Early outcomes of migraine after erenumab discontinuation: data from a real-life setting

• Published in: Neurological sciences Vol. 42; no. 8; pp. 3297 - 3303
• Main Authors: De Matteis, Eleonora, Affaitati, Giannapia, Frattale, Ilaria, Caponnetto, Valeria, Pistoia, Francesca, Giamberardino, Maria Adele, Sacco, Simona, Ornello, Raffaele
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2021; Springer Nature B.V
• Subjects: Calcitonin; Calcitonin gene-related peptide; Disease prevention; Drug dosages; Headache; Headaches; Medicine; Medicine & Public Health; Migraine; Monoclonal antibodies; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Article; Pain; Patients; Peptides; Psychiatry; Prevention; Calcitonin-gene-related peptide; Erenumab; Migraine
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-020-05022-z

Background Monoclonal antibodies targeting the calcitonin gene-related peptide, including erenumab, are migraine-specific preventive treatments, whose long-term effectiveness has still to be evaluated in real-life settings. We assessed early outcomes of erenumab discontinuation after a 52-week treatment in patients with a continuous positive response to the drug. Methods We evaluated the early outcomes after treatment completion in migraineurs from a real-life multicenter register. All patients received monthly erenumab for 52 weeks and attended a 8-week follow-up after treatment completion. Primary outcomes were responder rates and changes in monthly migraine days (MMDs), acute medications days (AMDs), and pain intensity on a Numerical Rating Scale (NRS score) during weeks 1–4 after erenumab treatment completion. Results The 32 included patients reported a decrease in MMDs, AMDs, and NRS score during the last 4 weeks of treatment compared with baseline ( P <0.001). During weeks 1–4 after treatment completion, all the outcome measures increased compared with the last 4 weeks of treatment ( P  < 0.001) despite staying lower than baseline (MMDs and AMDs P  < 0.001, NRS score P  = 0.005). Over the same time frame, 18 (56%) patients maintained a ≥ 50% reduction from baseline in MMDs. At week 4 after treatment completion, 10 (31%) patients restarted treatment due to disease rebound to baseline levels. Conclusions More than half patients had an early disease worsening, while the remaining patients maintained their responder status during weeks 1–4 after treatment completion. Further studies might identify predictors of prolonged response to erenumab and define the optimal treatment duration according to patients’ characteristics.