BackgroundErenumab, a fully human monoclonal antibody directed against the calcitonin gene-related peptide receptor, was approved for the prevention of episodic (EM) or chronic migraine (CM) at the monthly dose of 70 mg or 140 mg. We reviewed the available literature to understand if patients with prior preventive treatment failures benefit more from the 140 mg dose than the 70 mg.Main bodyWe searched papers indexed in PubMed and conference abstracts published in the last 2 years which assessed the safety and efficacy of erenumab in patients with prior preventive treatment failures. We reviewed the results of 3 randomized controlled trials and their subgroup analyses and open-label extensions. The 140 mg monthly dose of erenumab had a numerical advantage over the 70 mg monthly dose in patients with prior preventive treatment failures, both in EM and CM (with or without medication overuse) during the double blind phases of the trials and their open-label extensions. The numerical difference between the two doses increased with the increase in the number of prior preventive treatment failures.ConclusionsThe available data suggest that erenumab 140 mg monthly might be preferred over the 70 mg monthly dose in patients with EM or CM and prior preventive treatment failures. Further data are needed to assess the long-term efficacy in clinical practice of the two doses of erenumab, while their safety profile is comparable.

中文翻译：

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多次预防性治疗失败后，erenumab 预防偏头痛的适当剂量：一项重要评估

背景 Erenumab 是一种针对降钙素基因相关肽受体的全人源单克隆抗体，被批准用于预防发作性 (EM) 或慢性偏头痛 (CM)，每月剂量为 70 毫克或 140 毫克。我们回顾了现有文献，以了解先前预防性治疗失败的患者是否从 140 mg 剂量中受益比 70 mg 更多。主体我们检索了 PubMed 索引的论文和过去 2 年发表的会议摘要，这些论文评估了 erenumab 的安全性和有效性在先前预防性治疗失败的患者中。我们回顾了 3 项随机对照试验及其亚组分析和开放标签扩展的结果。在先前预防性治疗失败的患者中，每月 140 mg 剂量的 erenumab 比每月 70 mg 剂量具有数值优势，在试验的双盲阶段及其开放标签扩展期间，在 EM 和 CM 中（有或没有药物过度使用）。两种剂量之间的数值差异随着先前预防性治疗失败次数的增加而增加。结论现有数据表明，对于 EM 或 CM 和先前预防性治疗失败的患者，每月 140 mg erenumab 可能优于每月 70 mg 剂量。需要进一步的数据来评估两种剂量 erenumab 在临床实践中的长期疗效，同时它们的安全性具有可比性。结论 现有数据表明，对于 EM 或 CM 和既往预防性治疗失败的患者，每月 140 mg 的 erenumab 可能优于每月 70 mg 的剂量。需要进一步的数据来评估两种剂量 erenumab 在临床实践中的长期疗效，同时它们的安全性具有可比性。结论 现有数据表明，对于 EM 或 CM 和既往预防性治疗失败的患者，每月 140 mg 的 erenumab 可能优于每月 70 mg 的剂量。需要进一步的数据来评估两种剂量 erenumab 在临床实践中的长期疗效，同时它们的安全性具有可比性。