Erenumab dosage for migraine prevention: An evidence-based narrative review with recommendations.

Abstract

Therapeutic monoclonal antibodies against the calcitonin gene-related peptide (CGRP) receptor or its ligand have changed the landscape of treatment options for migraine. Erenumab is the first and only fully human monoclonal antibody designed to target and block the CGRP receptor. It is approved by the Food and Drug Administration for preventive treatment of migraine in adults. The recommended dose of erenumab is 70mg monthly, with guidance that some patients may benefit from the 140mg monthly dose. There is a need for information to guide clinical practice on the comparative efficacy and safety of these two dosing options. To evaluate therapeutic and tolerability differences between erenumab 70 and 140mg based on evidence from published literature. This narrative review evaluates therapeutic and tolerability differences between erenumab 70 and 140mg based on a literature search using PubMed interface, Embase and Ovid MEDLINE(R) databases. The key search terms included migraine, AMG 334, AMG334, erenumab, erenumab-aooe, and Aimovig. The search was limited to English language articles or conference abstracts published up to May 2021. From the literature search, we retrieved 23 relevant articles/conference abstracts (19 articles [5 randomized, double-blind studies] and 4 conference abstracts) for inclusion in this narrative review. Although the recommended starting dosage of erenumab is 70mg, this narrative review of the literature indicates that some patients may benefit from a dosage of 140mg erenumab once monthly-especially those with difficult-to-treat disease and prior treatment failures. The evidence indicates that erenumab at 140mg has a numerically better efficacy than 70mg across a broad spectrum of migraine outcomes, including preventing progression to chronic migraine. Cumulative data from the literature support a therapeutic gain with an increase from erenumab 70 to 140mg and a rationale for initiating 140mg in selected patients.