Erenumab for Medication Overuse Headache (140 mg)
Trial question
What is the effect of erenumab for non-opioid medication overuse headache in patients with chronic migraine?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
83.0% female
17.0% male
N = 389
389 patients (322 female, 67 male).
Inclusion criteria: adult patients with chronic migraine and non-opioid medication overuse headache who had ≥ 1 preventive treatment failures.
Key exclusion criteria: age < 18 years; age > 50 years at migraine onset or > 65 years at chronic migraine onset; history of hemiplegic migraine, cluster headache, or other trigeminal autonomic cephalalgia; current concomitant diagnosis of a secondary type of headache other than medication overuse headache.
Interventions
N=195 erenumab (at a SC dose of 140 mg monthly for 24 weeks).
N=194 placebo (matching SC placebo monthly).
Primary outcome
Medication overuse headache remission at 6 months
69.1%
52.6%
69.1 %
51.8 %
34.5 %
17.3 %
0.0 %
Erenumab
Placebo
Significant
increase ▲
NNT = 6
Significant increase in medication overuse headache remission at 6 months (69.1% vs. 52.6%; OR 2.01, 95% CI 1.33 to 3.05).
Secondary outcomes
Significantly greater reduction in least mean square monthly acute headache medication days over 4-6 months (9.4 days vs. 6.6 days; MD 2.7, 95% CI 1.6 to 3.9).
Significant increase in sustained medication overuse headache remission during the treatment period (61.3% vs. 37.6%; OR 2.63, 95% CI 1.75 to 3.96).
No significant difference in reduction in mean physical impairment average domain scores during treatment period (10.6 points vs. 8.5 points; AD 2.1 points, 95% CI -0.2 to 4.5).
Safety outcomes
No significant difference in adverse events.
Conclusion
In adult patients with chronic migraine and non-opioid medication overuse headache who had ≥ 1 preventive treatment failures, erenumab was superior to placebo with respect to medication overuse headache remission at 6 months.
Reference
Stewart J Tepper, David W Dodick, Michel Lanteri-Minet et al. Efficacy and Safety of Erenumab for Nonopioid Medication Overuse Headache in Chronic Migraine: A Phase 4, Randomized, Placebo-Controlled Trial. JAMA Neurol. 2024 Sep 16:e243043.
Open reference URL