OBJECTIVES: This chart review assessed effectiveness of fremanezumab, a fully-humanized monoclonal antibody (mAb; IgG2Δa) that selectively targets calcitonin-gene-related-peptide (CGRP), for reducing monthly migraine days (MMD) and monthly headache days (MHD) up to 6 months in patients with migraine who had previously discontinued another anti-CGRP pathway mAb.

METHODS: This panel-based chart review used electronic case report forms. Patient inclusion criteria were physician-diagnosed chronic or episodic migraine; fremanezumab initiation at ≥18 years of age after FDA approval (initiation, October 2, 2018–July 17, 2020); ≥1 dose of fremanezumab; and ≥2 MMD assessments (1 within 30-days before and ≥1 after initiation).

RESULTS: This study included data from 421 clinicians and 1,003 patients; 98 patients had discontinued another prior anti-CGRP pathway mAb, most commonly due to inadequate response to treatment (67.4%) and side effects (32.6%). Baseline MMD and MHD, respectively, were slightly higher in the prior anti-CGRP pathway mAb group (mean, 13.1 and 14.6) than the no prior anti-CGRP pathway mAb group (12.7 and 14.0). Similar sustained reductions in mean MMD from baseline were observed in the prior and no prior anti-CGRP pathway mAb groups, respectively, from Month 1 (−2.8 [percent reduction, 21.4%] and −4.8 [37.8%]) through Month 3 (−7.2 [55.0%] and −6.6 [52.0%]) and Month 6 (−9.0 [68.7%] and −9.2 [72.4%]; all P≥0.074 for prior vs no prior anti-CGRP pathway mAb). Similar sustained reductions were also observed in MHD in the prior anti-CGRP pathway mAb group (Month 1, −2.9 [19.9%]; Month 3, −7.4 [50.7%]; Month 6, −8.6 [58.9%]), and no prior anti-CGRP pathway mAb group (Month 1, −4.9 [35.0%]; Month 3, −6.7 [47.9%]; Month 6, −9.9 [70.7%]; all P≥0.111 for prior vs no prior anti-CGRP pathway mAb).

CONCLUSIONS: In this real-world study of patients with migraine, fremanezumab resulted in sustained clinically meaningful reductions, even in patients with prior anti-CGRP pathway mAb treatment.