LIBERTY Trial: Long-Term Study Comparing the Efficacy and Safety of Erenumab With Standard of Care in Subjects With Episodic Migraine

For decades antiepileptics, antidepressants, and antihypertensives were the three major classes of pharmacological therapy for migraine headache prevention.

That changed in 2018, when erenumab (Aimovig), become the first calcitonin-gene-related peptide (CGRP) antagonist approved by the FDA for migraine headaches.

This approval is attributable to the data from the LIBERTY trial. Published in the Lancet journal, this study was a 12-week, double-blind, placebo-controlled study that compared erenumab to placebo. The primary endpoint was a greater than 50% reduction in headache frequency after 9-12 weeks of treatment. Data showed that 30% of patients who were given erenumab significantly reduced their headaches, compared to just 14% in the placebo group.

Erenumab opened the door for several other CRGP inhibitors to hit the market, including fremanezumab, galcanezumab, and eptinezumab.

Erenumab has gone on to prove itself among some more tried and true migraine preventatives; the randomized, controlled, Head-to-head Study of Erenumab Against Topiramate in Patients With Episodic and Chronic Migraine (HER-MES) trial compared the tolerability and efficacy of erenumab versus topiramate. Over 24 weeks, investigators carried out a double-blind, double-dummy trial among patients who reported at least 4 migraine days per month.

Data showed that 38.9% of those who were given erenumab significantly reduced their headaches compared to 31% of those who were given topiramate. Erenumab also showed only a 10% medication discontinuation rate due to side effects compared to 39% of those who were on topiramate.

There is no doubt that with time CGRP inhibitors will become an even more dominant therapy in the world of migraine prevention.

 Feel free to review the landmark article here!

Learn more about erenumab here!

References:

  • Reuter U, Goadsby PJ, Lanteri-Minet M, Wen S, Hours-Zesiger P, Ferrari MD, Klatt J. Efficacy and tolerability of erenumab in patients with episodic migraine in whom two-to-four previous preventive treatments were unsuccessful: a randomised, double-blind, placebo-controlled, phase 3b study. Lancet. 2018 Nov 24;392(10161):2280-2287. Doi: 10.1016/S0140-6736(18)32534-0. Epub 2018 Oct 22. PMID: 30360965.
  • Reuter U, Ehrlich M, Gendolla A, et al. Erenumab versus topiramate for the prevention of migraine – a randomised, double-blind, active-controlled phase 4 trial. Cephalalgia. 2022;42(2):108-118. doi:10.1177/03331024211053571

About the Synopsis Author

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Brian Hanrahan, MD

Co-Founder, NowYouKnowNeuro
St. Luke’s University Health Network, Bethlehem PA

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Brian Hanrahan, MD & Steven Gangloff, MD

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