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June 2021; 11 (3) Research

Efficacy of Erenumab in the Treatment of Trigeminal Neuralgia

A Retrospective Case Series

Eliot Parascandolo, Kelsey Levinson, Paul Rizzoli, Roni Sharon
First published April 1, 2021, DOI: https://doi.org/10.1212/CPJ.0000000000001075
Eliot Parascandolo
Sackler Faculty of Medicine (EP, KL, RS), Tel Aviv University, Israel; Graham Headache Center (PR), Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA; and Department of Neurology (RS), Sheba—Tel HaShomer, Ramat Gan, Israel.
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  • For correspondence: eliotdparas96@gmail.com
Kelsey Levinson
Sackler Faculty of Medicine (EP, KL, RS), Tel Aviv University, Israel; Graham Headache Center (PR), Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA; and Department of Neurology (RS), Sheba—Tel HaShomer, Ramat Gan, Israel.
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Paul Rizzoli
Sackler Faculty of Medicine (EP, KL, RS), Tel Aviv University, Israel; Graham Headache Center (PR), Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA; and Department of Neurology (RS), Sheba—Tel HaShomer, Ramat Gan, Israel.
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  • For correspondence: prizzoli@bwh.harvard.edu
Roni Sharon
Sackler Faculty of Medicine (EP, KL, RS), Tel Aviv University, Israel; Graham Headache Center (PR), Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA; and Department of Neurology (RS), Sheba—Tel HaShomer, Ramat Gan, Israel.
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Citation
Efficacy of Erenumab in the Treatment of Trigeminal Neuralgia
A Retrospective Case Series
Eliot Parascandolo, Kelsey Levinson, Paul Rizzoli, Roni Sharon
Neurol Clin Pract Jun 2021, 11 (3) 227-231; DOI: 10.1212/CPJ.0000000000001075

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Abstract

Objective Trigeminal neuralgia (TN) is a chronic, often refractory, pain condition, which adversely affects the lives of patients. Current treatments are only mildly effective. Anti–calcitonin gene-related peptide (CGRP) monoclonal antibodies have been successfully studied in the treatment of migraines. CGRP plays a role in both TN and migraine. It is prudent to attempt CGRP monoclonal antibody therapy in TN. Erenumab, a human anti-CGRP monoclonal antibody medication, modulates CGRP, which is elevated in patients with TN. The primary objective of this study was to evaluate the efficacy of erenumab for patients with TN.

Methods Retrospective analysis was performed on data collected from 10 patients diagnosed with TN and treated with erenumab for 6 months. Pain was tracked using a numeric pain rating scale (NPRS) from 0 to 10. The effect of erenumab on NPRS after 6 months' time was the primary end point. Secondary end points included side effects to therapy, improvement in headache frequency in those with comorbid migraine, evaluating mood following therapy, and global mood improvement using scale (worse, no change, improved).

Results Nine of 10 patients (90.0%) reported improvement in pain severity and in global mood improvement. Three patients reported resolution of anxiety and/or depression. Side effects were minimal, with 3 patients reporting constipation, injection site reactions, or both.

Conclusions Based on these results, erenumab appears to be an efficacious treatment option for patients with refractory TN. Patients experienced improvement in pain, reduced frequency of headache, and improvement in mood. Treatment was well tolerated with only mild side effects reported.

Classification of Evidence This study provides Class IV evidence that erenumab increases the probability of improved pain control in patients with medication-resistant TN.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Received January 5, 2021.
  • Accepted March 15, 2021.
  • © 2021 American Academy of Neurology
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