Association between response to triptans and response to erenumab: real-life data

Frattale, Ilaria; Caponnetto, Valeria; Casalena, Alfonsina; Assetta, Maurizio; Maddestra, Maurizio; Marzoli, Fabio; Affaitati, Giannapia; Giamberardino, Maria Adele; Viola, Stefano; Gabriele, Amleto; Pistoia, Francesca; Cerone, Davide; Marini, Carmine; Sacco, Simona; Ornello, Raffaele

doi:10.21203/rs.3.rs-100067/v1

Cited by 7 publications

(12 citation statements)

References 19 publications

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“…In this light, a positive response to triptans might be a marker of favorable response also to the mAbs targeting the CGRP pathway. This observation has been similarly reported in other real‐life studies treating patients with erenumab [34] and may be clinically valuable to optimize prevention strategies in migraine patients.…”

Section: Discussionsupporting

confidence: 81%

Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3‐month observational, longitudinal, cohort, multicenter, Italian real‐life study

Vernieri

Altamura

Brunelli

et al. 2021

Euro J of Neurology

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Section: Discussionsupporting

confidence: 81%

Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3‐month observational, longitudinal, cohort, multicenter, Italian real‐life study

Vernieri

Altamura

Brunelli

et al. 2021

Euro J of Neurology

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“…Although not significant, responders also showed clinically meaningful improvement in additional decrease of non-migraine headache days and HIT-6 disability score. These results are in line with other larger international studies, where efficacy of erenumab in the real-world setting has outperformed that seen in clinical trials [17][18][19][20][21][22][23][24][25][26]. Similar to these experiences, a high rate of previously failed preventive therapies did not predict treatment failure.…”

Section: Discussionsupporting

confidence: 88%

“…Scheffler et al hypothesized that high patient expectations and lack of a placebo arm could contribute to this [17]. Although our numbers were too small to determine predictors of response, real-world studies have demonstrated a positive association between response to erenumab and response to triptans, as well as triptan medication overuse on 10 days or more per month [18,19]. Even if AEs with erenumab are more frequently seen in the real-world setting and have been reported to be as high as 70-91.9%, the majority of patients find that treatment benefits surpass drawbacks, leading to a decision to pursue therapy [20,21].…”

Section: Discussionmentioning

confidence: 81%

Real-Life Response to Erenumab in a Therapy-Resistant Case Series of Migraine Patients From the Province of Québec, Eastern Canada

Eghtesadi¹,

Leroux²,

Pagé

2021

Clin Drug Investig

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Background and ObjectiveErenumab is the first migraine-specific preventive therapy approved by Health Canada since the approval of onabotulinumtoxinA 10 years ago. It is one of four calcitonin gene-related peptide antagonist monoclonal antibodies that have been commercialized worldwide for use in the headache pipeline. The objective of our study was to determine real-life efficacy of monthly erenumab for the prevention of migraine in a small case series of difficult-to-treat patients followed at a tertiary headache clinic from the Canadian province of Québec. Methods We performed a retrospective chart audit of patients having failed four or more conventional migraine oral preventive therapies and who were treated with monthly self-administered subcutaneous erenumab (70 or 140 mg/mL dose) over a 1-year period. We assessed the patients' baseline characteristics, response to treatment, and tolerability. Results A total of 18 patients with a diagnosis of high-frequency episodic migraines or chronic migraine met criteria (83.3% female; mean age: 48.7 years; mean duration of migraine condition: 32.9 years). Patients self-administered erenumab using a prefilled disposable autoinjector on a monthly basis; 16 patients received a 140 mg/mL dosage, two patients received a 70 mg/mL dosage. At 1 year follow-up, 50% of patients reported ≥ 50% reduction in migraine frequency and were deemed responders. Patients attempted six doses of erenumab therapy prior to discontinuation for non-response, except for two patients with other concomitant chronic pain conditions, who required ten doses to reach a 50% response. For the overall cohort, there was a decrease of 5.2 monthly migraine days; 9 days for responders and 1.3 days for non-responders (t-test (df = 16) = -2.77, p = 0.014). There was an additional decrease of 7 monthly non-migraine days amongst patients with unremitting daily headaches; 8 days for responders and 5 days for non-responders (p > 0.05). There was a decrease of 5.4 monthly days using acute analgesics; 8.9 days for responders and 2 days for non-responders (T(16) = -2.33, p = 0.033). The overall mean reduction in disability using the Headache Impact Test (HIT-6) score was 5.6 points; only responders showed a reduction in HIT-6 severity category (p > 0.05). The most commonly reported adverse event was constipation (16.7%), which did not lead to treatment discontinuation and was successfully managed in all patients with early counselling and intervention. Conclusion This study supports the efficacy of erenumab in a case series of therapy-resistant migraine patients from the region of Québec. A high rate of previously failed preventive oral agents and medication overuse did not predict response in our patient cohort. In the presence of real-world complexity factors, such as psychological distress, regular opioid consumption and concomitant chronic pain conditions, a longer therapy trial may be warranted in obtaining optimal response.

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“…Our results showed an association between a positive triptan response and a successful Erenumab treatment which is reflected in a single study earlier this year. 13 The failure of triptans was also associated with a lower response to BTX 26 in a small cohort study of 44 patients with refractory chronic migraine. Thus, the response to triptan in patients with migraine seems to be an important factor in predicting the successful response to a preventive treatment.…”

Section: Discussionmentioning

confidence: 99%

“…To date, only one recent report showed a positive association between a triptan response and a successful Erenumab treatment. 13 Further, in patients with chronic migraine treated with BTX injections, cranial allodynia, unilateral migraine and short disease duration, absence of depression, and absence of medication overuse were associated with a positive treatment response, although these findings were not consistent across studies. [14][15][16][17][18] Thus, this study aimed to identify predictors of treatment response to Erenumab in a cohort of patients with episodic and chronic refractory migraine.…”

Section: Introductionmentioning

confidence: 89%

Identification of predictors of response to Erenumab in a cohort of patients with migraine

Salem-Abdou

Simonyan

Puymirat

2021

Cephalalgia Reports

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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.

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Association between response to triptans and response to erenumab: real-life data

Cited by 7 publications

References 19 publications

Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3‐month observational, longitudinal, cohort, multicenter, Italian real‐life study

Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3‐month observational, longitudinal, cohort, multicenter, Italian real‐life study

Real-Life Response to Erenumab in a Therapy-Resistant Case Series of Migraine Patients From the Province of Québec, Eastern Canada

Identification of predictors of response to Erenumab in a cohort of patients with migraine

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