Dr Christine SzekelyChristine Szekely, PhD
After its FDA approval in May 2018, erenumab (Aimovig, Amgen/Novartis) has been utilized by a number of migraine specialists in real-world clinical practice, and a recent assessment of prescription trends has revealed that approximately 40% of those prescribed the therapy had a diagnosis of chronic migraine, suggesting its use has been largely in a severe patient population.

Additionally, the data revealed that the majority of the prescriptions came from neurologists at a dose of 70 mg, with infrequent alterations in dose or change to another anti-calcitonin gene-related peptide (CGRP) therapies. Most of these patients were persistent to the therapy after 3 months.

Led by Christine Szekely, PhD, epidemiologist, Amgen, the investigators presented their data in a poster at the 2019 American Headache Society Annual Meeting, July 11-14, in Philadelphia, Pennsylvania. The group sought to describe the real-world patient demographics, clinical characteristics, and patterns of treatment with erenumab, using data from the Practice Fusion ambulatory Electronic Health Record (PF EHR) database (n = 2476).

“Despite lifestyle modifications and the availability of acute and preventive pharmacotherapies, migraine remains inadequately treated in a significant number of patients,” Szekely and colleagues wrote. “Recently, a new class of migraine-specific preventive treatment became available in the US market that targets the CGRP pathway.”

Of the total cohort, 69.6% (n = 1724) of patients were initiated on the 70-mg dose, primarily by a neurologist or pain specialist (66.6%). The patients were an average of 49 years of age, and 86.3% were women. Additionally, a number of patients had common comorbidities of migraine, most notably anxiety (24.7%), depression (18.1%), hypertension (15.5%), osteoarthritis (12.0%), and epilepsy/seizure (6.3%), among others.

All told, 42.4% (n = 1050) of those prescribed the CGRP inhibitor were diagnosed with chronic migraine. Migraine Disability Assessment (MIDAS) scores were available for 6% (n = 149) of the cohort, with 49.7% (n = 74) of that subgroup reporting a score ≥21, indicating severe disability. Moderate disability was indicated by 22.1% (n = 33) of patients, while 10.7% (n = 16) and 17.4% (n = 26) indicated mild and little/no disability, respectively.

Prior to beginning treatment with erenumab, the majority of patients (72.5%; n = 1796) were prescribed or had a documented acute migraine therapy, including triptans (55.3%), nonsteroidal anti-inflammatories (NSAIDS; 24.8%), opioids (18.7%), and ergotamines (2.7%). Furthermore, 74.3% (n = 1839) of patients were prescribed treatments for migraine prevention—mostly anticonvulsants (58.4%), though anti-hypertensives, botulinum toxin, antidepressants, and others were also utilized. Of those patients, 29.9% (n = 740) had been on 1 preventive, 23.3% (n = 577) had 2, and 21.1% (n = 533) had ≥3.

“Most patients who initiated erenumab did not change their dose. However, 4.3% switched from 70 mg to 140 mg and 0.7% switched from 140 mg to 70 mg,” Szekely et al wrote, noting that 95% (n = 1293) remained on their dose. Additionally, 93.5% of those who initiated therapy with erenumab did not switch to another therapy within 3 months, though a small number—13 total—switched to another anti-CGRP medication, either fremanezumab (n = 10) or galcanezumab (n = 3).

As for persistence, 58.8% (n = 1455) of patients reached the 3-monht follow-up time point, and 84.6% of those (n = 1231) were adherent to the CGRP inhibitor 3 months post-index.

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REFERENCE
Szekely C, Fischer L, Rasmussen S, Bensink ME, Kallenbach L. Early use of erenumab in US real-world practice. Presented at: 2019 American Headache Society Annual Meeting. July 11-14, 2019; Philadelphia, PA. Poster P286LB.