Conversion from chronic to episodic migraine in patients treated with erenumab: real-life data from an Italian region

Abstract

Background: Most patients treated with erenumab in clinical practice have chronic migraine (CM). We assessed the rate and possible predictors of conversion from CM to episodic migraine (EM) in a real-life study. Main body: We performed a subgroup analysis of patients treated with erenumab from January 2019 to February 2020 in the Abruzzo region, central Italy. Treatment was provided according to current clinical practice. For the purpose of the present study, we included patients fulfilling the definition of CM for the three months preceding erenumab treatment and with at least 6 months of follow-up after treatment. We assessed the rate of conversion to EM from baseline to Months 4-6 of treatment and during each month of treatment. To test the clinical validity of conversion to EM, we also assessed the decrease in monthly headache days (MHDs), acute medication days, and median headache intensity on a Numerical Rating Scale (NRS). We included in our study 91 patients with CM. At Months 4-6, 62 patients (68.1%) converted from CM to EM; the proportion of converters increased from Month 1 to Month 5. In the overall group of patients, median MHDs decreased from 26.5 (IQR 20-30) to 7.5 (IQR 5-16; P < 0.001) compared with baseline, while median acute medication days decreased from 21 (IQR 16-30) to 6 (IQR 3-10; P < 0.001) and median NRS scores decreased from 8 (IQR 7-9) to 6 (IQR 4-7; P < 0.001). Significant decreases were found both in converters and in non-converters. We found no significant predictors of conversion to EM among the patients' baseline characteristics. Conclusions: In our study, two thirds of patients with CM converted to EM during 6 months of treatment with erenumab. MHDs, acute medication use, and headache intensity decreased regardless of conversion from CM to EM.

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

“…showing that in the first 3 months of therapy, the nonconsecutive conversion rate was at least 48.4% [39]. In our CM cohort, as one could expect, patients with higher headache impact at baseline (i.e., more MHD, more painful attacks, more severe disability, and more failed preventive treatments) less easily converted to EM.…”

Psychological predictors of negative treatment outcome with Erenumab in chronic migraine: data from an open label long-term prospective study

“…A few other studies have sought to identify possible predictors of response to erenumab in CM. Ornello and colleagues [ 54 ] compared CM patients converting or non-converting to episodic migraine after erenumab treatment and found that depressive symptomatology was not a significant predictor of conversion. It must be noted that they selected a different timing of efficacy (months 4–6) and the numerosity of the non-converter groups was quite limited (18 subjects), which may have affected the study power.…”

Real-world evidence data on the monoclonal antibody erenumab in migraine prevention: perspectives of treating physicians in Germany

“…To date, there are no well-proven treatments available to reduce accompanying aura. An aura prevalence of 35 % - 52 % [ 10 – 12 ] and 23 % - 35 % [ 15 , 17 , 30 , 31 ] was reported in clinical trials and in real-world studies investigating erenumab, respectively. In our survey, physicians reported that 35 % of their patients had reduced accompanying aura, which was more pronounced in EM than in CM patients (41.7 % and 28.8 %).…”