Erenumab Effective for Nonopioid Overuse Headache in Chronic Migraine

Monthly injections of erenumab (140 mg) have been shown to be safe and effective in achieving remission of medication overuse headache (MOH) in patients suffering from nonopioid chronic migraine (CM) and MOH, according to a recent study published in JAMA Neurology. The study, led by Stewart J. Tepper, M.D., from the New England Institute for Neurology and Headache in Stamford, Connecticut, explored the efficacy and safety of erenumab in treating these conditions.

The study included 584 participants who were randomly assigned to receive either erenumab (70 mg or 140 mg) or a placebo once a month for 24 weeks. The primary aim was to determine the rate of MOH remission among these groups. The results at the six-month mark indicated significant differences between the treatment groups and the placebo group.

Specifically, 69.1 percent of participants who received the 140-mg dose of erenumab achieved MOH remission, with an odds ratio of 2.01 and a 95 percent confidence interval ranging from 1.33 to 3.05. This was significantly higher compared to the placebo group, where only 52.6 percent of participants achieved remission. The 70-mg dose group also showed positive results, with a 60.3 percent remission rate; however, this was not statistically significant when compared to the placebo group, as indicated by an odds ratio of 1.37 and a 95 percent confidence interval from 0.92 to 2.05.

Furthermore, the study measured the change in average monthly acute headache medication days from baseline. The 140-mg dose group experienced a reduction of 9.4 days, which was 2.7 days fewer than the placebo group. The 70-mg dose group had a reduction of 7.8 days, 1.2 days fewer than the placebo group.

The sustainability of MOH remission throughout the treatment period was also assessed. It was found that 61.3 percent of those in the 140-mg erenumab group maintained remission, compared to 49.5 percent in the 70-mg group and 37.6 percent in the placebo group. These results demonstrate the longer-term efficacy of the higher dose of erenumab in maintaining MOH remission.

In terms of safety, the study reported a similar profile to previous trials. In the combined erenumab groups, 66.8 percent of participants experienced treatment-emergent adverse events. The most common events were constipation, affecting 15.2 percent of participants, and COVID-19, affecting 13.9 percent.

The authors of the study highlighted that this research is the first controlled trial to provide American Academy of Neurology class I evidence of the benefits of a migraine preventive treatment in patients with nonopioid CM-MOH. This lends significant credibility to the use of erenumab for this condition and offers a promising option for those suffering from chronic migraines exacerbated by medication overuse.

Several authors disclosed relationships with pharmaceutical companies, including Amgen, which manufactures erenumab and funded the study.

Overall, the findings from this study suggest that monthly injections of erenumab, particularly at the 140 mg dosage, can be a safe and effective treatment for achieving and maintaining remission of medication overuse headaches in patients with chronic migraines.