Central effects of erenumab in migraine patients: An event-related functional imaging study.

Abstract

OBJECTIVE:

To determine whether erenumab, a new monoclonal antibody to the calcitonin gene-related peptide (CGRP) receptor, exerts functional central effects in migraineurs by performing functional imaging scans on patients treated with erenumab.

METHODS:

We conducted an fMRI study on 27 patients with migraine using a well-established trigeminal nociceptive paradigm, examining patients before and 2 weeks after administration of the CGRP receptor antibody erenumab 70 mg.

RESULTS:

Comparing both visit days in all patients (n = 27) revealed that erenumab leads to a decrease in activation in the right thalamus (i.e., contralateral to the stimulated side), right middle temporal gyrus, right lingual gyrus, left operculum, and several clusters on both sides of the cerebellum. Furthermore, when responders (n = 9) and nonresponders (n = 8) of the respective same headache state were compared, we found a significant reduction of hypothalamic activation after the administration of erenumab in responders only (t = 4.78; contrast estimate 29.79 [90% confidence interval 19.53-40.05]). This finding of reduced hypothalamic activation was confirmed when absolute headache days was used as a regressor.

INTERPRETATION:

These findings suggest that erenumab may not be an exclusively peripheral migraine treatment but has additional central effects. Whether this is due to secondary changes after peripheral modulation of sensory input or indeed represents a direct central mode of action is discussed.

• Authors: Christian Ziegeler, Jan Mehnert, Katharina Asmussen, Arne May
• Journal: Neurology (Neurology) Vol. 95 Issue 20 Pg. e2794-e2802 (11 17 2020) ISSN: 1526-632X [Electronic] United States
• PMID: 32917805 (Publication Type: Clinical Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 American Academy of Neurology.

Chemical References

• Antibodies, Monoclonal, Humanized
• Calcitonin Gene-Related Peptide Receptor Antagonists
• Receptors, Calcitonin Gene-Related Peptide
• Spin Labels
• erenumab

Topics

• Adult
• Antibodies, Monoclonal, Humanized (administration & dosage, pharmacology)
• Brain (diagnostic imaging, drug effects, physiopathology)
• Calcitonin Gene-Related Peptide Receptor Antagonists (administration & dosage, pharmacology)
• Connectome
• Female
• Follow-Up Studies
• Functional Neuroimaging
• Humans
• Hypothalamus (diagnostic imaging, drug effects, physiopathology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Migraine Disorders (diagnostic imaging, drug therapy, physiopathology)
• Nerve Net (diagnostic imaging, drug effects, physiopathology)
• Nociception (physiology)
• Outcome Assessment, Health Care
• Pain Measurement
• Physical Stimulation
• Receptors, Calcitonin Gene-Related Peptide (immunology)
• Spin Labels
• Trigeminal Nerve (physiopathology)
• Young Adult