A Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Effect of Erenumab on Exercise Time During a Treadmill Test in Patients With Stable Angina

Christophe Depre, Lubomir Antalik, Amaal Starling, Michael Koren, Osaro Eisele, Robert A. Lenz, Daniel D. Mikol

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

Objective: To determine the potential impact of erenumab, a human anti-calcitonin gene-related peptide (CGRP) receptor monoclonal antibody, on total exercise time (TET), time to exercise-induced angina, and ST depression in a double-blind, placebo-controlled study in patients with stable angina due to documented coronary artery disease. Background: The relative importance of the CGRP receptor pathway during myocardial ischemia has not been established. Methods: An exercise treadmill test was conducted following a single IV infusion of erenumab 140 mg or placebo. The primary endpoint was the change from baseline in exercise duration as measured by TET with a noninferiority margin of −90 seconds. Safety follow-up visits occurred through week 12. Eighty-eight participants were included in the analysis. Results: LS mean (SE) change in TET was −2.9 [14.8] seconds in the erenumab group and 8.1 [14.4] seconds in placebo; adjusted mean (90% CI) treatment difference was −11.0 (–44.9, 22.9) seconds. The CI lower bound (–44.9 sec) did not reach pre-defined non-inferiority margin of −90 seconds, demonstrating that TET change from baseline in the erenumab group was non-inferior to placebo. There was no difference in time to exercise-induced angina in erenumab and placebo groups (median [90% CI] time of 500 [420, 540] vs 508 [405, 572] seconds; hazard ratio [90% CI]: 1.11 [0.73, 1.69], P =.69) or time to onset of ≥1 mm ST-segment depression (median [90% CI] time of 407 [380, 443] vs 420 [409,480] seconds; hazard ratio [95% CI]: 1.14 [0.76, 1.69], P =.59). Adverse events were reported by 27% and 32% of patients in erenumab and placebo groups. Conclusions: Erenumab did not adversely affect exercise time in a high cardiovascular risk population of patients, supporting that inhibition of the canonical CGRP receptor does not worsen myocardial ischemia.

Original languageEnglish (US)
Pages (from-to)715-723
Number of pages9
JournalHeadache
Volume58
Issue number5
DOIs
StatePublished - May 1 2018

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Keywords

  • calcitonin gene-related peptide
  • cardiovascular
  • clinical trial
  • safety

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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