Background: The migraine-specific monoclonal antibody Erenumab targeting the calcitonin gene related peptide receptor is an effective and well tolerated preventive treatment of episodic and chronic migraine. However, its price limits its use as a first line therapy against migraine. Therefore, identifying patients who will adequately respond to such treatment is paramount. Methods: In this retrospective, real-life cohort study, 172 adult patients with refractory episodic or chronic migraine treated with Erenumab were included. To identify the predictors of response to Erenumab, bivariate subgroup analysis of several potential factors was performed, and multivariate logistic regression modeling was done to obtain Odds Ratio (OR). Results: Of the 172 patients, 57.0% achieved a successful treatment response (reduction of monthly migraine days by ≥50%). Statistically significant predictors of a treatment response were the presence of chronic migraine, tension-type headache, and a positive response to triptan with an odd ratio of 0.473 (95% CI, 0.235–0.952), 0.485 (95% CI, 0.245–0.962) and 3.985 (95% CI, 1.811–8.770), respectively (P < 0.05). Conclusions: Successful Erenumab treatment response rate was 57.0% in this retrospective cohort. As chronic migraine and tension-type headache were negative predictors of Erenumab response while triptan response was a positive predictor, this data suggests the potential for Erenumab monotherapy without the need for traditional preventive treatment in refractory migraine sufferers improving side effect profile and treatment adherence for a cohort of patients difficult to treat.

Background: Erenumab is an antibody anti-calcitonin gene related peptide (CGRP) receptor approved for the treatment of episodic (EM) and chronic migraine (CM). In this study, we aimed to identify the predictors of response to the treatment. Methods: This is an ongoing retrospective cohort study of 120 patients (49 with cervicalgia) with EM or CM treated with Erenumab. The first endpoint was to identify the success rate of this treatment (at least 50% reduction in monthly migraine days during the third month of the treatment). The second endpoint was to identify the predictors of response to Erenumab treatment. Results: Seventy one percent of patients achieved a favorable response (P-value<0.001) to Erenumab. Patients with cervicalgia showed a lower treatment success rate (21.1% with vs 40.8% without cervicalgia) while patients without cervicalgia showed a higher treatment success rate (78. 9% without vs 59.2% with cervicalgia) with a P-value of 0.025 and an odd ratio of 0.388 (95% CI 0.174-0.869, P-value=0.021). A similar trend was observed in patients with occipital neuralgia and obesity (P-value<0.08). Conclusions: The preliminary analysis of this study demonstrates that cervicalgia (and to a lesser extend occipital neuralgia and obesity) is a negative predictor of response to Erenumab in patients with migraine.