Introduction

Erenumab (trade name: Aimovig) has been approved in Germany since July 2018 for the prevention of migraine. It is an option for adults who have migraine attacks on at least four days a month.

Migraine attacks start suddenly with severe pain on one side of your head. They are much worse than normal headaches and are described as throbbing or pounding. Migraine attacks are usually accompanied by additional symptoms such as nausea, vomiting or sensitivity to light and noise. Left untreated, the symptoms last between four hours and three days. Migraine can greatly affect everyday life.

Erenumab is an antibody. It inhibits the effect of a certain protein (calcitonin gene-related peptide, CGRP) that plays a role in triggering migraine attacks. This aims to prevent attacks.

Application

Erenumab is injected into the skin (subcutaneously) every four weeks. The dose is 70 mg. In certain cases this can be increased to 140 mg. If the symptoms haven’t improved after three months, the doctor and patient should consider stopping the treatment.

Other treatments

For patients who haven't had treatment before or who didn't tolerate or didn't benefit enough from preventive treatment, the treatment options include the drugs metoprolol, propranolol, flunarizine, topiramate and amitriptyline – depending on which drug was used before. If these drugs aren't effective either or can't be used, further options are valproic acid or, for certain patients, clostridium botulinum toxin type A. If none of the preventive treatments is suitable, best supportive care (BSC) is an option. This treatment should be tailored to the patient's individual needs, with the aim of relieving symptoms and improving quality of life.

Assessment

In 2019, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of erenumab compared with the standard treatments for people with migraine.

The manufacturer provided one study involving people who had tried at least 2 treatments without success and who had migraine attacks on four to fourteen days a month. The data of 193 people could be used in the analysis. 88 people had treatment with erenumab for 3 months, while the other 105 patients received a placebo (fake medication). Both groups also received best supportive care. The following results were found after three months:

What are the advantages of erenumab?

  • Migraine days per month: Early results suggest that erenumab has an advantage here. After starting treatment with erenumab, the number of migraine days decreased by half or more in about 30 out of 100 people. With the placebo, only about 14 out of 100 people experienced the same improvement.
  • Limitations due to headaches: The results suggest that erenumab has an advantage here. 51 out of 100 people who received erenumab felt less limited by the headaches in their everyday life, compared to only about 27 out of 100 people who received a placebo.
  • People who received erenumab also felt they had fewer activity limitations in general.

What are the disadvantages of erenumab?

Erenumab wasn’t found to have any disadvantages compared with the placebo.

No differences

  • Physical functioning and work productivity: There was no significant difference between erenumab and the placebo here.
  • Severe side effects and stopping treatment due to side effects: There was no difference here. Severe side effects occurred in only a few rare cases in both groups.
  • General health: There was no noticeable difference between erenumab and the placebo here either.

What remains unanswered?

Health-related quality of life: The manufacturer didn’t provide any data on this matter.

More information

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of erenumab (Aimovig).

Labels: Aimovig, Erenumab, G43