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Erenumab – Uses, Dosage & Side Effects

Erenumab is a monoclonal antibody used for the preventive treatment of migraine in adults. It blocks the CGRP receptor, reducing the frequency and severity of migraine attacks.

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Things worth knowing about "Erenumab"

Erenumab is a monoclonal antibody used for the preventive treatment of migraine in adults. It blocks the CGRP receptor, reducing the frequency and severity of migraine attacks.

What is Erenumab?

Erenumab is a monoclonal antibody approved for the preventive (prophylactic) treatment of migraine in adults. It is a biologic medication that specifically targets a key mechanism involved in triggering migraine attacks. Erenumab is marketed under the brand name Aimovig and is approved by the European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA).

Mechanism of Action

Erenumab works by binding specifically to the CGRP receptor (Calcitonin Gene-Related Peptide receptor). CGRP is a neuropeptide that plays a critical role in the pathophysiology of migraine: it is released in elevated concentrations during a migraine attack and causes dilation of blood vessels and neurogenic inflammation around the meninges, resulting in pain. By blocking the CGRP receptor, erenumab prevents CGRP from binding and exerting its pain-promoting effects, thereby reducing the frequency and intensity of migraine attacks.

Indications

Erenumab is approved for the prophylaxis of migraine in adults who experience at least 4 migraine days per month. It is used in:

Episodic migraine (up to 14 migraine days per month)
Chronic migraine (15 or more headache days per month, of which at least 8 have migraine characteristics)

Erenumab is not intended for the acute treatment of migraine attacks; it is used exclusively for prevention.

Dosage and Administration

Erenumab is administered as a subcutaneous injection (under the skin) once monthly. The recommended starting dose is 70 mg per month. For patients who do not achieve sufficient response, the dose may be increased to 140 mg per month. After appropriate training by a healthcare professional, the injection can be self-administered by the patient or given by a caregiver.

Side Effects

Erenumab is generally well tolerated. The most common side effects include:

Injection site reactions (redness, swelling, pain)
Constipation, occasionally severe
Muscle cramps
Nausea
Itching (pruritus)

In rare cases, allergic reactions may occur. Patients with known hypersensitivity to the active substance or any of the excipients should not use erenumab.

Contraindications and Special Considerations

Erenumab is not recommended during pregnancy or breastfeeding, as adequate safety data in humans are not yet available. Women of childbearing potential should use reliable contraception during treatment. Caution is advised in patients with severe renal or hepatic impairment. Concurrent medications should always be discussed with a healthcare provider to rule out interactions.

Clinical Efficacy

Multiple large Phase III clinical trials have demonstrated that erenumab significantly reduces the number of monthly migraine days compared to placebo. In episodic migraine, an average reduction of 3 to 4 days per month was observed; in chronic migraine, reductions of up to 6 days per month were reported. Approximately 40 to 50% of patients achieved at least a 50% reduction in monthly migraine days.

References

European Medicines Agency (EMA): Aimovig (Erenumab) – Summary of Product Characteristics and Assessment Report. EMA, 2018. https://www.ema.europa.eu/en/medicines/human/EPAR/aimovig
Goadsby PJ, Reuter U, Hallström Y et al.: A Controlled Trial of Erenumab for Episodic Migraine. New England Journal of Medicine, 2017; 377(22): 2123–2132.
U.S. Food and Drug Administration (FDA): Aimovig (Erenumab-aooe) – Prescribing Information. FDA, 2018. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=761077

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