Study: Erenumab Superior to Topiramate for Patients With Episodic, Chronic Migraine


Erenumab (Aimovig, Novartis) demonstrated superior efficacy and a significantly better tolerability profile compared to topiramate in patients with episodic and chronic migraine, according to data from the HER-MES study, published in Cephalalgia.

Participants were found to have a significantly lower treatment discontinuation rate due to adverse events, with only 10.6% of patients administered erenumab discontinuing treatment compared to 38.9% of patients administered topiramate. Further, patients were significantly more likely to achieve a clinically meaningful improvement in migraine frequency when they were randomized to erenumab at 55.4% compared to 31.2% of patients on topiramate.

“Results of this first and only head-to-head study show superior tolerability and efficacy for Aimovig versus topiramate, further demonstrating the value of Aimovig to patients living with migraine,” said Lykke Hinsch Gylvin, neuroscience global medical franchise head at Novartis Pharmaceuticals, in a press release. “We are proud to continue reimagining migraine care by providing a safe and effective preventive treatment option to patients living with this highly debilitating disease.”

HER-MES is a randomized, double blind, double-dummy, active-controlled, parallel-group phase 4 study designed to evaluate the tolerability and efficacy of erenumab compared to topiramate in a patient-centered setting. It enrolled 777 adult patients with episodic or chronic migraine who had not previously received treatment or who had failed 3 previous therapies with propranolol/metoprolol, amitriptyline, and flunarizine.

Patients were randomized 1:1 to receive either erenumab or topiramate, with the erenumab arm split into dosages of 70 mg or 140 mg. A dose increase from 70 mg to 140 mg was possible at any time during the study. Patients in the topiramate arm were given the drug at the highest-tolerated dose (50-100 mg), starting with a 6-week titration phase.

“HER-MES is the first study that directly compared the therapeutic effect of an antibody and a small molecule in migraine prevention,” said Uwe Reuter, MD, PhD, MBA, managing medical director at Charité Universitätsmedizin, in the release. “The positive outcomes strengthen the position of erenumab as a safe and effective migraine prevention treatment that can significantly enhance quality of life for migraine patients with an improved dosing regimen.”


Novartis announces new publication in Cephalalgia of data showcasing superior tolerability and efficacy of Aimovig® (erenumab) compared with topiramate in migraine prevention [news release]. Novartis; November 8, 2021. Accessed November 8, 2021.

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