4CPS-130 R-start: effectiveness of fremanezumab after 18 months of treatment in patients with chronic migraine

<h3>Background and Importance</h3> The therapeutic management of chronic migraine has been significantly transformed with monoclonal antibodies specifically directed against calcitonin gene-related peptide (anti-CGRP).The European Headache Federation recommends a duration of up to 12–18 months and re-evaluate response and if necessary resta<b>rt.</b> <h3>Aim and Objectives</h3> The aim was to assess the response rate after the first-line of anti-CGRP treatment. As a secondary objective we aimed to assess whether the clinical response in case of restart was comparable to the first period. <h3>Material and Methods</h3> Observational, descriptive, longitudinal, unicentric and retrospective study. Patients on anti-CGRP treatment from 2020 to April 2024 were included. The variables collected were: anti-CGRP, dates of start, end and restart, migraine days per month (MDM) and pain scale (VAS) at month 0,3,6,9,12 and 18 of each treatment cycle. Observed differences in MMD and VAS between the baseline and treatment period during the first anti-CGRP cycle were assessed and compared with differences observed at restart. Analysis of qualitative variables was performed a frequency analysis, while for the quantitative ones, were obtained measures of dispersion with Stata 16.0. <h3>Results</h3> Our study included 172 naïve patients treated with fremanezumab: 52% discontinued treatment after 18 months;36% remained on the first cycle at the time of the study because they had not completed the recommended duration and 2.3% continued for more than 18 months, based on clinical criteria. After 18 months with fremanezumab(n=90):31% needed to restart with the same anti-CGRP,35% required a switch to erenumab, of which 50% finally required a switch to galcanezumab and 4% restarted treatment with botulinum toxin. Only 12% maintained clinical response to fremanezumab after completion of the first cycle, with no need for further treatment.8% lost follow-up. Drug-free time was 135 days(SD=122)in patients who needed to restart and 262 days(SD=289)in responders after the first course of fremanezumab. The mean differences in clinical response observed after fremanezumab restart were: an improvement of −0.43 MDM (SD=4.81) and a worsening of −0.29 points (SD=2.25) on the VAS scale compared to the first cycle of fremanezumab. <h3>Conclusion and Relevance</h3> The response rate without fremanezumab after 12–18 months of treatment was low, requiring retreatment in 88% of patients. Restarting treatment with fremanezumab in responders was an effective strategy, maintaining clinical response, in terms of MDM and VAS. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest