Erenumab effective for nonopioid medication overuse headache in chronic migraine

Monthly use of erenumab injections (140 mg) is safe and effective in achieving medication overuse headache (MOH) remission in patients with nonopioid chronic migraine (CM) and MOH, according to a study published online Sept. 16 in JAMA Neurology.

Stewart J. Tepper, M.D., from the New England Institute for Neurology and Headache in Stamford, Connecticut, and colleagues assessed the safety and efficacy of erenumab in patients with nonopioid CM-MOH. The analysis included 584 participants randomly assigned to erenumab (70 mg or 140 mg) or placebo, once monthly for 24 weeks.

The researchers found that at month 6, 69.1% of participants in the erenumab 140-mg group (odds ratio, 2.01; 95% confidence interval, 1.33 to 3.05; P < 0.001 versus placebo) and 60.3% in the erenumab 70-mg group (odds ratio, 1.37; 95% confidence interval, 0.92 to 2.05; P = 0.13 versus placebo) achieved MOH remission versus 52.6% of participants in the placebo group.

From baseline, least squares mean change in average monthly acute headache medication days was –9.4 days in the erenumab 140-mg group (difference from placebo, –2.7) and –7.8 days in the erenumab 70-mg group (difference from placebo, –1.2). Throughout the treatment period, MOH remission was sustained in 61.3% of participants in the erenumab 140-mg group, 49.5% of participants in the 70-mg group, and 37.6% in the placebo group.

The safety profile was similar to that seen in previous trials, with treatment-emergent adverse event incidence in the combined erenumab group of 66.8%, including most commonly constipation (15.2%) and COVID-19 (13.9%).

“This study is the first controlled trial to provide American Academy of Neurology class I evidence of beneficial effects of a migraine preventive treatment in patients with CM-MOH (nonopioid),” the authors write.

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