In the 24-week double-blind treatment phase of the STRIVE study, 955 participants were randomised to placebo, erenumab 70 mg, or erenumab 140 mg monthly. In the dose-blinded active treatment phase, the 845 patients who remained in the study were rerandomised to erenumab 70 mg or 140 mg from week 24 to 52. At week 52, the change in number of monthly migraine days in the erenumab 70 mg and 140 mg groups during active treatment phase was ā4.2 and ā4.6, respectively, compared to study baseline; and ā1.1 and ā1.8 compared to active treatment phase baseline. Improvements were also seen in monthly acute migraine-specific medication treatment days. After 52 weeks, 61% of patients on 70 mg and 65% of patients on 140 mg achieved a ā„50% reduction in monthly migraine days; 38.5% and 40.8% achieved a ā„75% reduction; and 20% and 21% achieved 100% reduction.
Another study showed efficacy of erenumab in chronic migraine patients with medication overuse who had previously failed preventive treatment [2]. This was a post-hoc analysis for the medication overuse subgroup (n=349/667, 52.3%) of a pivotal placebo-controlled, double-blind, randomised study of erenumab in chronic migraine patients [3]. Changes in monthly migraine days were significantly greater for this group compared with placebo: -5.5 (70 mg) and -7.4 (140 mg) vs -2.9 days (P<0.001). The proportion of medication overuse patients with at least a 50% reduction in monthly migraine days was also greater for erenumab: 31.9% and 41.7% vs 15.2%.
In the 52-week, open-label extension of the same parent study [3], two-thirds of 469 patients converted and/or sustained conversion from chronic migraine to episodic migraine, with higher conversion rates at 140 mg [4]. Conversion to episodic migraine is clinically meaningful, which can be deduced by greater monthly migraine days reductions and higher ā„50% response rates. Most conversions had already taken place at 12 weeks. The overall proportion of converters was 64% at 12 weeks, and 72% at 52 weeks.
1. Chou DE, et al. AA2019, S38.005
2. Dodick D, et al. AAN 2019, S38.002.
3. Tepper S, et al. Lancet Neurol. 2017;16(6):425-34.
4. Lipton R, et al. AAN 2019, S17.008.
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Table of Contents: AAN 2019
Featured articles
Letter from the Editor
Interview with Prof. Natalia Rost
Alzheimer's Disease and other Dementias
Amyloid PET in cognitively impaired patients
Tight blood pressure control lowers risk of mild cognitive impairment
Epilepsy
Headache and Migraine
Multiple Sclerosis and NMOSD
Immune tolerance by peptide-loaded tolerogenic dendritic cells
Biotin, ocrelizumab, and ibudilast in progressive MS
No increased MS relapse risk postpartum
Neuromuscular Disorders
First-ever effective and safe treatment of CMT1A
Parkinsonās Disease and other Movement Disorders
Leukaemia and hypertension therapies tested in Parkinson’s disease
Stroke
Miscellaneous
Possibly lifesaving therapy in refractory PML
New AAN guideline for treating Tourette syndrome
Subspecialty teleneurology: feasible and highly valued
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