OBJECTIVES: This analysis compared the efficacy of the migraine preventive treatments fremanezumab and erenumab in patients with episodic migraine (EM) who had failed 2-4 prior migraine preventive treatments/classes using an indirect treatment comparison approach.

METHODS: Two trials were identified: the FOCUS study of fremanezumab in migraine patients failing 2-4 prior migraine preventive treatment classes and the LIBERTY study of erenumab in migraine patients failing 2-4 prior migraine preventive treatments. In FOCUS, patients were randomized to 12 weeks of double-blind monthly fremanezumab 225mg, quarterly fremanezumab 675mg, or placebo. In LIBERTY, patients were randomized to 12 weeks of double-blind monthly erenumab 140mg or placebo. The Bucher method was used to estimate relative treatment effects of fremanezumab and erenumab, based on reductions in monthly migraine days (MMD), in patients with EM who had failed 2-4 prior migraine preventive treatments/classes. The effects of fremanezumab relative to erenumab were estimated using the direct estimates of each of these treatments against placebo from their respective trials.

RESULTS: Compared to erenumab, reductions from baseline in MMD over 12 weeks were significantly greater for quarterly fremanezumab and monthly fremanezumab (mean difference vs erenumab [95% CI], both 1.2 [0.1, 2.2] MMD; both P<0.05). Significantly greater reductions from baseline in MMD were also observed within the first 4 weeks of treatment compared to erenumab for both quarterly fremanezumab (1.8 [0.5, 3.1] MMD; P<0.01) and monthly fremanezumab (1.7 [0.4, 3.0] MMD; P<0.05). Compared to erenumab, proportions of patients who experienced ≥50% reductions in MMD were generally greater for fremanezumab versus placebo at all evaluated time points, although differences did not reach statistical significance.

CONCLUSIONS: The results of this indirect treatment comparison indicate that, in EM patients failing 2-4 prior migraine preventive treatments/classes, fremanezumab treatment resulted in significantly greater reductions in MMD over 4 and 12 weeks as compared to erenumab treatment.