Benefit of Migraine Prevention with Erenumab in Patients Receiving Background Standard-of-care Acute Treatment (1381)

Objective: To assess effect of erenumab (erenumab-aooe in the US) over acute migraine-specific medications (AMSMs) in patients with episodic (EM) and chronic migraine (CM). Background: Migraine prevention is underutilized. Erenumab, a human monoclonal antibody selectively targeting the canonical calcitonin gene-related peptide receptor, is approved for migraine prevention in adults. Its additional benefit in patients using AMSMs (ie, triptans) has not been established. Design/Methods: Post hoc analysis of a subgroup with ≥4 days AMSM use during the 4-week baseline period of two pivotal trials in EM (STRIVE, NCT02456740) and CM (NCT02066415) compared preventive treatment (erenumab 70 and 140 mg) plus AMSM with AMSM alone (placebo arm); all patients continued AMSM as needed. Change from baseline for MMDs, monthly AMSM days, HIT-6 and MIDAS scores (EM: averaged over months 4–6; CM: month 3) were assessed. Results: 428 EM patients (erenumab 70 mg, n=136; erenumab 140 mg n=144; AMSM alone, n=148) and 457 CM patients (n=122; n=135; n=200; respectively) were included. Erenumab 70 and 140 mg plus AMSMs significantly reduced MMDs and monthly AMSM days compared with AMSM alone in EM (difference in LSM [95% CI] MMDs: −2.1 [−2.8, −1.4], −2.9 [−3.6, −2.2], respectively; monthly AMSM days: −1.9 [−2.5, −1.3], −2.6 [−3.2, −2.0]; both P Conclusions: A post hoc analysis of AMSM users from two pivotal EM and CM trials demonstrated that preventive treatment with erenumab plus AMSM as needed significantly reduced MMDs, AMSM use, and disability (including HIT-6 and MIDAS) compared with AMSMs alone in placebo arms. These findings suggest the clinical benefit of effective prevention with erenumab over acute treatment alone in patients using AMSMs at baseline. Disclosure: Dr. Starling has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Alder, Amgen, eNeura, Eli Lilly & Company, and Novartis. 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. Bernstein has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen. Dr. Ailani has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen, Allergan, Eli Lilly and Company, Biohaven, Lundbeck, Theranica, Impel, Satsuma, Zosano, Revance,and Teva. Dr. Ailani has received personal compensation in an editorial capacity for Current Pain and Headache. Dr. Ailani has received research support from Allergan, Biohaven, Zosano, Eli Likky and Company.Dr. Zhang has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Employee of Amgen Inc.. Dr. Lima has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with former employee of Biogen. Dr. Chou has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen. Dr. Chou holds stock and/or stock options in Amgen.