Abstract Details

Title Ischemic Colitis Associated with Erenumab Use for Migraine

Topic Headache

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 7-007

Objective To describe a case of ischemic colitis following initiation of erenumab for treatment of refractory migraine.

Background Antagonism of calcitonin gene-related peptide (CGRP) is a newly approved mechanism for treatment of migraine. Apart from the trigeminovascular system, CGRP is also widely distributed in the gastrointestinal tract and contributes to regulation of motility and blood flow. There have been theoretical concerns about vasoconstriction from antagonism of CGRP that were not observed in clinical trials.

Design/Methods Single patient case report of ischemic colitis with use of erenumab (antagonist of CGRP receptor).

Results A 41 year old woman with rheumatoid arthritis on tofacitinib, Raynaud’s syndrome, and attention deficit hyperactivity disorder on dextroamphetamine-amphetamine experienced chronic migraine refractory to treatment with topiramate, nortriptyline, and valproate. She used rizatriptan and butalbital-acetaminophen-caffeine for abortive therapy of headaches. She was started on erenumab (Aimovig), and one month after the first injection, she had severe upper abdominal pain. Colonoscopy showed ulcers at the splenic flexure with biopsy consistent with ischemic colitis. CT angiography of the abdomen did not show any fixed obstruction of the mesenteric vasculature. No other clear secondary cause was found.

Conclusions Although a single case, the time course of ischemic colitis following initiation of erenumab suggests a possible association. Other contributing factors included concurrent use of rizatriptan and amphetamines, which are both vasoconstrictive. Prescribers should be cautious of use of CGRP antagonists in patients with vasoconstrictive disease (Raynaud’s in this patient) and on multiple other vasoactive medications.

Authors/Disclosures
Shamik Bhattacharyya, MD, FAAN (Brigham and Women's Hospital) PRESENTER	Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuroLambda. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Merck. The institution of Dr. Bhattacharyya has received research support from Alexion Pharmaceuticals. The institution of Dr. Bhattacharyya has received research support from National Institute of Health. The institution of Dr. Bhattacharyya has received research support from UCB. The institution of Dr. Bhattacharyya has received research support from Genentech. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care.
	No disclosure on file

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