Monthly Versus Quarterly Fremanezumab in Real Life: A Comparison of Effectiveness, Tolerability, and Adherence

Background: While clinical trials have shown no differences between monthly and quarterly regimens of fremanezumab, limited real-life data exist for comparison. This study is aimed at comparing treatment regimens in real life.

Methods: This observational, multicentre study conducted a retrospective analysis of patients initiating monthly or quarterly fremanezumab. Primary endpoints were the comparison of monthly migraine days’ reduction, adverse effects, and treatment discontinuation rates at 3 and 6 months. Secondary endpoints included changes in headache and medication intake frequencies, response rates, and patient-reported outcomes.

Results: One hundred and eleven patients were included, with a median age of 48.5 years, 91% women, and 54.1% with chronic migraine. Sixty-four patients received a monthly regimen and 47 a quarterly. Baseline characteristics were similar. Reductions in monthly migraine days did not differ between treatment regimens (−5 [IQR −9, −1] for monthly versus −6 [IQR −8, −3] for quarterly at 3 months, p = 0.867, and −5 [IQR −10, −2] versus −5.5 [IQR −8.5, −3] at 6 months, p = 0.666, respectively). Adverse effects and discontinuation rates were similar between groups. Secondary endpoints were comparable, except for a higher PGIC scale for the quarterly group at 6 months (6 [IQR 4–6] versus 4 [IQR 2–6], p = 0.007). No differences were observed in the subgroup analysis of episodic or chronic migraine.

Conclusions: Monthly and quarterly fremanezumab demonstrated comparable effectiveness, tolerability, and adherence in real life. Quarterly regimen may result in a more favorable global impression of change.