Highlights from

EAN 2019

European Academy of Neurology

Oslo 29 June - 2 July 2019

Short- and long-term efficacy of erenumab in hard-to-treat patients

In a hard-to-treat patient population with multiple prior preventive treatment failures, efficacy of erenumab 140 mg was sustained throughout a 24- week period in an open-label extension phase (OLE) of the LIBERTY study [1]. Erenumab also showed sustained efficacy through week 52 in patients with ≥1 prior preventive treatment failures in the STRIVE study [2].

The placebo-controlled LIBERTY study demonstrated efficacy of erenumab 140 mg after 12 weeks in episodic migraine patients with prior preventive treatment failures. The 240 patients completing the double-blind phase were then enrolled into the OLE to receive monthly erenumab 140 mg.

Overall, efficacy data over 24 weeks (assessed over weeks 13–16, 17–20, and 21–24) was generally in line with prior erenumab trials. Patients with continuous use of erenumab showed sustained efficacy in all outcomes assessed. Patients who switched from placebo to erenumab in the OLE showed improvement from the first measurement at week 16 on all outcomes assessed [1]. Of 228 patients (95.0%) who completed the 24-week visit, 39.2% had achieved at least a 50% reduction in monthly migraine days (MMDs), 15.9% at least a 75% reduction, and 7.0% a 100% reduction. The mean change from the double-blind treatment phase baseline was -2.7 in MMDs, -1.4 in monthly acute migraine-specific medication days (MSMD), -7.6 in Headache Impact Test-6 (HIT-6) score, -2.5 in Migraine Physical Function Impact Diary (MPFID) physical impairment score, and -4.0 in MPFID everyday activities score.

In the double-blind 24-week treatment phase of the STRIVE study, 955 patients were randomised (1:1:1) to placebo, erenumab 70 mg or erenumab 140 mg monthly. For the subsequent 28-week active treatment phase, 845 patients were re-randomised (1:1) to erenumab 70 mg or 140 mg. Of these, 343 (41%) had failed ≥1 prior preventive therapy.

At week 52, a consistent decrease in both MMD and MSMD was observed with erenumab 70 and 140 mg [2]. Mean change in MMD was -3.4 and -4.2, respectively; mean change in MSMD was -1.9 and -2.5. The proportion of patients achieving ≥50% MMD reduction in the last month of the active treatment phase was 52% and 55%, respectively; 29% and 33% achieved ≥75% MMD reduction, and 12% and 16% a 100% reduction. Erenumab was generally well-tolerated over the duration of the extended dose-blinded active treatment phase in this subgroup.

  1. Reuter U, et al. EAN 2019, EPO2147.
  2. Schwedt J, et al. EAN 2019, EPO2148.

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