Focus of the Report: This Health Technology Assessment focuses on the efficacy and safety of a monoclonal antibody, erenumab (Aimovig), for prevention of episodic or chronic migraine.

Technology Description: Erenumab is a human calcitonin gene–related peptide (CGRP) receptor monoclonal antibody that is produced using recombinant DNA technology in cell culture. CGRP binds to a receptor found in cerebrovascular smooth muscle cell membranes, causing vasodilation of blood vessels. CGRP is involved with the pathogenesis of migraine, presumably through its vasodilatory effect. Erenumab is a CGRP receptor antagonist, which prevents binding of CGRP to the receptor.

Controversy: Most current drugs used for migraine prevention were originally designed for other indications and many have drug interactions and side effects with prolonged use. In addition, available therapies are not effective in all patients, prompting the need for new migraine treatments. Erenumab is a first-in-class migraine preventive medication that may have a more favorable safety and tolerability profile than the available alternatives.

Key Questions:

  • Is erenumab effective in preventing episodic or chronic migraine?

  • How does erenumab compare with other migraine prevention medications?

  • Is erenumab safe?

  • Have definitive patient selection criteria been identified for erenumab?

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