Multiple Sclerosis With Migraine and Pyoderma Gangrenosum Treated With Ofatumumab and Erenumab

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. Migraine is a common comorbidity in MS, with primary headache syndromes frequently observed. Ofatumumab, a high-efficacy anti-cluster of differentiation 20 (CD20) monoclonal antibody, and erenumab, a calcitonin gene-related peptide (CGRP) receptor antagonist, are available as subcutaneously administered monoclonal antibody agents. Despite their independent efficacy, there is limited evidence regarding the concurrent use of these two agents in patients with MS and migraine, especially in those with dermatological conditions such as pyoderma gangrenosum. We treated a 43-year-old Japanese woman with relapsing-remitting MS (RRMS), migraine, and pyoderma gangrenosum. She experienced persistent migraines despite valproic acid and sumatriptan use. After the administration of intravenous methylprednisolone (IVMP), ofatumumab treatment was introduced; erenumab was later initiated to manage migraines. The addition of erenumab reduced the patient's monthly migraine days (MMDs) and monthly headache days (MHDs). No progression of MS or worsening of pyoderma gangrenosum was observed. The Expanded Disability Status Scale (EDSS) score remained stable, and cognitive function was preserved. The combination therapy demonstrated effectiveness without exacerbating the patient's underlying dermatological condition. This case suggests that combining ofatumumab and erenumab is a viable therapeutic option for patients with MS and comorbid migraine and pyoderma gangrenosum, offering effective disease control with an acceptable safety profile.