A review of the results from the phase 3 STRIVE and ARISE trials looking at erenumab (Aimovig) as a preventive therapy for migraine, including anecdotes of personal experiences from 2 migraine experts.
The arize trial compared 70 milligrams of a rhenium ab with placebo in the preventive treatment of migraine and again of course this was drug given by injection the study shows overall that about 40% of people who got active drug and about 30% of people who got placebo had a 50% or greater reduction in monthly migraine days and that standard of a 50% reduction in
Monthly migraine days is one standard metric that’s used in trials the study also included a impact diary called the mp fed and there was improvement and functional status on a rhenium ab treated patients versus placebo treated patients now the truth is that the summary measures that emerge from trials don’t really fully reflect the benefits of drug that we see
In practice because in trials for one thing patients know they may be getting placebo and that attenuates the response rate and for another thing in practice we don’t give with sibo so the right way of measuring the benefit of drug in my opinion is not by examining improvement relative tulsi bow but rather by examining the change made in patients lives because
That better reflects the experience we may well obtain in practice so the study demonstrates that a render med is an effective preventive treatment for episodic migraine and certainly my practice experiences confirm that the so-called strive study was a phase 3 study in the in episodic migraine and preventive study patients were screened they then had a one-month
Baseline diary and six months of treatment the last three months were taken as the as the primary endpoint measurement there was a reduction in migraine days there were 50% responses for the 70 milligram 43% and for 140 milligrams 50% reduction in migraine days compared to 27% for placebo the those reductions were paralleled by reductions in migraine specific
Treatments and by improvements on disability measures that were developed for the study in strife the medicines were very well tolerated some injection site irritation a couple of percent of patients had some constipation compared to 1% on placebo and a few percent have some nasal symptomatology that’s branded as rhinitis but it’s not clear at all what that is
Overall tolerability is excellent none of the sort of problems that one sees with prevent ease we currently have them no weight gain cognitive problems no pins and pins and needles and really the the simplicity of a monthly injection so i do not use a random ab as a first-line treatment in many ways based on what we know of its efficacy and safety profile it might
Be justifiable to give it more broadly but i tend to use random ab in both episodic migraine and chronic migraine in patients who have significant levels of headache related disability and who have not responded to conventional oral therapies so at the moment there is very little pushback in terms of prescribing a rhenium ab and i tend to use it in people who’ve
Tried and failed at least two conventional oral preventive medications most often one anti epilepsy drug and one beta blocker but i’ve also used it in people who’ve tried and failed every trick i have in the book because the drug has only recently become available so i think the bottom line is that it’s a very useful drug in patients with frequent had a who have
Significant disability who have not gotten the benefits that they’re looking for from conventional oral preventives in addition on the chronic migraine side for many years on a botulinum toxin a was the only preventive fda approved for migraine so in my practice if somebody gets on about your lanham toxin a and they have a great response then they don’t i have not
Been giving them a rhenium ab but if they have a partial response so let’s say they go from 25 headache days a month to 10 headache days a month then i’ve been giving a rhenium ab on top of on about you item toxin a and have seen substantial success doing that and i’ve also in the chronic migraines said and given it to many patients who’ve failed on about you lynam
Toxin a and they’re no longer taking it because it doesn’t work of the patients that i’ve seen that have used a rhenium ab so far they’ve actually it per se it’s feeding that’s a surprisingly good i’ve been thinking about the c grp mechanism for a long time and it’s actually great to see people come back and have benefit and no downside to it be happy with their
Improvement almost have it’s a it’s an interesting interaction as a physician one almost has less to discuss because if something’s working and there’s no side effects then we can agree that we’re going to go ahead and there’s not much else to say apart from happy to see well
Transcribed from video
Practical Implications of the STRIVE and ARISE Trials By Neurology Live
