Fremanezumab May Help Reduce Medication Overuse in Chronic Migraine

The following article is part of conference coverage from the 2018 American Headache Society Annual Scientific Meeting in San Francisco, California. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AHS 2018.

SAN FRANCISCO—Treatment with fremanezumab may help reduce medication overuse and the number of days of acute medication use in individuals with chronic migraine, according to research presented at this the 2018 American Headache Society Annual Scientific Meeting, held June 28- July 1, 2018 in San Francisco, California.

Headache medication — including opiates, triptans, ergot derivatives, and analgesic drug combinations — have the potential of being overused by patients with chronic migraine. Fremanezumab, a humanized monoclonal antibody raised against calcitonin gene-related peptide, has indicated efficacy in previous clinical trials in reducing headache severity and frequency in chronic migraine.

In the current phase 3 placebo-controlled trial, individuals with chronic migraine were randomly assigned to receive quarterly fremanezumab (one 675 mg subcutaneous injection at baseline; n=201) followed by placebo injections at weeks 4 and 8; monthly fremanezumab only (monthly injections: 675 mg at baseline; 225 mg at weeks 4 and 8; n=198); or placebo (n=188) over a 12-week period. Medication overuse was defined as use of acute headache medication ≥15 days, use of migraine-specific acute medication ≥10 days, or use of combination medications for headache ≥10 days over a 28-day baseline period.

A greater percentage of study participants treated with fremanezumab vs placebo indicated a lack of medication overuse during the study period (quarterly fremanezumab, 55%; P =.0389; monthly fremanezumab, 61%; P =.0024; placebo, 46%). This drug treatment effect was noticeable beginning at week 4 (quarterly fremanezumab, 51%; P =.0091; monthly fremanezumab, 54%; P =.0014; placebo, 39%).

The number of days with headache medication overuse at baseline was comparable across groups in participants who were responsive to treatment (quarterly fremanezumab: n=111, 16.6±0.32 days; monthly fremanezumab: n=120, 16.7±0.33 days; placebo: n=87, 16.6±0.35 days). In those patients, the treatment with fremanezumab was also found to result in less use of acute headache medication during the 12-week study period compared with placebo (quarterly fremanezumab: –9.0±0.41 days, P =.0017; monthly fremanezumab: –8.9±0.41 days, P =.0040; placebo: –7.1±0.46 days).

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Reference

Wong P, Silberstein SD, Ashina S, et al. The impact of fremanezumab on medication overuse in patients with chronic migraine. Presented at: 2018 American Headache Society Annual Scientific Meeting. June 28-July 1, 2018; San Francisco, CA. Abstract 449590.