Date of Award

2023

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine “Does erenumab reduce monthly migraine frequency from baseline in adults with episodic migraines?”

STUDY DESIGN: An EBM review of three double blind, RCTs (randomized control trials) that were published in peer reviewed journals.

DATA SOURCE: The three studies were found on PubMed, published after 2011, and chosen based upon the ability to answer the patient-oriented outcome and objective.

OUTCOMES: All studies used the same criteria from the self- reported diaries: “Migraine days were defined as the onset, continuation, or recurrence of a qualified migraine headache for at least 30 minutes with either ≥2 pain features or ≥1 non-pain symptom or the use of an acute migraine medication”. The pain features included unilateral, throbbing, moderate to severe, or exacerbated with physical activity. The non-pain symptoms included nausea/vomiting, or photophobia/ phonophobia. The primary outcome was a reduction from baseline in monthly migraine days, with secondary outcomes of ≥50% reduction from baseline for patients.

RESULTS: Three studies concluded that erenumab is effective at reducing monthly migraine days, with a significant number of patients having ≥50% reduction from baseline per month. Dodick et al. had an odds ratio of 1.59 (95% CI, 1.12 to 2.27), a p-value of 0.010 when compared to the placebo, with a NNT of 10. Sakia et al. had an odds ratio of 5.60 (95% CI, 2.60 to 12.6) with a p-value for erenumab compared to the placebo of <.001. The NNT was 5. Wang et al. had a calculated NNT of 10, an odds ratio of 1.5 (95% CI, 1.1 to 2.1) and a p-value=0.007 for erenumab compared to the placebo.

CONCLUSIONS: All studies concluded that erenumab is effective at reducing monthly migraine days, with a statically significant number of subjects achieving a ≥50% reduction from baseline. Recently, erenumab was found to be superior to topiramate at reducing migraines. Additionally, the 3-year safety data and efficacy of erenumab did not demonstrate additional concerns. Further research is needed to compare erenumab with monthly injectables like Emgality® instead of daily pills.

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