Eptinezumab for prevention of chronic migraine: A randomized phase 2b clinical trial.

Abstract

BACKGROUND:

Calcitonin gene-related peptide plays an important role in migraine pathophysiology. We evaluated eptinezumab, an intravenous (IV) anti-calcitonin gene-related peptide monoclonal antibody, for the prevention of chronic migraine.

OBJECTIVE:

To determine the safety, tolerability, and effectiveness of four dose levels of eptinezumab and to inform the phase 3 development program.

METHODS:

This was a phase 2b, parallel-group, double-blind, randomized, placebo-controlled, dose-ranging clinical trial. Men and women (N = 616) aged 18-55 years were included if they had a diagnosis of chronic migraine, with onset at age ≤35 years and history of chronic migraine ≥1 year. During the 28-day screening period, patients must have had ≥15 headache days, including ≥8 migraine days, with ≥5 migraine attacks as recorded in the electronic diary. Patients were assigned in a 1:1:1:1:1 ratio to eptinezumab 300, 100, 30, 10 mg or placebo, administered as a single IV infusion. The primary endpoint was the percentage of patients with a ≥75% decrease in monthly migraine days over weeks 1-12 compared with the 28-day screening period.

RESULTS:

The ≥75% migraine responder rates over weeks 1-12 for eptinezumab 300, 100, 30, and 10 mg were 33.3%, 31.4%, 28.2%, and 26.8%, respectively, versus 20.7% for placebo (p = 0.033, 0.072, 0.201, 0.294 vs. placebo). Secondary efficacy endpoints (e.g. ≥50% responder rate, change from baseline in frequency of migraine/headache days, and percentage of severe migraines) had results favoring the three higher eptinezumab doses versus placebo. Eptinezumab was well tolerated and adverse event rates were similar to placebo.

CONCLUSIONS:

The results of this trial demonstrate that eptinezumab appears effective and well-tolerated for the preventive treatment of chronic migraine and justifies the conduct of pivotal phase 3 trials for migraine prevention.

TRIAL REGISTRATION:

ClinicalTrials.gov identifier: NCT02275117.

• Authors: David W Dodick, Richard B Lipton, Stephen Silberstein, Peter J Goadsby, David Biondi, Joe Hirman, Roger Cady, Jeff Smith
• Journal: Cephalalgia : an international journal of headache (Cephalalgia) Vol. 39 Issue 9 Pg. 1075-1085 (Aug 2019) ISSN: 1468-2982 [Electronic] England
• PMID: 31234642 (Publication Type: Clinical Trial, Phase II, Journal Article, Randomized Controlled Trial)

Chemical References

• Antibodies, Monoclonal, Humanized
• Calcitonin Gene-Related Peptide Receptor Antagonists
• eptinezumab

Topics

• Adolescent
• Adult
• Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects)
• Calcitonin Gene-Related Peptide Receptor Antagonists (administration & dosage, adverse effects)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Female
• Humans
• Male
• Middle Aged
• Migraine Disorders (prevention & control)
• Treatment Outcome
• Young Adult