Conversation 3

Fremanezumab for the treatment of chronic migraine

Background:

  1. The prevalence of migraine in the world is about 15 to 18 percent.
  2. Chronic migraine is defined as at least 15 headache days per month for 3 months. One headache day = 4 hours or more of moderately severe or severe headache.
  3. There is a peptide called the Calcitonin Gene Related Peptide (CGRP) that seems to modulate pain and vascular reactivity in migraine.
  4. Fremanezumab is a monoclonal antibody against CGRP. It is given by subcutaneous injections.
  5. Patients who had difficult to treat migraine were not included in the trial. (exclusion criteria)

Results

Headache days are defined as: more than 4 hours of headache per day with headache being of moderate severity / number of days using headache relieving medicines

  1. With fremanezumab once in 3 months, about 9 headache days were reported from 375 people. (this was 4 to 5 fewer headache days compared to before the study)
  2. With fremanezumab once a month, about 8 headache days were reported from 375 people (this was 4 to 5 fewer headache days compared to before the study)
  3. With placebo once a month, about 10 headache days were reported from 371 people (this was 2 to 3 fewer headache days compared to before the study)
  4. The reduction in headache days with fremanezumab was statistically significant (p value less than 0.001)
  5. During the 12 weeks of the trial, the use of headache relieving medicines was less by 4 days in the active group and by 2 days in the placebo group. (significant because p value less than 0.001)

Conclusion by authors: This trial showed that fremanezumab, given monthly or quarterly as subcutaneous injections, was effective for the preventive treatment of chronic migraine.

Discussion: Do you agree with the conclusion by the authors?

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