Individuals with frequent and serious migraines are candidates for preventative therapies, most commonly with beta blockers (metoprolol, propanolol), antidepressants (amitriptyline, venlafaxine) and anticonvulsants (topiramate). These agents generally reduce the frequency of migraines by 50% in about half of patients.
Erenumab-aooe is a human monoclonal antibody that binds to the calcitonin gene-related peptide (CGRP) receptor and antagonizes CGRP receptor function overall reducing the inflammatory process thought to be a major component of migraines. The drug has been studied in three randomized, double-blind studies comparing erenumab to placebo. In the largest, 955 patients with an average of 8.3 migraines per month were randomized to erenumab or placebo. Does evaluated included 70mg and 140mg. The study demonstrated that patients taking the 70 mg dose had 3.2 fewer “migraine days” per month compared with 1.8 fewer days for those assigned to the placebo group. The reduction with the 140-mg dose was 3.7 days per month. The most commonly reported adverse effects were injection site reactions (5%) and constipation (3%).
The recommended dose of erenumab is 70mg subcutaneously once a month. Erenumab appears about as effective as other therapies, and lacking cardiovascular and sedative effects, may be more tolerable. However, it's cost at ~$700 a dose may preclude its widespread use and beta blockers, anitdepressants or anticonvulsants remain standard first line therapy
Additional information about migraine prophylaxis with Metoprolol, Propranolol, Amitriptyline, Venlafaxine and Topiramate can be found in the Top 300 Pharmacy Drug Cards. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to the Top 300 Pharmacy Drug Cards. If your institution does not provide access, ask your medical librarian about subscribing.
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