Clinic and genetic predictors in response to erenumab

Abstract

Background and purpose Erenumab (ERE) is the first anticalcitonin gene‐related peptide receptor monoclonal antibody approved for migraine prevention. A proportion of patients do not adequately respond to ERE. Methods Prospective multicenter study involving 110 migraine patients starting ERE 70 mg monthly. Baseline socio‐demographics and migraine characteristics, including mean monthly migraine days (MMDs), migraine‐related burden (MIDAS [Migraine Disability Assessment scale] and Headache Impact Test‐6), and use of abortive medications, during 3 months before and after ERE start were collected. Real‐time polymerase chain reaction was used to determine polymorphic variants of calcitonin receptor‐like receptor and receptor activity‐modifying protein‐1 genes. Logistic regression models were used to identify independent predictors for 50% responder patients (50‐RESP) and 75% responder patients (75‐RESP). Results At month 3, MMDs decreased from 17.2 to 9.2 (p < 0.0001), 59/110 (53.6%) patients were 50‐RESP, and 30/110 (27.3%) were 75‐RESP. Age at migraine onset (odds ratio [OR] [95% confidence interval (95% CI)]: 1.062 [1.008–1.120], p = 0.024), number of failed preventive medications (0.753 [0.600–0.946], p = 0.015), and MIDAS score (1.011 [1.002–1.020], p = 0.017) were associated with 75‐RESP. Among the genetic variants investigated, RAMP1 rs7590387 was found associated with a lower probability of being 75‐RESP (per G allele OR [95% CI]: 0.53 [0.29–0.99], p = 0.048]), but this association did not survive adjustment for confounding clinical variables (per G allele, 0.55 [0.28–1.10], p = 0.09]). Conclusions In this real‐word study, treatment with ERE significantly reduced MMDs. The number of failed preventive medications, migraine burden, and age at migraine onset predicted response to ERE. Larger studies are required to confirm a possible role of RAMP1 rs7590387 as genetic predictor of ERE efficacy.

Machine‐learning‐based approach for predicting response to anti‐calcitonin gene‐related peptide (CGRP) receptor or ligand antibody treatment in patients with migraine: A multicenter Spanish study

“…All the variables have previously been associated with anti-CGRP receptor or ligand antibody therapy response in a real-life study [15]. However, neither these nor other possible demographic or clinical variables have been found to be consistently and widely useful for predicting response to anti-CGRP therapies in previous studies [17,19]. Moreover, according to the present study, no demographic predictors were found to significantly contribute to the models, suggesting that demographic characteristics at baseline do not significantly contribute to response to anti-CGRP therapies, which indicates that these therapies may be effective in very different populations.…”

“…Moreover, real-life clinical practice studies, performed according to the European guidelines of the International Headache Society [13], have reported significant reductions in monthly migraine days and monthly headache days after 3 and 6 months of treatment [14,15]. However, only few studies have explored possible predictors of response to anti-CGRP therapies and these have had disparate results [15,16,8,[17][18][19].…”

Conversion from chronic to episodic migraine in patients treated with galcanezumab in real life in Italy: the 12-month observational, longitudinal, cohort multicenter GARLIT experience

“…While it is not unexpected that more frequent attacks are less likely to decline to an episodic frequency, the association between younger onset age and worse outcomes deserves careful consideration. Interestingly, a study investigating genetic and clinical conditions predicting erenumab therapy outcomes reported an association of younger onset age and a variant of the receptor activity modifying protein 1 with a less prominent response [ 27 ]. CM is often pictured as the result of inadequate therapeutic management.…”

Cerebral Blood Flow and Other Predictors of Responsiveness to Erenumab and Fremanezumab in Migraine—A Real-Life Study

“…In a study by Iannote et al fewer migraine days at baseline were associated with ≥ 50% response rate at 1 month and fewer MMDs, years of chronic migraine, and monthly analgesic use at 6 months ( 25 ). Another study revealed that age at migraine onset, number of failed preventive medications, and MIDAS score were associated with >75% erenumab response ( 26 ). Although several authors reported a link between response to triptans and response to erenumab, we did not find a similar significant association in our study ( 27 , 28 ).…”