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CGRP inhibitor erenumab safe and effective in migraine with aura

JAMA Neurology
Reuters Health - 22/12/2021 - The calcitonin-gene-related peptide (CGRP) receptor inhibitor erenumab has similar safety and efficacy in patients with migraine with aura as in those with migraine without aura, according to an analysis of clinical-trial data.

"Efficacy of migraine preventives in aura patients is debatable," Dr. Messoud Ashina of Rigshospitalet Glostrup, in Denmark, told Reuters Health by email.

Migraine with aura is associated with an increased risk of vascular disease, he explained, and erenumab blocks the CGRP receptor, which is involved in the regulation of vascular tone. "It was unknown if coexisting migraine with aura would impact efficacy and safety of erenumab," Dr. Ashina said.

To investigate, he and his colleagues did a post hoc analysis of four clinical trials in which 2,443 patients with migraine with and without aura were treated with erenumab (70 or 140 mg day) or placebo.

In both patients with and without aura, erenumab treatment was associated with reduced migraine frequency and fewer days of acute migraine-specific medication use, with no differences in the safety profiles of patients in either group, the researchers report in JAMA Neurology.

"Our post hoc analyses showed a similar efficacy and safety profile of erenumab treatment in patients with and without history of aura," Dr. Ashina told Reuters Health.

"It's been rewarding for me as a clinician to see patients" who fail several other preventive treatments yet respond to erenumab treatment, Dr. Ashina commented in a JAMA Neurology podcast.

"Of course, not all of them are responding but the majority of the patients, I would say at least 60%, respond, which corresponds to the numbers we're seeing in the clinical trials," Dr. Ashina added.

"This is also good news because not always do the data from the clinical trials correspond to the real world and the real-world data shows, now that we have an accumulation of the data for the monoclonal antibodies including erenumab, that it works in clinical practice. So this is great news for our patients," Dr. Ashina said.

Dr. Cynthia Armand, JAMA Neurology web editor and podcast host, with Albert Einstein College of Medicine, in New York City, said the monoclonal antibodies have "certainly been a game changer. That's been my experience as well and it's great when you see that external validity and generalizability of medications coming through in real-life data."

This study was funded by Amgen. Dr. Ashina and several co-authors have disclosed financial relationships with the company.

SOURCE: https://bit.ly/3GZ2dEW JAMA Neurology, online December 20, 2021.

By Megan Brooks

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