Dr Stephen Silberstein Compares the Effects of Erenumab on Chronic, Episodic Migraine

October 7, 2020

Because patients with chronic migraine experience more monthly migraine days (MMD) than those with episodic migraine, chronic migraineurs will experience a greater reduction of MMD with erenumab, said Stephen Silberstein, MD, professor of neurology at Thomas Jefferson University and director of the Headache Center at Jefferson Health.

Because patients with chronic migraine experience more monthly migraine days (MMD) than those with episodic migraine, chronic migraineurs will experience a greater reduction of MMD with erenumab, said Stephen Silberstein, MD, professor of neurology at Thomas Jefferson University and director of the Headache Center at Jefferson Health.

Transcript:

The American Journal of Managed Care® (AJMC®): How do the results of the 5-year study on the safety and efficacy of erenumab compare to those published after 3 years?

Dr. Silberstein: Basically speaking, this is an extension. Basically, there's no change. What do I mean by that? No safety signals. The patients continue to do well, they're happy with the drug. If they drop out, it's because they're doing well and they don't want to change the dosage. No surprises, and they've done well.

AJMC®: A similar study analyzed the safety and efficacy of erenumab over 1 year in patients with chronic migraine. Do the new results suggest the treatment is more beneficial in episodic migraineurs as opposed to chronic migraineurs?

Dr. Silberstein: Here's the point. If you look at reduction in migraine days, you're going to find a greater reduction in chronic migraine compared to episodic migraine. Patients with chronic migraine have headaches 20-some days of the month. Patients will episodic migraine have less than 10. What we're really going to see is the fact that the reduction in headache days is going to be greater in the chronic than the episodic. But if we look at 50% reduction, it's pretty similar.

AJMC®: What accounts for the differences in response that were observed over the 5-year study?

Dr. Silberstein: With the passage of time with most treatments, patients tend to do better. We observed this just in patients in our office we started on an antibody and with the passage of time they get better. I think what happens is the excited nervous system tends to quiet down and as we say pain begets pain. Lack of pain begets lack of pain.