Promising Results for Erenumab in Treating Episodic Migraine, shows APPRAISE Trial
In a novel trial, researchers have found that erenumab may be a more effective and tolerable option for
patients with episodic migraine who have not responded well to previous oral
migraine preventive medications (OMPMs). The findings, published in a recent
issue of a prestigious medical journal, shed light on the potential benefits of
early intervention with erenumab for individuals who have previously failed one
or two preventive treatments.
The trial results were published in the journal JAMA Neurology.
Individuals suffering from migraines frequently
find themselves navigating a challenging cycle of trying out various
nonspecific preventive medications. This cycle is often driven by two primary
factors: poor tolerability and inadequate efficacy. As a result, many patients
experience low adherence to their prescribed treatments, ultimately leading to
an increased burden of disease. Hence researchers
conducted a 12-month prospective, multicenter, randomized clinical trial, known
as the APPRAISE trial, involving 621 adult participants from 17 countries.
These individuals, aged 18 years or older, had a history of migraine lasting 12
months or longer and experienced between 4 and fewer than 15 monthly migraine
days (MMDs).
Patients
were randomly assigned to receive either erenumab or OMPMs, with dose
adjustments permitted according to label recommendations. The primary endpoint
of the study was the proportion of patients who completed one year of treatment
and achieved a reduction of 50% or more in MMDs compared to baseline at month
12. Additional
measures assessed in the study encompassed two secondary endpoints: the
cumulative mean change from baseline in monthly migraine days (MMDs) throughout
the treatment duration and the proportion of responders as per the Patients’
Global Impression of Change (PGIC) scale at the 12-month mark for patients
adhering to their initially assigned treatment.
Findings:
The results
of the study were striking.
Significantly
more patients treated with erenumab reached the primary endpoint compared to
those on OMPMs.
Specifically,
56.2% of patients in the erenumab group achieved the desired reduction in MMDs,
while only 16.8% of patients in the OMPM group reached the same milestone.
Furthermore,
erenumab demonstrated higher responder rates on the Patients’ Global Impression
of Change (PGIC) scale, indicating greater overall satisfaction with treatment.
In addition
to improved efficacy, erenumab also exhibited superior tolerability and
adherence compared to OMPMs.
The study findings revealed a noteworthy
reduction in the cumulative average monthly migraine days (MMDs) among patients
receiving erenumab compared to those treated with nonspecific oral migraine
preventive medications (OMPMs).
Fewer
patients in the erenumab group switched medications or discontinued treatment
due to adverse events, highlighting the potential for better patient outcomes
with this specific preventive medication.
The study’s
implications extend beyond clinical practice, offering hope to millions of
individuals worldwide who suffer from episodic migraine.
By identifying a
specific medication that demonstrates superior efficacy, tolerability, and
adherence, researchers have paved the way for more targeted and personalized
treatment approaches in the management of this debilitating condition. As further
research continues to unfold, the potential for erenumab to revolutionize the
treatment landscape for episodic migraine appears increasingly promising. With
continued advancements in medical science, individuals affected by this
condition can look forward to a future marked by improved symptom management
and enhanced quality of life.
Further reading: Pozo-Rosich P, Dolezil D, Paemeleire K, et al. Early Use of Erenumab vs Nonspecific Oral Migraine Preventives: The APPRAISE Randomized Clinical Trial. JAMA Neurol. Published online March 25, 2024. doi:10.1001/jamaneurol.2024.0368.
