AT A GLANCE

Erenumab (Aimovig, Novartis and Amgen), an anti-calcitonin gene-related peptide (CGRP)-receptor monoclonal antibody, may improve rosacea-associated erythema and flushing, a new study suggests.

In the single-group, 12-week, nonrandomized, controlled trial of 30 individuals with rosacea-associated erythema and flushing, subcutaneous injections of erenumab administered every four weeks for 12 weeks significantly reduced days with flushing and erythema by weeks nine through 12 compared with baseline. Participants generally tolerated the treatment well, which was consistent with previous data.

For the study, participants received 140 mg of erenumab subcutaneously every four weeks for 12 weeks. No concomitant rosacea treatment was allowed throughout the study period.

Of 30 participants, 27 completed the 12-week study. The mean number of days with moderate to extreme flushing was reduced by −6.9 days from 23.6 days at baseline. The mean number of days with moderate to severe erythema was reduced by −8.1 days from 15.2 days at baseline. Adverse events included transient mild to moderate constipation, transient worsening of flushing, bloating, and upper respiratory tract infections, which is consistent with previous data.

The 2019 Global Rosacea Consensus Panel recommends general skin care, β-blockers, and α-adrenergic agents for flushing and vascular lasers for persistent erythema, but these treatments may not always be effective or tolerated, points out John Barbieri, MD, MBA, a dermatologist at Brigham and Women's Hospital in Boston and the Associate Editor and Evidence-Based Practice Editor of JAMA Dermatology, in an accompanying editorial.

There remains an unmet need for additional options that can address flushing and erythema in rosacea, he notes.

Why CGRP? There is an association of rosacea with the risk of migraine, and both conditions feature neurovascular reactivity as part of their pathogenesis, he writes.

“Patients with rosacea have elevated levels of CGRP present in their blood and facial skin biopsies, suggesting CGRP inhibition might have a role in the management of rosacea,” Dr. Barbieri writes. “While this trial provides exciting preliminary data about a novel therapeutic mechanism to treat flushing and erythema in rosacea, there is a need for future randomized clinical trials to evaluate the efficacy of CGRP inhibition for this indication.”

The treatment only showed relatively modest improvements in quality of life in the new study. Additionally, CGRP inhibitors are currently relatively expensive. “CGRP inhibition is a promising potential treatment strategy for those with comorbid migraine or with flushing and erythema recalcitrant to other treatment options.”

The study and editorial appear in the April 17, 2024 issue of JAMA Dermatology.

DRUG AT A GLANCE

Given by injection once per month, erenumab (Aimovig, Novartis and Amgen) is a CGRP antagonist used to prevent migraines.