Erenumab superior to topiramate for migraine treatment

In the direct head-to-head HER-MES study, in patients with episodic and chronic migraine, erenumab showed significantly better tolerability and efficacy versus topiramate. Fewer patients discontinued erenumab during the 24-week treatment phase, and a greater proportion achieved ≥50% reduction in monthly migraine days.

Erenumab is a CGRP receptor blocker, while the anticonvulsant topiramate is one of the most commonly prescribed prophylactic migraine drugs. For the first time, erenumab was directly compared with topiramate in a randomised, double-blind, double-dummy study [1]. The HER-MES study (NCT03828539) comprised a 24-week double-blind treatment period in which patients were randomised to either 70 mg or 140 mg subcutaneous erenumab (investigator's choice) and an oral placebo; or to the maximally tolerated dose of oral topiramate (50–100 mg daily) and a subcutaneous placebo. The primary endpoint was treatment discontinuation due to adverse events (AEs). The secondary endpoint was achieving a ≥50% reduction from baseline monthly migraine days (MMDs) over months 4, 5, and 6. The study enrolled 777 adult patients with ≥4 MMDs who were naïve to, were unsuitable for, or had previously failed ≤3 prophylactic migraine treatments. Participants had a mean age of 41 years; about 86% were women.

Both primary endpoints were met, showing significant differences in favour of erenumab compared with topiramate. During the double-blind period, 10.6% of patients in the erenumab group versus 38.9% in the topiramate group discontinued medication due to AEs (OR 0.19; P<0.001). The total number of study treatment-related AEs was 215 (55.4%) versus 315 (81.2%); the number of patients experiencing a serious AE was 1 and 2, respectively. The safety profile in the HER-MES study was generally consistent with that observed in previous clinical erenumab trials. Erenumab was also significantly more efficacious in terms of MMDs. In the erenumab and active control group, 55.4% and 31.2% of patients experienced a ≥50% reduction of MMD (OR 2.76; P<0.001).

1. Reuter U, et al. Erenumab versus topiramate for the prevention of migraine: Results of a randomised, active controlled double-dummy trial (HER-MES). OPR-200, EAN 2021 Virtual Congress, 19–22 June.

 

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Posted on 18 August 20211 February 2024