New monoclonal antibody shows efficacy in chronic migraine patients with medication overuse

A new human antibody may soon become available as a specific medication for preventing frequent migraine attacks. As confirmed by an international team of researchers at the 3rd European Academy of Neurology Congress, there is a way to reduce the number of days that patients with medication overuse suffer from migraine headaches, as well as the quantity of medication for the treatment of acute migraine attacks they take.

Used as a prophylaxis, a new monoclonal antibody helps even the most severely-hit of those migraine patients who overuse medication for the treatments of acute migraine attacks. People who suffer from chronic migraine are largely at the mercy of this debilitating condition. Until now, only topiramate and Botulinum toxin A are approved to treat patients with chronic migraine and medication overuse.

Neurologists and other pain specialists have been following the development of erenumab, an antibody which has already delivered promising results in frequent episodic migraine, with great interest. This fully human monoclonal antibody blocks the calcitonin gene-related peptide (CGRP) receptor, which is suspected of being involved in the transmission of pain-inducing migraine signals. In a phase II trial conducted last year, a group of patients with chronic migraine with an average of 18 migraine days per month showed significantly reduced monthly migraine days by an average of 6.6 days from baseline - significantly greater than the reduction of 4.2 days in the placebo group. Erenumab's efficacy was confirmed in the results of two phase III trials.

In Amsterdam an international research team presented an interesting sub-analysis of the phase II clinical trial. Based in Denmark, Germany and the USA, the neurologists looked at whether the antibody showed efficacy in chronic migraine patients with medication overuse, i.e. patients who exceeded the tolerated dose of medication to combat acute migraine attacks. The participants were stratified by baseline medication overuse and divided into three groups: the first group received a placebo, the second were given 70 mg of erenumab, and the third received 140 mg. On average, participants suffered migraine attacks on 18.8-19.6 days per month.

"Our analysis shows that erenumab reduces the number of migraine days in patients with medication overuse just as efficiently as in the group as a whole," confirmed Prof Hans-Christoph Diener from the University of Duisburg-Essen's Faculty of Medicine. Irrespective of the dose, patients given erenumab had 6.6 more pain-free days a month on average, in contrast with a reduction in the number of migraine days for the placebo group of 3.5 days. While the frequency of attacks in the erenumab groups dropped by half or more for over a third of participants (35 and 36 per cent, respectively), the same was true for less than a fifth (18 per cent) of those in the placebo group. A comparison of the amount of medication used revealed a similarly striking pattern: patients with erenumab were able to forego additional migraine medication on 5.4 and 4.9 more days, while the patients in the placebo group managed to go without on just 2.1 additional days.