The Efficacy and Safety of Erenumab in Patients with Migraine: A Systematic Review and Meta-Analysis
Mohamed E. Haseeb1, Hazem E. Mohammed2, Hatem Yaser2, George Hanen1, Mohamed Nasser1, Shehab Yaser2, Zeyad Bady2, Mohamed Shehata3
1Faculty of Medicine, Minia University, Minia, Egypt, 2Faculty of Medicine, Assiut University, Assiut, Egypt, 3Egyptian Fellowship of Neurology, Ministry of Health, Cairo, Egypt
Objective:

This study aimed to evaluate the safety and effectiveness of Erenumab, a monoclonal antibody targeting calcitonin gene-related peptide (CGRP) receptor, in treating patients with migraines.

Background:

Migraine is a common and debilitating condition that affects approximately 14% of the global population. Preventive treatments typically include beta-blockers, antidepressants, and anticonvulsants, but these drugs often have limited effectiveness, poor tolerance, and low patient adherence. Erenumab has recently shown promise in migraine prevention.

Design/Methods:

We conducted a systematic review of six electronic databases up to July 2024. Data were analyzed using Review Manager 5.4 software, employing weighted mean difference (MD) and standard deviation (SD) for continuous data, or risk ratio (RR) for categorical data, with a 95% confidence interval (CI). Statistical significance was determined at a P-value < 0.05. This study is registered with PROSPERO (CRD42024573300). We also performed subgroup analyses and assessed the evidence quality using the GRADE system.

Results:

Twenty randomized controlled trials (n = 5212) were included. Erenumab significantly improved monthly migraine days (MMD), monthly acute migraine-specific medication days (MSMD), Headache Impact Test (HIT-6) scores, and ≥50% MMD reduction at three months. Notable outcomes included MMD (MD: -1.78, 95% CI: [-2.37 to -1.20], P<0.00001), MSMD (MD: -1.36, 95% CI: [-1.92 to -0.81], P<0.00001), and HIT-6 (MD: -2.83, 95% CI: [-3.83 to -1.82], P<0.00001). Patients who had failed previous preventive treatments responded better to Erenumab. There was no significant difference in effectiveness between episodic and chronic migraine patients. Constipation and injection-site pain were the main side effects. Evidence quality was downgraded to low due to inconsistency and potential publication bias.

Conclusions:

Erenumab significantly reduced migraine attacks and medication use, especially in patients with previous treatment failures. The 140 mg dose was more effective than 70 mg for reducing MSMD, with a safety profile similar to placebo.

10.1212/WNL.0000000000211099
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