Long-term efficacy of erenumab in chronic migraine (CM) patients with or without acute medication overuse (AMO) (870)

Objective: Evaluate the long-term efficacy of erenumab in CM patients with/without AMO.

Background: Patients with CM and AMO are often difficult to treat and represent an unmet need. Erenumab, an anti-CGRP receptor monoclonal antibody for migraine prevention, has efficacy in this patient population.

Design/Methods: This is a subgroup analysis of the 52-week, open-label extension (OLE) of a double-blind study evaluating erenumab in patients with CM. In the parent study, patients received placebo, 70mg erenumab, or 140mg erenumab monthly for 3 months. Patients then received 70mg or 140mg erenumab monthly in the OLE. Change from parent study baseline in monthly migraine days (MMD) and acute migraine-specific medication use days (MSMD) during the OLE were analyzed for 52-week completers by last dose received for patients with/without AMO.

Results: 252/609 (41%) patients in the OLE had AMO at parent study baseline; 77% of AMO and non-AMO patients completed 52 weeks of treatment. For the 70mg and 140mg groups, respectively, mean (95% CI) change from baseline in MMD was −8.9 (−10.3, −7.5) and − 10.0 (−11.9, −8.0) in AMO patients and −8.2 (−9.3, −7.1) and −10.8 (−12.0, −9.6) in non-AMO patients; ≥50% reductions in MMD (95% CI) occurred in 53% (43, 63) and 61% (49, 72) of AMO patients and 53% (44, 62) and 71% (62, 79) of non-AMO patients; and mean (95% CI) change from baseline in MSMD was −7.0 (−8.1, −5.8) and −6.4 (−8.0, −4.9) in AMO patients and −3.5 (−4.3, −2.7) and −4.0 (−5.0, −3.1) in non-AMO patients. Among patients overusing simple analgesics, triptans, or combination therapy at baseline, 81% (43/53), 72% (140/195), and 70% (162/232), respectively, transitioned to non-overuse at week 52.

Conclusions: CM patients with/without AMO treated with erenumab had sustained reductions in MMD with remission of overuse in ≥70% of cases.

Disclosure: Dr. Tepper has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Consultant and/or Advisory Boards: Acorda, Alder, Alexsa, Allergan, Alphasights, Amgen, ATI, Axsome Therapeutics, Cefaly, Charleston Labs, DeepBench, Dr. Reddy’s, ElectroCore, Eli Lilly, eNeura, GLG, Guidepoint Global, Magellan Rx Management, Neurolief, N. Dr. Tepper has received personal compensation in an editorial capacity for Headache Currents, Headache, Wiley Blackwell, American Headache Society. Dr. Tepper has received research support from Alder, Allergan, Amgen, ATI, Dr. Reddy’s, ElectroCore, eNeura, Scion Neurostim, Teva, Zosano.Dr. Lipton has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Teva Pharmaceuticals. Dr. Lipton has received compensation for serving on the Board of Directors of eNeura and Biohaven. Dr. Lipton holds stock and/or stock options in Biohaven which sponsored research in which Dr. Lipton was involved as an investigator. Dr. Lipton holds stock and/or stock options in Biohaven. Dr. Lipton has received research support from Migraine Research Foundation the National Headache Foundation and Amgen.Dr. Silberstein has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Abide Therapeutics; Alder Biopharmaceuticals; Allergan, Inc.; Amgen; Avanir Pharmaceuticals, Inc.; Biohaven Pharmaceuticals; Cefaly; Curelator, Inc.; Dr. Reddy’s Laboratories; Egalet Corporation; GlaxoSmithKline Consumer Health Holdings, LLC.; eNeura Inc.; electroCore Medical, LLC; Impel NeuroPharma, Inc.; Lilly USA, LLC; Medscape, LLC; Novartis, Inc.; Satsuma Pharmaceuticals; Supernus Pharmaceuticals, Inc.; Teva Pharmaceuticals; Theranica; and Trigemina, Inc.Dr. Kudrow has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Eli Lilly, Amgen, Novartis, Alder, Biohaven, and Teva. Dr. Kudrow has received research support from Amgen, Lilly, Teva, Alder, Allergan, Biohaven, Axome, and Electrocore.Dr. Ashina has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Alder BioPharmaceuticals, Allergan, Amgen, Alder, Eli Lilly, Novartis, and Teva. Dr. Reuter has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with consulting%20fee%2C%20speaking%2Fteaching%20fee%2C%20from%20Allergan%2C%20Amgen%2C%20Autonomic%20Technologies%2C%20CoLucid%2C%20ElectroCore%2C%20EliLilly%2C%20Medscape%2C%20Novartis%2C%20StreamMedUp%2C%20%20TEVA%20Pharmaceuticals. Dr. Reuter has received research support from research%20grants%20from%20Allergan%2C%20Amgen%2C%20Autonomic%20Technologies%2C%20CoLucid%2C%20ElectroCore%2C%20EliLilly%2C%20Medscape%2C%20Novartis%2C%20StreamMedUp%2C%20%20TEVA%20Pharmaceuticals.David W. Dodick, MD, reports the following conflicts: Personal fees: AEON, Alder BioPharmaceuticals, Allergan, Amgen, Amzak Health, Association of Translational Medicine, Autonomic Technologies, Axsome, Biohaven, Charleston Laboratories, Clexio, Daniel Edelman Inc., Dr Reddy’s Laboratories/Promius, electroCore LLC, Eli Lilly, eNeura, Equinox, Foresite Capital, Impel, Ipsen, Neurolief, Nocira, Novartis, Oppenheimer, Pieris, PSL Group Services, Revance, Salvia, Satsuma, Sun Pharma (India), Supernus, Teva, Theranica, University Health Network, Upjohn (Division of Pfizer), Vedanta, WL Gore, XoC, Zosano, and ZP Opco; Speaking fees: Amgen, Eli Lilly, Lundbeck, and Novartis Canada; CME fees or royalty payments: Academy for Continued Healthcare Learning, Cambridge University Press, Catamount, Chameleon, Global Access Meetings, Global Life Sciences, Global Scientific Communications, Haymarket, HealthLogix, Medicom Worldwide, MedLogix Communications, Mednet, Miller Medical, Oxford University Press, PeerView, Universal Meeting Management, UpToDate (Elsevier), WebMD Health/Medscape, and Wolters Kluwer Health; Consulting without fee: Aural Analytics, Epien, Healint, Second Opinion/Mobile Health; Professional society fees or reimbursement for travel: American Academy of Neurology, American Brain Foundation, American Headache Society, American Migraine Foundation, Canadian Headache Society, and International Headache Society. Dr. Dodick has received compensation for serving on the Board of Directors of Epien, King-Devick Technologies, Matterhorn, Ontologics, and Precon Health. Dr. Dodick has received research support from American Migraine Foundation, Henry Jackson Foundation, PCORI, and US Department of Defense.Dr. Zhang has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Employee of Amgen Inc.. Dr. Cheng has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen. Dr. Mikol has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Employee of Amgen Inc.. Dr. Mikol has received compensation for serving on the Board of Directors of Amgen Inc.. Dr. Mikol holds stock and/or stock options in Amgen Inc..