Intravenous eptinezumab associated with a more rapid onset and prolongation of symptom relief from acute migraine versus placebo

1. Intravenous eptinezumab-treated participants achieved significantly earlier freedom from headaches and from their most bothersome symptoms compared to placebo in those suffering from an acute migraine attack.

2. No serious adverse events occurred in eptinezumab-treated or placebo-treated participants.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Patients who suffer from multiple migraines every month may require preventive migraine medication rather than acute rescue medication for symptom relief. Evidence suggests that many individuals overuse acute medication while waiting for preventive treatment to take effect. Eptinezumab is an anti-calcitonin gene-related peptide antibody indicated for preventive migraine treatment; however, its ability to provide a quick onset of symptom relief is unknown. The RELIEF randomized, controlled trial investigated the efficacy and safety of administering intravenous (IV) eptinezumab during an acute migraine attack in patients eligible for preventive migraine therapy (suffer from 4-15 migraines per month). Eptinezumab-treated participants achieved significantly decreased time to headache pain freedom and time to absence of the most bothersome symptom compared to placebo. Furthermore, sustained headache pain freedom and time to next migraine was significantly longer in those receiving eptinezumab than those receiving placebo infusion. No participant suffered from any serious adverse event during this study. Overall, this trial demonstrated that IV eptinezumab during an acute migraine attack was more effective than placebo in shortening the time interval to symptom freedom among patients eligible for preventive migraine therapy. One limitation of this study, however, is the question of feasibility and practical use of receiving IV treatment at the onset of an acute migraine attack.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Eptinezumab for prevention of chronic migraine: a randomized phase 2b clinical trial

In-Depth [randomized controlled trial]: This double-blinded, placebo-controlled, randomized trial was conducted across 47 sites in the United States and Georgia between November 2019 and July 2020. Adult patients with greater than 1-year migraine history, who suffered from 4-15 migraine days per month for the past three months were eligible for the study. Participants received 100 mg IV eptinezumab (n= 238) or placebo (n= 242) at the onset of an acute migraine attack. The co-primary outcomes were time to headache-pain freedom and time to the absence of the most bothersome symptom. Patients who received eptinezumab achieved headache freedom in a median time of 4 hours compared to a median time of 9 hours in the placebo cohort (HR: 1.54 [95% Confidence Interval [CI]: 1.20-1.98]; p<0.001). Eptinezumab-treated patients achieved the absence of their most bothersome symptom in a median time of 2 hours compared to 3 hours in placebo-treated patients (HR: 1.75 [95% CI: 1.41-2.19]; p<0.001). Those treated with eptinezumab had a median time of 10 days before the next migraine, whereas placebo-treated participants had a median time of 5 days before the next attack (HR: 0.60 [95% CI: 0.49-0.73]; p<0.001).

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