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Reversion of patients with chronic migraine to an episodic migraine with Fremanezumab treatment

Chronic migraine and episodic migraine are clinically, functionally, and anatomically differentiated, with evidence suggesting that they may be separate conditions.
Furthermore, patients with chronic migraine usually have more comorbid conditions and more‐frequent medication overuse, which complicates their clinical management.

Fremanezumab ( Ajovy ), a fully‐humanized monoclonal antibody ( IgG2Δa ) that selectively targets calcitonin gene‐related peptide ( CGRP ), is a preventive treatment designed to specifically target a pathophysiologic mechanism of migraine and has proven efficacy in the treatment of migraine.

The aim of study was to evaluate the effect of Fremanezumab on reversion from chronic migraine to episodic migraine.

Recent data from imaging studies suggest that chronic migraine may be a distinct entity, different from episodic migraine ( Schwedt T et al, Headache 2015;55(6):762‐777 ).

In this phase III, multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group study, adults with prospectively confirmed chronic migraine ( greater than or equal to 15 headache days and greater than or equal to 8 migraine days per month ) were randomized 1:1:1 to subcutaneous injections of Fremanezumab quarterly ( 675 mg at baseline; placebo at weeks 4 and 8 ), Fremanezumab monthly ( 675 mg at baseline; 225 mg at weeks 4 and 8 ), or matching placebo over a 12‐week treatment period.

Post hoc analyses evaluated the proportion of patients who reverted from chronic migraine to episodic migraine, defined as patients who had greater than or equal to 15 headache days per month at baseline ( 28‐day pre‐treatment period ) and then had less than 15 headache days per month in all 3 months of the treatment period.

In post‐hoc analysis of the 1130 patients with chronic migraine randomized in this trial ( quarterly, N=376; monthly, N=379; placebo, N=375 ), significantly more Fremanezumab‐treated patients reverted from having greater than or equal to 15 headache days per month at baseline to ( quarterly: 121 patients [ 32% ]; monthly: 133 patients [ 35% ] ) than those who received placebo ( 86 patients [ 23% ]; both, P less than or equal to 0.002 ).
On average, these Fremanezumab‐treated patients had 18‐19 headache days per month at baseline and showed reductions to 6‐9 headache days during any month in the treatment period, representing up to an approximately 70% reduction in headache days.

In conclusion, along with its efficacy as a migraine preventive treatment, Fremanezumab has demonstrated the potential benefit for reversion from chronic migraine to episodic migraine. ( Xagena )

Source: American Headache Society ( AHS ) Annual Meeting, 2018