Amgen has announced detailed global Phase 2 results showing erenumab demonstrated a statistically significant reduction in monthly migraine days compared with placebo in patients with chronic migraine. The data will be presented in posters #P057 and #P058 at the 5th European Headache and Migraine Trust International Congress (EHMTIC) in Glasgow, Scotland.
"Chronic migraine patients lose more than half of their life to migraines with 15 or more headache days a month, facing intolerable pain and physical impairment," said Stewart Tepper, M.D., professor of neurology at the Geisel School of Medicine at Dartmouth. "As a neurologist, these findings are exciting because they demonstrate that erenumab could serve as an important new therapy option for reducing the burden of this often-disabling disease."
The study included 667 patients (mean age 42.1, 79.0 percent female) who were randomized to receive either subcutaneous placebo (n=286) or subcutaneous erenumab 70 mg (n=191) or 140 mg (n=190) once a month. Patients had a mean baseline of 18.0 migraine days per month and a mean baseline of 21.1 headache days per month. Patients randomized to both erenumab dose groups experienced a statistically significant 6.6-day reduction from baseline in mean monthly migraine days compared with 4.2 days observed in the placebo group (p<0.001). All endpoint assessments compared the last four weeks of the 12-week treatment phase to baseline.
A reduction of 50 percent or more in number of monthly migraine days was observed in 40 percent and 41 percent (70 mg and 140 mg doses, respectively) of individuals in the erenumab groups at week 12, representing a significantly higher likelihood of response compared to 24 percent of those receiving placebo (both p<0.001). Reductions in monthly acute migraine-specific medication days were 3.5 days and 4.1 days in the 70 mg and 140 mg groups, respectively, representing significant improvements from baseline compared to a 1.6-day reduction in those receiving placebo (both doses p<0.001 versus baseline).
All groups showed numeric improvements in cumulative monthly headache hours. Compared to a 55.2-hour reduction versus baseline in the placebo group, reductions were 64.8 hours for 70 mg erenumab and 74.5 hours for 140 mg erenumab.
In an analysis of exploratory endpoints, both doses of erenumab were associated with significant improvements in health-related quality of life, headache impact, disability, and level of pain interference, compared to placebo.*
"Erenumab is specifically designed to prevent migraine by blocking a receptor that is believed to have a critical role in mediating the incapacitating pain of migraine," said Sean E. Harper, M.D., executive vice president of Research and Development at Amgen. "The results from this global chronic migraine study are exciting because they support the efficacy of erenumab for a patient population that has had few therapeutic options. We look forward to advancing erenumab to help provide a potential new treatment option for patients with this debilitating disease."
The safety profile of erenumab was similar to placebo across both treatment arms. No adverse event was reported in greater than five percent of patients treated with erenumab. The most common adverse events (in placebo, 70 mg erenumab, 140 mg erenumab groups, respectively) were injection site pain (1.1 percent, 3.7 percent, 3.7 percent), upper respiratory tract infection (1.4 percent, 2.6 percent, 3.2 percent) and nausea (2.5 percent, 2.1 percent, 3.2 percent).
The World Health Organization ranks migraine as one of the most debilitating of all illnesses.1,2 Chronic migraine is the most disabling form of the disease, and is associated with personal and societal burdens of pain, disability and financial cost.3
Results from Phase 3 studies investigating erenumab in episodic migraine are expected later this year. Erenumab is being co-developed by Amgen and Novartis. As part of the collaboration, Amgen retains commercialization rights in the U.S., Canada and Japan, and Novartis holds rights in Europe and rest of world.
*Assessment tools for exploratory endpoints including the Headache Impact Test (HIT-6™), the Migraine Disability Assessment (MIDAS), the Migraine-Specific Quality-of-Life Questionnaire (MSQ), and the Patient Reported Outcome Measurement Information System (PROMIS®). Pain Interference Scale Short Form. Exploratory endpoints were not adjusted for multiplicity.
About the 20120295 Study
The 20120295 study is a global Phase 2, randomized, 12-week, double-blind, placebo-controlled study evaluating the safety and efficacy of erenumab in chronic migraine prevention. In the study, 667 patients were randomized to receive once-monthly subcutaneous placebo or erenumab (70 mg or 140 mg) in a 3:2:2 ratio, respectively. The primary endpoint was change in monthly migraine days from baseline to the last four weeks of the 12-week treatment phase in patients with chronic migraine (the number of migraine days between weeks nine and 12). Secondary study endpoints included reduction of at least 50 percent from baseline in monthly migraine days, change from baseline in monthly acute migraine-specific medication days and change from baseline in cumulative monthly headache hours.
Erenumab is a fully human monoclonal antibody specifically designed for the prevention of migraine. Erenumab targets and blocks the Calcitonin-Gene-Related-Peptide (CGRP) receptor, thought to be pivotal in the genesis of migraine. Erenumab is currently being studied in several large global, randomized, double-blind, placebo-controlled trials to assess its safety and efficacy in migraine prevention.