Assessment of Risk for Constipation With Erenumab, Antiepileptic Drugs for Migraine Prevention - Clinical Pain Advisor
Risk for inpatient constipation was found to be similar among patients initiating migraine prevention treatment with erenumab or other anti-calcitonin gene-related peptide (anti-CGRP) receptor monoclonal antibodies, but the risk for constipation was lower for erenumab compared with antiepileptic drugs. These findings, from a retrospective observational study, were published in Pain and Therapy.
Investigators from Optum, Amgen Inc, and Novartis Pharmaceuticals Corp conducted this study using data from Optum's Electronic Health Record Research Database. Data from patients with diagnostic codes for migraine who were prescribed erenumab, fremanezumab, galcanezumab, eptinezumab, carbamazepine, gabapentin, topiramate, valproate sodium, valproic acid, divalproex sodium, or zonisamide as inpatients between 2018 and 2020 were included in this analysis. Risk for constipation and constipation-related complications was compared between erenumab and other anti-CGRP monoclonal antibodies or antiepileptic drugs using a propensity matching approach.
The mean ages of patients in the erenumab and other anti-CGRP monoclonal antibody matched groups (n=13,200 each) were 45.3 (standard deviation [SD], 12.7) and 45.3 (SD, 12.7) years, 88.4% and 88.1% were women, and 28.7% and 28.9% had a personal history of constipation, respectively.
The mean ages of patients in the erenumab and antiepileptic drug matched groups (n=15,441 each) were 45.6 (SD, 12.9) and 45.9 (SD, 13.3) years, 87.4% and 87.7% were women, and 31.7% and 31.1% had a personal history of constipation, respectively.
During the 90 days following the index prescription, 54 recipients of erenumab and 49 recipients of another anti-CGRP monoclonal antibody experienced constipation while as an inpatient, and 72 erenumab and 104 recipients of an antiepileptic drug experienced constipation as an inpatient. There was no difference in risk for inpatient constipation among patients receiving erenumab or another anti-CGRP monoclonal antibody (odds ratio [OR], 1.06; 95% CI, 0.72-1.55); however, erenumab was associated with decreased risk for inpatient constipation compared with antiepileptic drugs (OR, 0.69; 95% CI, 0.51-0.94).
Serious constipation-related complications occurred among 2 recipients of erenumab and 5 recipients of another anti-CGRP monoclonal antibody, as well as among 7 recipients of erenumab and 12 recipients of antiepileptic drugs. The overall risk rate for serious constipation-related complications was 2% for erenumab compared with 4% for other anti-CGRP monoclonal antibodies and 5% for erenumab compared with 9% for antiepileptic drugs.
This study may have been biased as it is possible that patients took antiepileptic drugs for indications other than migraine.
These data indicate that risk for inpatient constipation is similar between erenumab and other anti-CGRP monoclonal antibodies, but erenumab is associated with lower constipation risk than antiepileptic drugs. Risk for serious constipation complications was low overall. The study authors caution, "The findings observed in this study population, consisting predominantly of women who likely experienced moderate–severe migraine, may not be generalizable to the overall population of patients with migraine, despite the significance of migraine severity as a confounder."
Disclosure: This study was funded by Amgen Inc. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.
References:
Chomistek AK, Hoffman V, Urman R, et al. Inpatient constipation among migraine patients prescribed anti-calcitonin gene-related peptide monoclonal antibodies and standard of care antiepileptic drugs: a retrospective cohort study in a united states electronic health record database. Pain Ther. Published online October 7, 2022. doi:10.1007/s40122-022-00440-7
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