Migraine is consistently ranked among the top 20 most burdensome diseases worldwide.
Until now, existing prophylactic therapies for episodic migraine consisted mostly of repurposed medications for other conditions. They are normally prescribed based on the individual patient’s comorbidities and are often associated with poor tolerability, lack of efficacy, and high discontinuation rates among patients. Given all this, effective prophylactic therapies are clearly needed.
This week at the 2018 American Academy of Neurology (AAN) congress in Los Angeles, data about a promising new treatment for migraine prophylaxis was presented. Erenumab blocks the function of calcitonin gene-related peptide (CGRP), which is a neuropeptide produced in central and peripheral neurons. Binding of CGRP to its receptor (CGRP-R) plays a critical role in events that ultimately lead to migraine pain.
Erenumab, a fully humanized monoclonal antibody targeting CGRP-R, has recently completed a phase IIIb trial. The LIBERTY trial enrolled 246 patients who had failed two to four previous prophylactic treatments, and randomized them either to monthly subcutaneous injections of erenumab (140mg) or placebo, for 12 weeks.
The results of the study showed that over twice as many patients met the primary endpoint of the study by achieving at least 50% reduction in monthly migraine days on erenumab compared to placebo over the last four weeks of the double-blind treatment phase of the study (weeks 9-12) (30.3% with erenumab, 13.7% with placebo, p=0.002). Patients receiving erenumab injections also had statistically significant and clinically meaningful improvements across secondary endpoints, including a decrease in acute migraine-specific drug use and improved physical functioning as measured by the Migraine Physical Function Impact Diary (MPFID) scale. Some patients on erenumab were completely free of migraine days during this phase of the study. Furthermore, the treatment was well-tolerated as there were no adverse events leading to discontinuation of treatment.
The LIBERTY data presented at AAN highlighted again that erenumab (Aimovig™) is a safe and highly effective migraine prophylactic. Erenumab therefore offers a promising new option for patients who did not find relief with other prophylactic therapies.