Assessing Blood Pressure Changes and Hypertension-Related Outcomes in Patients with Migraine Treated with Erenumab: a Systematic Review and Single-Arm Meta-Analysis
Luana Makita1, Henrique Alexsander Neves1, Angela Maria Sandini Corso1, Vinicius Alves1, Giovana Kojima1, Rafael Kleimmann1, Rafael Oliveira2, Aishwarya Koppanatham3, Pedro Kowacs4, Elcio Piovesan5
1Complex of the Clinical Hospital of the Federal University of Parana, Curitiba, Brazil, 2Complex of the Hospital João de Barros Barreto of the Federal University of Pará, Belém, Brazil, 3Andhra Medical College, Visakhapatnam, India, 4Neurology Department, Institute of Neurology of Curitiba, Curitiba, Brazil; Neurology Division, Clinical Hospital Complex of the Federal University of Paraná, Curitiba, Brazil, 5Neurology Service, Department of Clinical Medicine, Complex of the Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
Objective:
We performed a systematic review and meta-analysis to evaluate the effect of erenumab on systemic blood pressure (BP) in patients with migraine.
Background:
The US Prescribing Information for erenumab was updated to include the potential risk of hypertension, although randomized trials did not link it previously. The association of this monoclonal antibody with an elevated BP remains uncertain.
Design/Methods:
Embase, PubMed, and the Cochrane were searched up to June 18 for studies examining the impact of erenumab on BP in migraineurs. I2 statistics and prediction intervals (PI) assessed heterogeneity, and sensitivity and subgroup analysis were used to explore it. Data was collected using mean difference (MD) or proportion of events. The quality of the studies was assessed with the Cochrane Risk of Bias tool. Generative AI was used only to enhance scientific writing clarity, with authors critically evaluating accuracy after each intervention.
Results:
Ten papers were included, comprising 3.449 participants, of whom 3.218 received erenumab. Systolic (MD 0.86; P>0.05; I2 = 63%; 95%CI [-1.02, 2.73]) and diastolic (MD 1.33; P>0.05; I2 = 69%; 95%CI [-0.05, 2.72]) BP measures did not significantly differ between post- and pre-erenumab treatment. This lack persisted at 3 and 12 months. The leave-one-out technique did not change heterogeneity. The proportion of participants presenting a worsening on BP appears to be 21.9% (PI 0.93, 89.37), with 56.1% (PI 0.60, 76.54) comprising non-hypertensive individuals at baseline. The incidence of patients starting antihypertensive medications during the study was 3.7% (PI 0.04, 79.52), with 62.9% (PI 0.03, 65.42) being non-hypertensive before erenumab treatment.
Conclusions:
We did not find an association of erenumab with an increased BP. However, there is considerable uncertainty in the current evidence. The decision to prescribe erenumab, especially for patients with multiple comorbidities, must be made weighing up risks and benefits. Further studies are needed to confirm the findings.
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