Improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment \u2013 real world outcomes

J Talbot,S Weatherby,L Crawford,R Stuckey,S Mullin

doi:10.1186/s10194-020-01214-2

Abstract

BackgroundThe CGRP antagonists offer a novel therapeutic approach in migraine. Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA.MethodsWe offered erenumab to 98 patients with a prior unsatisfactory response to onabotulinumtoxinA. Eighty of 98 had trialled greater occipital nerve injections (82%), 32/98 peripheral neurostimulation (33%) and 18/98 intravenous dihydroergotamine (18%). Thirty eight of 98 (39%) met the definition of triptan overuse and 43/98 (44%) analgesic overuse. All patients met the EHF criteria for ‘resistant migraine’. Outcome measures (recorded monthly) included days with headache limiting activities of daily living (“red”), not limiting (“amber”), headache free (“green”), and requiring triptans or other analgesics. Quality of life scores - headache impact test 6 (HIT-6), patient health questionnaire 9 (PHQ-9) and pain disability index (PDI) - were also measured.ResultsMean number of red days improved by − 6.4 days (SE 0.67, 95%CI − 7.7 to − 5.1, p=0.001) at 3 months; − 6.8 days (SE 0.96, 95%CI − 8.80 to − 4.9, p=0.001) at 6 months and − 6.5 days (SE 0.86, 95%CI − 8.3 to − 4.8, p=0.001) at 9 months. Repeated measures ANOVA confirmed improvements in the number of red (p=0.001), green (p=0.001), triptan (p=0.001) and painkiller days (p=0.001) as well as scores of the HIT-6 (p=0.001), PHQ-9 (p=0.001), and PDI (p=0.001) across the duration of study.ConclusionWe observed improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment.

Highlights

The calcitonin gene-related peptide (CGRP) antagonists offer a novel therapeutic approach in migraine
In 2018, erenumab was approved by both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for episodic migraine and chronic migraine in adults who have at least 4 migraine days per month
We present our outcomes of erenumab treatment in an open-label audit of patients with chronic migraine, all of whom had a prior unsatisfactory response to Onabotulinumtoxin A (BoNTA)

Summary

Introduction

The CGRP antagonists offer a novel therapeutic approach in migraine Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA. The calcitonin gene-related peptide (CGRP) monoclonal antibodies offer a novel therapeutic approach to migraine. Their efficacy has been demonstrated in clinical trials of both acute and chronic migraine [1,2,3,4,5,6,7,8,9,10]. In view of the relatively higher cost of this treatment compared to oral preventatives and its requirement to be administered in a clinic by trained healthcare providers, it is generally reserved for patients with more severe forms of migraine

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