The secondary end goals included the decrease from baseline in mean monthly acute headache prescription days (AHMD) at month 6 and the maintenance of MOH remission throughout the DBTP. Adverse events and alterations in vital signs served as safety endpoints.

The primary analysis sample consisted of 584 nonopioid-treated subjects with an average age of 44 years, 482 of whom were female (82.5%). Baseline demographics and illness characteristics were evenly distributed across groups. At month 6, 134 patients in the erenumab 140 mg group and 117 in the erenumab 70 mg group had achieved MOH remission when compared to 102 people enrolled in the placebo group (52.6%).

The usage of AHMD was similarly decreased in the erenumab groups compared to placebo. The least squares mean shift from baseline in average monthly AHMD was -9.4 (0.4) days in the erenumab 140 mg group and -7.8 (0.4) days in the erenumab 70 mg group when compared to -6.6 (0.4) days in the placebo group. verall, erenumab was successful in achieving and maintaining high rates of MOH remission, and the amount and quality of adverse events were consistent with the established safety profile of this medication.

Reference:

Tepper, S. J., Dodick, D. W., Lanteri-Minet, M., Dolezil, D., Gil-Gouveia, R., Lucas, C., Piasecka-Stryczynska, K., Szabó, G., Mikol, D. D., Chehrenama, M., Chou, D. E., Yang, Y., & Paiva da Silva Lima, G. (2024). Efficacy and safety of erenumab for nonopioid medication overuse headache in chronic migraine: A phase 4, randomized, placebo-controlled trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2024.3043