Real-world effectiveness after initiating fremanezumab treatment in US patients with episodic and chronic migraine or difficult-to-treat migraine

Abstract

Background: Fremanezumab, a fully humanized monoclonal antibody (mAb; IgG2Δa) that selectively targets calcitonin gene-related peptide (CGRP), is approved for the preventive treatment of migraine in adults. The efficacy and safety of fremanezumab for migraine prevention have been demonstrated in randomized, double-blind, placebo-controlled trials. Real-world effectiveness data are needed to complement clinical trial data. This study assessed the effectiveness of fremanezumab across different subgroups of adult patients with episodic migraine (EM), chronic migraine (CM), or difficult-to-treat (DTT) migraine in real-world clinical settings.

Methods: This retrospective, panel-based online chart review used electronic case report forms. Patient inclusion criteria were a physician diagnosis of EM or CM; age ≥ 18 years at the time of first fremanezumab initiation; ≥ 1 dose of fremanezumab treatment; ≥ 1 follow-up visit since first initiation; and ≥ 2 measurements of monthly migraine days (MMD; with 1 within a month before or at first initiation and ≥ 1 after first initiation). Changes in MMD and monthly headache days were assessed during the follow-up period. These endpoints were evaluated in subgroups of patients by migraine type (EM/CM) and in subgroups with DTT migraine (diagnosis of medication overuse [MO], major depressive disorder [MDD], generalized anxiety disorder [GAD], or prior exposure to a different CGRP pathway-targeted mAb [CGRP mAb]).

Results: Data were collected from 421 clinicians and 1003 patients. Mean (percent) reductions from baseline in MMD at Month 6 were - 7.7 (77.0%) in EM patients, - 10.1 (68.7%) in CM patients, - 10.8 (80.6%) in the MO subgroup, - 9.9 (68.3%) in the MDD subgroup, - 9.5 (66.4%) in the GAD subgroup, and - 9.0 (68.7%) in the prior CGRP mAb exposure subgroup. Improvements in MDD or GAD severity were reported by 45.5% and 45.8% of patients with comorbid MDD or GAD, respectively.

Conclusions: In this real-world study, fremanezumab demonstrated effectiveness for migraine regardless of migraine type or the presence of factors contributing to DTT migraine (MO, GAD, MDD, or prior exposure to a different CGRP mAb).

Keywords: CGRP; Chart review; Difficult-to-treat; Fremanezumab; Migraine; Migraine preventive treatment; Real-world effectiveness.

Fig. 1

Change from baseline in MMD across patient subgroups. BL, baseline; CGRP, calcitonin gene-related peptide; CM, chronic migraine; EM, episodic migraine; GAD, generalized anxiety disorder; mAb, monoclonal antibody; MDD, major depressive disorder; MMD, monthly migraine days; MO, medication overuse. ^aNumber of patients with available assessment at each time point

Fig. 2

Proportion of patients with ≥ 50% reduction from baseline in MMD across patient subgroups. CGRP, calcitonin gene-related peptide; CM, chronic migraine; EM, episodic migraine; GAD, generalized anxiety disorder; mAb, monoclonal antibody; MDD, major depressive disorder; MMD, monthly migraine days; MO, medication overuse. ^aNumber of patients with available assessment at each time point

Fig. 3

Change in MDD and GAD severity. GAD, generalized anxiety disorder; MDD, major depressive disorder

Fig. 4

Change from baseline in MHD across patient subgroups. BL, baseline; CGRP, calcitonin gene-related peptide; CM, chronic migraine; EM, episodic migraine; GAD, generalized anxiety disorder; mAb, monoclonal antibody; MDD, major depressive disorder; MHD, monthly headache days; MO, medication overuse. ^aNumber of patients with available assessment at each time point