Real-world assessment of fremanezumab for chronic migraine: adherence to NICE criteria, efficacy, & impact on co-morbidities

<h3>Background</h3> Chronic migraine effects 1-2% of the population. Fremanezumab, CGRP monoclonal antibody, is approved for chronic migraine where 3 oral prophylactics have failed. Long-term studies assessing the efficacy and impact of co-morbidities on CGRP treatment are lacking. <h3>Methods</h3> Retrospective audit of 527 patients from the Birmingham Headache Centre (2020–2023) was carried out to assess adherence to NICE criteria and to evaluate the impact of co-morbidities. Reductions in monthly migraine days (MMD) and monthly headache days (MHD) at 3 and 12 months were calculated, and further subgroup analyses were performed. <h3>Results</h3> Fremanezumab results in a mean monthly migraine day reduction of 8.59 days at 3 months and 11.63 days at 12 months, and with a NICE required ≥30% reduction achieved in 81% and 92% at 3 and 12 months, respectively. At 12 months a ≥30% reduction in MMD was seen in 87%. patients with prior Botox use and 88% Erenumab treatment. The response rates to fremanezumab were similar in patients with additional co-morbidities. Treatment cessation at 12 months was temporary with 83% restarting. <h3>Conclusion</h3> Fremanezumab is efficacious for treatment of chronic migraine with long term use often required, even with previous Botox and Erenumab use, and effective when comorbidities are present.