Goadsby PJ, et al. Controlled trial of erenumab for episodic migraine. PMID 29171821¶
Question¶
Does monthly blockade of the canonical CGRP receptor reduce monthly migraine days in adults with episodic migraine?
Design¶
- Randomized, double-blind, placebo-controlled phase 3 trial; ClinicalTrials.gov NCT02456740.
- 955 participants received placebo, erenumab 70 mg or erenumab 140 mg monthly.
- Six-month double-blind treatment; change in monthly migraine days during months 4–6 was the primary endpoint.
Results¶
| Outcome | Placebo | 70 mg | 140 mg |
|---|---|---|---|
| Change in monthly migraine days | −1.8 | −3.2 | −3.7 |
| ≥50% responder rate | 26.6% | 43.3% | 50.0% |
The active–placebo mean differences were therefore −1.4 and −1.9 monthly migraine days. Group means coexist with a substantial responder subgroup and a sizeable placebo response.
Interpretation¶
STRIVE established target-specific preventive efficacy and helped shift migraine drug development from repurposing toward mechanism-led therapy. It does not show that every person with migraine is CGRP-driven, nor that erenumab is superior to other preventives.
Limitations¶
- Trial eligibility and short controlled follow-up limit long-term and complex-comorbidity inference.
- Placebo comparison cannot determine best sequencing, relative value or cost-effectiveness.
- Monthly-day averages obscure within-person distributions and complete/nonresponse tails.
Knowledge-base use¶
Anchors preventive efficacy, trial-landscape interpretation and the distinction between relative and absolute benefit.