Hypersensitivity to CGRP as a Predictive Biomarker for Migraine Prevention with Erenumab
ABSTRACT
Background: This study aimed to assess the predictive value of CGRP-induced migraine attacks for the effectiveness of erenumab treatment in individuals with migraine.
Methods: 139 participants with migraine underwent a 20-minute infusion with CGRP, followed by a 24-week treatment period with erenumab. The primary endpoints were the predictive value of CGRP-induced migraine attacks on the effectiveness of erenumab, defined as a ≥50% reduction in monthly migraine days or a ≥50% reduction in either monthly migraine or monthly headache days of moderate to severe intensity.
Results: Among participants with CGRP-induced migraine attacks, 60 out of 99 (61%) achieved a ≥50% reduction in monthly migraine days during weeks 13-24 with erenumab. Conversely, 13 out of 25 (52%) where CGRP infusion did not induce a migraine achieved the same endpoint (p = 0.498). There were no significant differences between the ≥50% reduction in either monthly migraine or monthly headache days of moderate to severe intensity between CGRP-sensitive and non-sensitive participants (p = 0.625).
Conclusions: The findings suggest that the CGRP-provocation model cannot be used to predict erenumab’s effectiveness. It remains uncertain whether this finding extends to other monoclonal antibodies targeting the CGRP ligand or to gepants. Trial Registration: The study was registered at ClinicalTrials.gov (NCT04592952).
PMID: 38859744 | DOI: 10.1177/03331024241258734
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