The impact of fremanezumab on medication overuse in patients with chronic migraine: subgroup analysis of the HALO CM study.
BACKGROUND: We evaluated the efficacy of fremanezumab, a fully humanized monoclonal antibody that selectively targets calcitonin gene-related peptide, in patients with chronic migraine (CM) with and without medication overuse (MO).
METHODS: In a 12-week, phase 3 trial, patients with CM were randomized to fremanezumab quarterly (675 mg/placebo/placebo), monthly (675 mg/225 mg/225 mg), or placebo. Post hoc analyses assessed the impact of fremanezumab in patients with and without MO (monthly use of acute headache medication ≥15 days, migraine-specific acute medication ≥10 days, or combination medication ≥10 days) on efficacy outcomes, including headache days of at least moderate severity (HDs), and six-item Headache Impact Test (HIT-6) and Migraine-Specific Quality of Life (MSQoL) questionnaire scores.
RESULTS: Of 1130 patients enrolled, 587 (51.9%) had baseline MO. Fremanezumab reduced placebo-adjusted least-squares mean (95% confidence interval) monthly HDs (- 2.2 [- 3.1 to - 1.2] and - 2.7 [- 3.7 to - 1.8]; P < 0.0001) in patients with MO and without MO (quarterly - 1.4 [- 2.3 to - 0.5], P = 0.0026; monthly - 1.4 [- 2.3 to - 0.6], P = 0.0017). Significantly more fremanezumab-treated patients had ≥ 50% reduction in HDs versus placebo, regardless of baseline MO (with: quarterly 70/201 [34.8%], monthly 78/198 [39.4%] vs placebo 26/188 [13.8%]; without: quarterly 71/174 [40.8%], monthly 75/177 [42.4%] vs placebo 41/183 [22.4%]). Fremanezumab improved HIT-6 and MSQoL scores. Significantly more fremanezumab-treated patients reverted to no MO (quarterly 111/201 [55.2%], monthly 120/198 [60.6%]) versus placebo (87/188 [46.3%]).
CONCLUSIONS: Fremanezumab is effective for prevention of migraine in patients with CM, regardless of MO, and demonstrated a benefit over placebo in reducing MO.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02621931 (HALO CM), registered December 12, 2012.
Silberstein, Stephen D.; Cohen, Joshua M.; Seminerio, Michael J.; Yang, Ronghua; Ashina, Sait; and Katsarava, Zaza, "The impact of fremanezumab on medication overuse in patients with chronic migraine: subgroup analysis of the HALO CM study." (2020). Department of Neurology Faculty Papers. Paper 230.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
This article is the author’s final published version in Journal of Headache and Pain, Volume 21, Issue 1, September 2020, Article number 114.
The published version is available at https://doi.org/10.1186/s10194-020-01173-8. Copyright © Silberstein et al.