Erenumab is a
monoclonal antibody targeting the
calcitonin gene-related peptide (
CGRP) receptor suitable for episodic and chronic
migraine prevention. Randomized clinical trials proved the superiority of
erenumab to placebo in a strictly selected population, while real-world studies confirmed treatment efficacy in more severe forms of disease - most patients suffered from chronic
migraine with
medication overuse headache, had prior treatment failures, and long disease duration. According to guidelines, anti-CGRP pathway
monoclonal antibodies should be reserved to patients who failed or have
contraindication to several classes of preventive treatments. However, their ease of use, tolerability and efficacy make these
monoclonal antibodies ideally suitable for most patients with
migraine; cost-effectiveness needs to be considered when looking at expanding current prescription criteria. Also, data from open label extensions of randomized control trials confirmed sustained benefits of prolonged treatment up to 5 consecutive years without significant risk of adverse events. Further studies will provide insights on optimal
treatment duration to achieve
migraine remission and predictors of treatment response. In the present work, we aimed at reviewing design and results of the main studies on
erenumab and discussing treatment use in the current
migraine prevention scenario; we also summarized the main ongoing research projects and provided clinical perspectives for the future.