New prophylactics for migraine targeting CGRP have emerged. Real world data are important to obtain comprehensive understanding of response. We assessed consistency of response to erenumab, a monoclonal CGRP-receptor antibody, under real world circumstances. We aimed to determine which patients may be considered responders in clinical practice.
All erenumab treated patients (n = 100) completed a time-locked daily e-diary with automated algorithm to monitor response. Monthly migraine days (MMD), non-migrainous headache days (MnmHD), days of acute medication use (MAMD), well-being and pain-coping were assessed for a six month period. Primary outcome was reduction in MMD compared to baseline.
MMD and MAMD decreased in all months, in episodic and chronic migraine patients, compared to baseline (p < 0.001), while general well-being (p < 0.001) and pain coping (p < 0.001) improved. Of all patients 36% had ≥50% MMD reduction in ≥3/6 months, 6% in all 6 months. For ≥30% MMD reduction this was 60% and 24%, respectively. Almost 90% of patients with an average MMD reduction of ≥30% over the first three months, sustained this response in the last three months. In addition, 20% of patients without an initial response (average <30%), had a delayed response (average ≥30%) in the last three months.
Erenumab was effective in migraine patients highly refractory to previous prophylactics. We propose as a practical guideline to continue treatment for at least six months and to consider patients with ≥30% MMD reduction in at least half of the treatment period to be responders.

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