Fremanezumab yields sustained response, cuts use of migraine meds

Not only does fremanezumab lead to sustained reduction in migraine days, it also lessens the need for migraine-related acute medications and medical consultations, suggest studies presented at the American Headache Society (AHS) 2021 Scientific Session.

The fully-humanized monoclonal antibody fremanezumab acts by selective targeting the CGRP*, a neuropeptide involved in migraine-related pain.

Sustained response 

In the multicentre, double-blind HALO extension studies, patients with chronic or episodic migraine were randomized 1:1 to receive subcutaneous fremanezumab quarterly (675 mg) or monthly (225 mg) for another 12 months, after completing the placebo-controlled phase III stage. [AHS 2021, abstract P-163]

It took the participants just 1.7 months (pooling both dosing regimens) to achieve at least 50 percent reduction in mean migraine days from baseline (ie, ≥50 percent response) for those with episodic migraine and 2.3–2.5 months among those with chronic migraine. 

For ≥75 percent response, the mean time to achieve this was 2.4–2.7 months and 3.1 months among patients with episodic and chronic migraine, respectively.

After 12 months, approximately half of the patients still maintained ≥50 percent response in both patients with episodic migraine (50 percent and 45 percent with monthly and quarterly dosing, respectively) and those with chronic migraine (48 percent and 53 percent with quarterly and monthly dosing, respectively).

In terms of >75 percent response, about one third of patients showed sustained response at 12 months, regardless of whether they had episodic (31–36 percent) or chronic migraine (29–38 percent).

“Both quarterly and monthly fremanezumab were effective in achieving lasting clinically meaningful response in episodic and chronic migraine,” the researchers stated. 

Less need for healthcare resources

While fremanezumab has been approved as preventive therapy for adults with migraine, “decision makers need data on real-world impact of fremanezumab treatment on resource utilization to inform choice of preventive treatment,” said the researchers.

In a retrospective real-world study, researchers analysed healthcare utilization data of 691 adults with migraine (mean age 45 years, 86 percent female, 79 percent with episodic migraine) based on records from a healthcare insurance claim database in the US. [AHS 2021, abstract P-99]

Compared with the 6-month period before the index date of pharmacy claim for fremanezumab, the patients had significantly fewer migraine-related inpatients visits (mean, 0.01 vs 0.03), outpatient visits (mean, 1.87 vs 2.17), and emergency department (ED) visits (mean, 0.09 vs 0.12; p<0.05 for all) during the 6-month follow-up after index date.

In addition, claims for migraine-related acute medication prescription were also significantly lower during post-index vs pre-index period (4.12 vs 4.96; p<0.05).

In particular, the acute medications that were needed less included triptans and opioids, as shown in a separate study of 1,225 migraine patients (mean age 44.6 years, 85 percent female) using the same claim database as above. [AHS 2021, abstract P-98]

During the 12-month period before the index claim, 69 percent of patients were using triptans compared with 58 percent during the 12-month period post-index (p<0.001).

Similarly, more patients were using opioids during pre-index vs post-index period (30 percent vs 26 percent; p=0.048).

“Within the first 12 months of treatment initiation, fremanezumab treatment is associated with statistically significant reductions in acute medication claims, including reductions in opioid and triptan claims,” concluded the researchers.

 

 

*CGRP: calcitonin gene-related peptide