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

Ziegeler, Christian; Mehnert, Jan; Asmussen, Katharina; May, Arne

OBJECTIVE To determine whether erenumab, a new monoclonal antibody to the calcitonin gene-related peptide (CGRP) receptor, exerts functional central effects in migraineurs, we performed functional imaging scans on patients treated with erenumab. METHODS We conducted a functional magnetic resonance imaging (fMRI) study on 27 migraine patients, using a well-established trigeminal nociceptive paradigm, examining patients before and two 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 contrasting responders (n=9) and non-responders (n=8) of the respective same headache state, we found a significant reduction of hypothalamic activation after the administration of erenumab in responders only (T-value: 4.78; contrast estimate [90% CI]: 29.79 [19.53; 40.05]). This finding of reduced hypothalamic activation was confirmed when using the absolute headache days 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 following peripheral modulation of sensory input or indeed represents a direct central mode of action is discussed.