Erenumab decreases migraine frequency in patients who fail preventive therapies (LIBERTY)

Reference

Reuter U, Goadsby PJ, Lanteri-Minet M, et al. Efficacy and tolerability of erenumab in patients with episodic migraine in whom two-to-four previous preventive treatments were unsuccessful: a randomised, double-blind, placebo-controlled, phase 3b study. Lancet 2018;392(10161):2280-2287.

Synopsis

These researchers, supported by the manufacturer, studied adults with frequent migraines (between 4 and 14 headache days per month) with or without aura who had no meaningful reduction in headaches with, or were intolerant to, 2 to 4 preventive treatments (eg, beta blockers, anticonvulsants, antidepressants, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and so forth). After eligibility screening, the patients kept headache diaries for 4 weeks and then entered into a 12-week double-blind period. The researchers randomized the patients to receive 2 subcutaneous injections of erenumab 70 mg/mL (total dose 140 mg; n = 121) or placebo (n = 125) every 4 weeks. At the end of 12 weeks, the rate of response, defined as a 50% reduction from the patients' own baseline monthly rate of headaches, was 30% in the patients treated with erenumab and 14% among those treated with placebo (number needed to treat = 6; 95% CI 4 - 16). The erenumab-treated patients also used fewer abortive medications. Slightly more than half of patients in each group experienced at least one adverse event, with no meaningful differences in any specific event singly (injection site pain, back pain, naspopharyngitis, dizziness, fatigues, and so forth) or in aggregate. The treatment is likely to be used for longer than 12 weeks, so the potential for unanticipated long-term harms is unaddressed. How much does it cost? The lowest GoodRx.com price is approximately $580 (that is 17% off the average retail price of $700). The manufacturer's website has a discount program in which "eligible commercial patients pay $5 per month, or if insurance is denied or requires a prior authorization, your patient gets Aimovig at no cost for up to 12 doses while coverage is pursued. Eligibility and program limits apply." Not considered as part of the eligibility for this study is riboflavin 400 mg daily. You could purchase 4 months of high-dose riboflavin (POEM 421) online at Amazon for $15.