Different dosage regimens of erenumab for the treatment of migraine: A systematic review and meta-analysis of the efficacy and safety of randomized controlled trials

Background Migraine is a worldwide epidemic neurological disorder that has a significant influence on the quality of life. Migraine attacks are considered to be related to a calcitonin gene-related peptide (CGRP) signaling molecule, and anti-CGRP medications are used to abort and prevent migraine attacks. Erenumab, a monoclonal antibody that targets the CGRP receptor, is the first migraine preventive medication approved by the US Food and Drug Administration. In the present study, we evaluate the efficacy and safety of erenumab. Objective This study aims to systematically assess the efficacy and safety of erenumab as a migraine preventive treatment compared to a placebo. Methods Randomized, placebo-controlled, single or double-blind trials were searched through MEDLINE, Embase, Cochrane Library, and up to May 2022. The efficacy outcomes we collected include changes from baseline on monthly migraine days, monthly acute migraine-specific medication days, >= 50% responder rate, >= 75% responder rate, and 100% responder rate at week 12. Safety outcomes include treatment emergent adverse events, serious adverse events, and any adverse event that leads to discontinuation of treatment. The study was registered with PROSPERO (Registry number: CRD42022338861). Result In all eight included trials, we found that erenumab (28, 70, and 140 mg) is very effective and has a significantly greater reduction in baseline monthly migraine days (28 mg: mean difference [MD] = -1.1, 95% confidence interval [CI]: -2.0 to -0.2, p = 0.020; 70 mg: MD = -1.4, 95% CI: -1.8 to -1.1, p < 0.001, I-2 = 26%; 140 mg: MD = -1.8, 95% CI: -2.1 to -1.4, p < 0.001, I-2 = 0%) than placebo at week 12, especially with 140 mg. Otherwise, we found that there were no statistical differences in the occurrence of adverse events (7 mg: risk ratio [RR] = 0.9, 95% CI: 0.7 to 1.2, p = 0.570; 21 mg: RR = 1.0, 95% CI: 0.8 to 1.2, p = 0.730; 28 mg: RR = 0.9, 95% CI: 0.7 to 1.1, p = 0.340; 70 mg: RR = 1.0, 95% CI: 0.9 to 1.0, p = 0.230, I-2 = 0%; 140 mg: RR = 1.0, 95% CI: 0.9 to 1.1, p = 0.880, I-2 = 40%) between the erenumab and placebo groups. Conclusions In our study, we found that erenumab, especially at the dose of 140 mg, is an effective and well-tolerated preventive treatment for migraine.