The first real-world meta-analysis of erenumab across 53 studies found it reduced monthly migraines by about 7 days and improved disability scores, with effects sustained or improving over 12 months.
7.18 fewer migraine days per monthPooled real-world data from 53 studies showing erenumab's effectiveness in everyday clinical practice, not just controlled trials
What the researchers found
Across 53 real-world studies, erenumab reduced monthly migraine days by 7.18 days and monthly headache days by 6.89 days at 3 months. HIT-6 disability scores improved by 6.97 points, medication use dropped by 6.22 days/month, and pain intensity decreased by 1.71 points. Effects increased slightly at 6 and 12 months. Approximately one-third of patients achieved >30% response, one-sixth achieved >50% response, and 3–4% became completely migraine-free. Adverse event rates were 0.34 at 6 months and 0.43 at 12 months.
Why it matters
Clinical trials of erenumab used strict selection criteria, leaving questions about real-world performance. This first real-world meta-analysis of 53 studies confirms that erenumab delivers clinically meaningful migraine reduction outside controlled trial settings, validating CGRP pathway targeting as an effective approach for the broader migraine population.
The numbers in context
53 studies · MMD reduction -7.18 days · MHD reduction -6.89 days · HIT-6 improvement -6.97 · medication days -6.22 · ~33% achieved >30% response · ~17% achieved >50% response · 3-4% complete response · AE rate 0.34–0.43
How the study worked
Systematic review and meta-analysis. Databases searched: PubMed, Scopus, Web of Science, and Cochrane Library from inception to December 2023. Studies reporting real-world erenumab outcomes were included. Meta-analyses of proportions or mean differences were performed for multiple endpoints at 3, 6, and 12 months.
Who was studied
Real-world migraine patients treated with erenumab across 53 observational studies worldwide
What this study cannot tell us
Included studies are observational real-world data without control groups, so placebo effects cannot be excluded. Heterogeneity across 53 studies in patient populations, dosing protocols, and outcome definitions may affect pooled estimates. Publication bias may favor positive results.
How to read the evidence
Systematic review and meta-analysis of 53 real-world observational studies — the highest level of evidence for real-world effectiveness. However, the lack of control groups in individual studies means placebo effects cannot be excluded. The large number of studies provides robust pooled estimates.
When this study was published
Published in 2024 with literature searched through December 2023, this is the most current comprehensive real-world evidence synthesis for erenumab.
The bigger picture
The CGRP pathway has revolutionized migraine treatment. This meta-analysis provides the strongest real-world evidence to date that targeting this peptide system delivers meaningful results outside of clinical trials. As more anti-CGRP therapies become available, this data helps establish the benchmark against which newer treatments will be compared.
Questions still open
- How does erenumab's real-world effectiveness compare to the newer anti-CGRP antibodies (fremanezumab, galcanezumab) and gepants?
- What patient characteristics predict who will be in the ~17% achieving >50% response versus non-responders?
- Do the 3-4% who achieve complete migraine freedom maintain that response long-term beyond 12 months?
Common questions
What is erenumab and how does it work?
Is a 7-day reduction in migraines clinically meaningful?
Read the original research
Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis.
European journal of pharmacology, 976, 176702
Citation
Fernández-Bravo-Rodrigo, Jaime; Cavero-Redondo, Iván; Lucerón-Lucas-Torres, Maribel; Martínez-García, Irene; Flor-García, Amparo; Barreda-Hernández, Dolores; Pascual-Morena, Carlos. (2024). Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis.. European journal of pharmacology, 976, 176702. https://doi.org/10.1016/j.ejphar.2024.176702