Erenumab

Introduction to Erenumab

Erenumab (brand name: Aimovig) is a fully human monoclonal antibody that belongs to the class of calcitonin gene-related peptide (CGRP) receptor antagonists. It was approved by the FDA in 2018 for the preventive treatment of migraine in adults. Erenumab represents a significant advance in migraine therapy, offering a targeted approach to migraine prevention.

Mechanism of Action

Erenumab works by:

  • Selectively binding to the CGRP receptor
  • Blocking the biological activity of CGRP, a neuropeptide involved in migraine pathophysiology
  • Inhibiting CGRP-mediated vasodilation and neurogenic inflammation
  • Preventing CGRP-induced sensitization of trigeminal neurons
This mechanism effectively disrupts the migraine cascade, reducing the frequency and severity of migraine attacks.

Indications

Erenumab is primarily indicated for:

  • Preventive treatment of migraine in adults
  • Both episodic and chronic migraine
It is particularly beneficial for patients who have failed or are intolerant to other preventive treatments.

Dosage and Administration

  • Available in pre-filled autoinjector pens
  • Recommended dosage: 70 mg once monthly; some patients may benefit from 140 mg once monthly
  • Administered subcutaneously
  • Can be self-administered by patients after proper training
  • No dose adjustment required for renal or hepatic impairment

Efficacy

Clinical trials have demonstrated significant efficacy:

  • Reduction in monthly migraine days by 3-4 days compared to placebo
  • 50% or greater reduction in monthly migraine days in about 40-50% of patients
  • Improvement in quality of life and disability scores
  • Onset of efficacy observed as early as the first month of treatment
  • Sustained efficacy demonstrated in long-term studies (up to 5 years)

Safety and Adverse Effects

Erenumab is generally well-tolerated. Common adverse effects include:

  • Injection site reactions (pain, erythema, pruritus)
  • Constipation
  • Muscle spasms
  • Mild to moderate upper respiratory tract infections
Rare but serious adverse effects may include:
  • Hypersensitivity reactions
  • Hypertension
  • Cardiovascular effects (theoretical risk based on CGRP's vasodilatory properties)
Long-term safety data is still being collected.

Pediatric Considerations

While Erenumab is not currently approved for use in pediatric populations:

  • Clinical trials in adolescents (12-17 years) are ongoing
  • Preliminary data suggests a similar safety profile to adults
  • Efficacy in pediatric populations is still being evaluated
  • Off-label use in refractory cases has been reported in literature, but more research is needed
  • Pediatricians should closely monitor ongoing research and guidelines for potential future use in pediatric migraine prevention



Further Reading
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