The Optimum Dose of Erenumab to Improve Quality of Life in Patients with Episodic Migraines: A Systematic Review, Meta-analysis and Network Meta-analysis.
Julio Furlan1, Alexander Gasser2, Nicholas Sequeira2, Mohammad Alavinia3
1KITE Research Institute and Toronto Rehabilitation Institute, University Health Network; University of Toronto, 2University of Toronto, 3KITE Research Institute, University Health Network
Objective:
This study examined the optimum dose of erenumab in the management of patients with episodic migraines in order to improve their quality of life.
Background:
Erenumab has previously been shown to reduce monthly migraine days and monthly acute migraine-specific medications days. However, an individual’s quality of life, often measured by patient-reported outcomes (PROs), has not been comprehensively elucidated.
Design/Methods:
This systematic review followed by a meta-analysis and network-meta-analysis was conducted according to the recommendations from the PRISMA statement (PROSPERO: CRD42023387753). The literature search strategy was performed through MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials on November 29, 2023. The Headache Impact Test (HIT-6) was the most commonly used instrument for measuring quality-of-life in patients with headaches among the published papers. A minimally clinically important difference of 5 points in the HIT-6 was used to determine significantly improved outcome in the network meta-analysis.
Results:
We captured six publications on clinical trials that included the Headache Impact Test (HIT-6). Different doses of erenumab (7mg, 28mg, 70mg and 140mg) were compared against all doses and with placebo at 12 weeks and/or 4-6 months in those six studies. However, erenumab 70mg and 140mg were the most commonly investigated doses among those clinical trials. Overall, there was no statistical difference between erenumab at 70mg and 140mg regarding the primary outcome measure (i.e. change in monthly migraine days) for the same time points. The results of our network meta-analysis suggested that only erenumab at 140mg significantly improved quality of life as assessed using HIT-6 compared to erenumab 70mg and placebo.
Conclusions:
The results of our network meta-analysis suggest that, while erenumab either at 70mg or 140mg similarly decrease the monthly migraine days, only erenumab at 140mg significantly improved quality of life as assessed using HIT-6 when compared with erenumab 70mg and placebo.
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