Erenumab during pregnancy: a case report in a patient with chronic migraine
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LETTER TO THE EDITOR
Erenumab during pregnancy: a case report in a patient with chronic migraine Luisa Fofi 1 & Gabriella Egeo 1 & Cinzia Aurilia 1 & Piero Barbanti 1,2 Received: 6 August 2020 / Accepted: 20 November 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, Migraine is very common in women of childbearing age, reaching a prevalence of 25% [1]. The preventive treatment of migraine in women of reproductive age must be carefully chosen, since some oral drugs like valproate and topiramate have known teratogenic effects. The new anti-calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies represent a new era in the preventive treatment of migraine, because of their favorable efficacy and tolerability profile. However, there are very limited data on their effects during pregnancy; therefore—since CGRP is a potent vasodilator potentially involved in the blood flow regulation in the uteroplacental system—theoretical concerns exist [2]. Erenumab—a fully human monoclonal antibody targeting the receptor of the CGRP and the first drug in this new class— showed to be effective and well tolerated in episodic and chronic migraine [3]. In a pre- and post-natal development study in cynomolgus monkey, erenumab administration from gestation days 20–22 through birth induced no adverse effects on the pregnancy and the embryo-fetal growth and development at exposures 17-fold the human dose of 140 mg/month [4]. Nevertheless, due to the lack of clinical data and the theoretical role of CGRP in regulating uterine vascular resistance, the use of erenumab during pregnancy is currently not recommended. We would like to share with you our experience of the first case of the occurrence of pregnancy during erenumab treatment in a patient affected by chronic migraine. Written informed consent was obtained from the patient for the description and publication of this case report. * Piero Barbanti [email protected] 1
Headache and Pain Unit, IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy
2
San Raffaele University, Rome, Italy
This is a 37-year-old woman, married, working as a lawyer. Her medical history was positive for endometriosis, polycystic ovarian and an untreated anxiety disorder. She had no previous pregnancy or abortions. The patient was affected by migraine without aura since the age of 6. Until early adolescence, migraine had a frequency of 4 days per month and was responsive to non-steroidal anti-inflammatory drugs. Migraine started worsening at the age of 16, becoming chronic (15– 20 days/month) without medication overuse. The putative chronification factors were stress and anxiety. The attacks were successfully treated with triptans. Over the course of the disease, the patient used amitriptyline, cinnarizine, flunarizine, propranolol, metoprolol, and topiramate, but all these treatments proved ineffective or had unbearable side effects, which led to a premature discontinuation. At the time of her first visit to our unit, she was on prophylaxis with sodium valproate 600
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