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Buse DC, Krasenbaum LJ, Seminerio MJ, Packnett ER, Carr K, Ortega M, Driessen MT. Real-world Impact of Fremanezumab on Migraine-Related Health Care Resource Utilization in Patients with Comorbidities, Acute Medication Overuse, and/or Unsatisfactory Prior Migraine Preventive Response. Pain Ther 2024:10.1007/s40122-024-00583-9. [PMID: 38472655 DOI: 10.1007/s40122-024-00583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Fremanezumab, a humanized monoclonal antibody targeting calcitonin gene-related peptide, is indicated for preventive treatment of migraine in adults. Real-world evidence assessing the effect of fremanezumab on migraine-related medication use, health care resource utilization (HCRU), and costs in patient populations with comorbidities, acute medication overuse (AMO), and/or unsatisfactory prior migraine preventive response (UPMPR) is needed. METHODS Data for this US, retrospective claims analysis were obtained from the Merative® MarketScan® Commercial and supplemental databases. Eligible adults with migraine initiated fremanezumab between 1 September 2018 and 30 June 2019 (date of earliest fremanezumab claim is the index date), had ≥ 12 months of continuous enrollment prior to initiation (preindex period) and ≥ 6 months of data following initiation (postindex period; variable follow-up after 6 months), and had certain preindex migraine comorbidities (depression, anxiety, and cardiovascular disease), potential AMO, or UPMPR. Changes in migraine-related concomitant acute and preventive medication use, HCRU, and costs were assessed pre- versus postindex. RESULTS In total, 3193 patients met the eligibility criteria. From pre- to postindex, mean (SD) per patient per month (PPPM) number of migraine-related acute medication and preventive medication claims (excluding fremanezumab), respectively, decreased from 0.97 (0.90) to 0.86 (0.87) (P < 0.001) and 0.94 (0.74) to 0.81 (0.75) (P < 0.001). Migraine-related outpatient and neurologist office visits, emergency department visits, and other outpatient services PPPM decreased pre- versus postindex (P < 0.001 for all), resulting in a reduction in mean (SD) total health care costs PPPM from US$541 (US$858) to US$490 (US$974) (P = 0.003). Patients showed high adherence and persistence rates, with mean (SD) proportion of days covered of 0.71 (0.29), medication possession ratio of 0.74 (0.31), and persistence duration of 160.3 (33.2) days 6 months postindex. CONCLUSIONS Patients with certain migraine comorbidities, potential AMO, and/or UPMPR in a real-world setting had reduced migraine-related medication use, HCRU, and costs following initiation of fremanezumab. Graphical abstract available for this article.
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Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | | | | | | | - Karen Carr
- Teva Branded Pharmaceuticals, Parsippany, NJ, USA
| | - Mario Ortega
- Teva Branded Pharmaceuticals, Parsippany, NJ, USA
| | - Maurice T Driessen
- Teva Pharmaceuticals, Piet Heinkade 107, 1019 BR, Amsterdam, Netherlands.
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Ahmed Z, Honomichl R, Thompson SF, Cohen JM, Schuster A, Thompson NR, Lapin B, Udeh BL, Ramirez Campos V, Krasenbaum LJ, Katzan IL. Clinical characteristics and patient-reported outcomes of chronic and episodic migraine patients at a US tertiary headache center: A retrospective observational study. Headache 2023. [PMID: 37314065 DOI: 10.1111/head.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe differences in clinical and demographic characteristics between patients with episodic migraine (EM) or chronic migraine (CM) and determine the effect of migraine subtype on patient-reported outcome measures (PROM). BACKGROUND Prior studies have characterized migraine in the general population. While this provides a basis for our understanding of migraine, we have less insight into the characteristics, comorbidities, and outcomes of migraine patients who present to subspecialty headache clinics. These patients represent a subset of the population that bears the greatest burden of migraine disability and are more representative of migraine patients who seek medical care. Valuable insights can be gained from a better understanding of CM and EM in this population. METHODS We conducted a retrospective observational cohort study of patients with CM or EM seen in the Cleveland Clinic Headache Center between January 2012 and June 2017. Demographics, clinical characteristics, and patient-reported outcome measures (3-Level European Quality of Life 5-Dimension [EQ-5D-3L], Headache Impact Test-6 [HIT-6], Patient Health Questionnaire-9 [PHQ-9]) were compared between groups. RESULTS Eleven thousand thirty-seven patients who had 29,032 visits were included. More CM patients reported being on disability 517/3652 (14.2%) than EM patients 249/4881 (5.1%) and had significantly worse mean HIT-6 (67.3 ± 7.4 vs. 63.1 ± 7.4, p < 0.001) and median [interquartile range] EQ-5D-3L (0.77 [0.44-0.82] vs. 0.83 [0.77-1.00], p < 0.001), and PHQ-9 (10 [6-16] vs. 5 [2-10], p < 0.001). CONCLUSIONS There are multiple differences in demographic characteristics and comorbid conditions between patients with CM and EM. After adjustment for these factors, CM patients had higher PHQ-9 scores, lower quality of life scores, greater disability, and greater work restrictions/unemployment.
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Affiliation(s)
- Zubair Ahmed
- Headache Section, Center for Neurologic Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan Honomichl
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Joshua M Cohen
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, Pennsylvania, USA
| | - Andrew Schuster
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicolas R Thompson
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brittany Lapin
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Belinda L Udeh
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Population Health Research, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Lynda J Krasenbaum
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, Pennsylvania, USA
| | - Irene L Katzan
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Rhyne C, Cohen JM, Seminerio MJ, Carr K, Krasenbaum LJ. Burden of migraine with acute medication overuse or psychiatric comorbidities and treatment with CGRP pathway-targeted monoclonal antibodies: A review. Medicine (Baltimore) 2023; 102:e33874. [PMID: 37335663 DOI: 10.1097/md.0000000000033874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Migraine is a complex and often debilitating neurological disease that affects more than 1 billion people worldwide. It is characterized by moderate-to-intense, throbbing headache attacks that are worsened by activity and is associated with nausea, vomiting, and sensitivity to light and sound. Migraine, ranked the second leading cause of years lived with disability by the World Health Organization, can diminish patients' quality of life and bring significant personal and economic burden. Furthermore, migraine patients with a history of acute medication overuse (AMO) or psychiatric comorbidities, such as depression or anxiety, may experience even greater impairment and burden, and their migraine may be more difficult-to-treat. Appropriate treatment of migraine is essential to reduce this burden and improve patient outcomes, especially for those with AMO or psychiatric comorbidities. There are several available preventive treatment options for migraine, though many of these are not migraine-specific and may have limited efficacy and/or poor tolerability. The calcitonin gene-related peptide pathway plays a key role in the pathophysiology of migraine, and monoclonal antibodies that target the calcitonin gene-related peptide pathway have been developed as specific preventive treatments for migraine. Four of these monoclonal antibodies have been approved for the preventive treatment of migraine after demonstrating favorable safety and efficacy profiles. These treatments offer substantial benefits for migraine patients, including those with AMO or common psychiatric comorbidities, by reducing monthly headache days and migraine days, days of acute medication use, and disability measures, as well as improving quality of life.
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Affiliation(s)
| | - Joshua M Cohen
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA
| | | | - Karen Carr
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA
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Mackenzie KD, Ortega M, Kessler Y, Campos VR, Krasenbaum LJ, Carr K, Ning X, Stratton J. Commentary: Constipation caused by anti-calcitonin gene-related peptide migraine therapeutics explained by antagonism of calcitonin gene-related peptide’s motor-stimulating and prosecretory function in the intestine. Front Physiol 2022; 13:1067274. [DOI: 10.3389/fphys.2022.1067274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
Calcitonin gene-related peptide (CGRP) pathway-targeted treatments have been shown to be efficacious in the prevention of episodic and chronic migraine. Currently approved therapies include monoclonal antibodies (mAbs) that target CGRP (eptinezumab, fremanezumab, and galcanezumab) and the CGRP receptor (erenumab), and small molecule CGRP receptor antagonists (atogepant and rimegepant). While CGRP pathway–targeted treatments are generally well-tolerated, in a review article by Holzer and Holzer-Petsche published in the January 2022 issue of Frontiers in Physiology the authors discussed the role of the CGRP pathway in gastrointestinal physiology, with a specific focus on constipation associated with the use of CGRP pathway–targeted treatments. The authors state that real-world surveys have shown constipation to be a “major adverse event” reported in “more than 50% of patients treated with erenumab, fremanezumab or galcanezumab.” As described in the current commentary, the limited data from the cited references in the review article by Holzer and Holzer-Petsche do not support that statement.
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Nahas SJ, Naegel S, Cohen JM, Ning X, Janka L, Campos VR, Krasenbaum LJ, Holle-Lee D, Kudrow D, Lampl C. Correction: Efficacy and safety of fremanezumab in clinical trial participants aged ≥60 years with episodic or chronic migraine: pooled results from 3 randomized, double-blind, placebo-controlled phase 3 studies. J Headache Pain 2022; 23:57. [PMID: 35581545 PMCID: PMC9112594 DOI: 10.1186/s10194-022-01423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Stephanie J Nahas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Steffen Naegel
- Department of Neurology, University Hospital Halle (Saale) and University Halle-Wittenberg, Halle, Germany
| | | | - Xiaoping Ning
- Teva Pharmaceutical Industries, West Chester, PA, USA
| | - Lindsay Janka
- Teva Pharmaceutical Industries, West Chester, PA, USA
| | | | | | - Dagny Holle-Lee
- Department of Neurology and Westgerman Headache Center Essen, University Hospital, Essen, Germany
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Christian Lampl
- Headache Medical Centre, Linz, Austria.,Department of Neurology, Konventhospital Barmherzige Brüder, Linz, Austria
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Krasenbaum LJ, Pedarla VL, Thompson SF, Tangirala K, Cohen JM, Driessen MT. A real-world study of acute and preventive medication use, adherence, and persistence in patients prescribed fremanezumab in the United States. J Headache Pain 2022; 23:54. [PMID: 35508970 PMCID: PMC9066733 DOI: 10.1186/s10194-022-01413-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Following approval of fremanezumab for the prevention of migraine in adults, health care decision makers are interested in understanding real-world clinical characteristics and treatment patterns among patients initiating fremanezumab therapy. Methods Data were obtained for this retrospective (pre-post) study from the Veradigm Health Insights database. The study period was January 1, 2014, to June 30, 2019. Patients were included if they were aged ≥ 18 years; had ≥ 1 migraine diagnosis during the study period; and had a medication record for fremanezumab on or after diagnosis during the identification period (September 1, 2018–December 31, 2018). Treatment patterns, including adherence, persistence, and utilization of acute and preventive migraine medication prescriptions, were evaluated. Results Of 987 patients initiating fremanezumab during the study period, 738 (74.8%) were adherent to fremanezumab by proportion of days covered (PDC; ≥ 80%) and 780 (79.0%) were adherent by medication possession ratio (MPR; ≥ 80%). A total of 746 (75.6%) patients were persistent for ≥ 6 months. Quarterly fremanezumab (n = 186) was associated with higher rates of adherence versus monthly fremanezumab (n = 801) by PDC (quarterly, 91.3%; monthly, 84.9%; P < 0.001) and MPR (quarterly, 92.2%; monthly, 87.9%; P = 0.006) and higher persistence at ≥ 6 months (quarterly, 82.8%; monthly, 73.9%; P = 0.011). After fremanezumab initiation, patients who were persistent for ≥ 6 months experienced significant reductions from baseline in the mean monthly number of acute and preventive migraine medication prescriptions (P < 0.001). Subgroup analyses in patients with comorbid depression and anxiety showed meaningful real-world benefits based on significant reductions in the number of patients who were prescribed antidepressants (baseline, 68.6%; follow-up, 56.4%; P = 0.0025) and anxiolytic medications (baseline, 55.0%; follow-up, 47.2%; P = 0.037), respectively. In a subgroup of patients with comorbid hypertension at baseline, fremanezumab treatment resulted in nonsignificant reductions in blood pressure. Conclusions Overall, adherence and persistence to fremanezumab in this real-world study was high in patients with migraine, with higher rates observed for quarterly fremanezumab. Patients who were persistent for ≥ 6 months experienced significant reductions in acute and preventive migraine medication use, while a subgroup of migraine patients with comorbid depression and anxiety at baseline showed significant reductions in antidepressant and anxiolytic medication use. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01413-z.
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McAllister P, Lamerato L, Krasenbaum LJ, Cohen JM, Tangirala K, Thompson S, Driessen M, Casciano J, Dotiwala Z, Mauskop A. Real-world impact of fremanezumab on migraine symptoms and resource utilization in the United States. J Headache Pain 2021; 22:156. [PMID: 34930112 PMCID: PMC8903530 DOI: 10.1186/s10194-021-01358-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene-related peptide (CGRP), is approved for migraine prevention in adults. Real-world data on the effectiveness of fremanezumab are limited. This retrospective, observational cohort study assessed patient-reported migraine symptoms, health care resource utilization (HCRU), and direct medical costs before and after fremanezumab treatment initiation. Methods Data were extracted from September 2018 through June 2020 from the Midwest component of EMRClaims+®, an integrated health services database containing > 20 million medical records from national commercial insurance claims, Medicare claims, and regional electronic medical records. Patients included in the cohort analysis were aged ≥ 18 years and were administered fremanezumab, with enrollment or treatment history for ≥ 6 months prior (pre-index) to initiating fremanezumab (index date) and ≥ 1 month after the index date (post-index), and without pregnancy or pregnancy-related encounters during the study period. Patient-reported headache frequency, migraine pain intensity (MPI), composite migraine symptoms, and HCRU were assessed pre-index and ≥ 1 month after fremanezumab initiation. Wilcoxon signed-rank tests were used to compare means of migraine symptoms and outcomes and HCRU before and after fremanezumab initiation. Results Overall, 172 patients were eligible for analysis. Of patients who self-reported (n = 129), 83.7% reported improvement in headache frequency or symptoms after fremanezumab treatment. Specifically, headache frequency decreased by 63% after fremanezumab initiation: mean (standard deviation) headache frequency was 22.24 (9.29) days per month pre-index versus 8.24 (7.42) days per month post-index (P < 0.0001). Mean MPI also decreased by 18% after fremanezumab initiation: MPI was 5.47 (3.19) pre-index versus 4.51 (3.34) post-index (P = 0.014). Mean emergency room (ER) visits per month decreased from 0.72 to 0.54 (P = 0.003), and mean outpatient visits per month decreased from 1.04 to 0.81 (P < 0.001). Mean hospitalizations per month decreased, but the results did not reach statistical significance (P = 0.095). Hospitalization and ER costs decreased, while outpatient costs increased, from pre-index to post-index, but differences were not statistically significant (P ≥ 0.232). Conclusions Significant reductions in headache frequency, MPI, and HCRU were observed after fremanezumab initiation in patients with migraine in a US real-world setting.
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Affiliation(s)
- Peter McAllister
- New England Institute for Neurology and Headache, New England Institute for Clinical Research and Ki Clinical Research, Yale University, 30 Buxton Farm Road, Suite 230, Stamford, CT, 06905, USA.
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | | | - Joshua M Cohen
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Krishna Tangirala
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Stephen Thompson
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | | | | | | | - Alexander Mauskop
- Department of Neurology, SUNY Downstate Medical Center, New York Headache Center, New York, NY, USA
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Nahas SJ, Naegel S, Cohen JM, Ning X, Janka L, Campos VR, Krasenbaum LJ, Holle-Lee D, Kudrow D, Lampl C. Efficacy and safety of fremanezumab in clinical trial participants aged ≥60 years with episodic or chronic migraine: pooled results from 3 randomized, double-blind, placebo-controlled phase 3 studies. J Headache Pain 2021; 22:141. [PMID: 34819017 PMCID: PMC8903616 DOI: 10.1186/s10194-021-01351-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/31/2021] [Indexed: 01/17/2023] Open
Abstract
Background Although migraine is less common in older people, preventive treatment of migraine in these individuals may be more challenging due to the presence of multiple comorbidities and polypharmacy. Additionally, evidence for migraine treatment efficacy, safety, and tolerability is limited in this population. We evaluated efficacy, safety, and tolerability of fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene–related peptide (CGRP), in clinical trial participants aged ≥60 years with episodic migraine (EM) or chronic migraine (CM). Methods This analysis included data from 3 randomized, double-blind, placebo-controlled phase 3 studies: the HALO EM study, HALO CM study, and FOCUS study in participants with EM or CM and prior inadequate response to 2–4 migraine preventive medication classes. Participants in all studies were randomized 1:1:1 to receive 12 weeks of subcutaneous treatment with quarterly fremanezumab (Months 1/2/3: EM/CM, 675 mg/placebo/placebo), monthly fremanezumab (Months 1/2/3: EM, 225 mg/225 mg/225 mg; CM, 675 mg/225 mg/225 mg), or matched monthly placebo. Results These pooled analyses included 246 participants aged ≥60 years. Reductions in monthly migraine days from baseline over 12 weeks were significantly greater with fremanezumab (least-squares mean change from baseline [standard error]: quarterly fremanezumab, − 4.3 [0.59]; monthly fremanezumab, − 4.6 [0.54]) versus placebo (placebo, − 2.3 [0.57]; both P < 0.01 vs placebo). As early as Week 1, significant reductions from baseline in weekly migraine days were observed with fremanezumab versus placebo (both P < 0.01). With fremanezumab treatment versus placebo, a significantly higher proportion of participants achieved ≥50% reduction in monthly migraine days, and significant improvements in disability and quality-of-life outcomes were observed (P < 0.05). Proportions of participants experiencing serious adverse events and adverse events leading to discontinuation were low and similar in the fremanezumab and placebo groups. Efficacy and safety results were comparable to the overall pooled population (N = 2843). Conclusions This pooled subgroup analysis demonstrates that fremanezumab treatment is efficacious and well-tolerated over 12 weeks in participants aged ≥60 years with EM or CM. These data may help healthcare providers with clinical decision making and preventive treatment selection for older patients with migraine. Trial registration ClinicalTrials.gov identifiers: HALO CM: NCT02621931; HALO EM: NCT02629861; FOCUS: NCT03308968. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01351-2.
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Affiliation(s)
- Stephanie J Nahas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Steffen Naegel
- Department of Neurology, University Hospital Halle (Saale) and University Halle-Wittenberg, Halle, Germany
| | | | - Xiaoping Ning
- Teva Pharmaceutical Industries, West Chester, PA, USA
| | - Lindsay Janka
- Teva Pharmaceutical Industries, West Chester, PA, USA
| | | | | | - Dagny Holle-Lee
- Department of Neurology and Westgerman Headache Center Essen, University Hospital, Essen, Germany
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Christian Lampl
- Headache Medical Centre, Linz, Austria.,Department of Neurology, Konventhospital Barmherzige Brüder, Linz, Austria
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Barash S, Ramirez Campos V, Ning X, Driessen MT, Krasenbaum LJ, Carr K, Cohen JM. Comment on: Gao B, Lu Q, Wan R, Wang Z, Yang Y, Chen Z, Wang Z. "Monthly versus quarterly fremanezumab for the prevention of migraine: a systemic review and meta-analysis from randomized controlled trials". Naunyn Schmiedebergs Arch Pharmacol. 2021 Apr;394(4):819-828. Epublished November 2020. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:2343-2346. [PMID: 34581836 PMCID: PMC8514361 DOI: 10.1007/s00210-021-02156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
Recently, Gao et al. published an article titled "Monthly versus quarterly fremanezumab for the prevention of migraine: a systemic review and meta-analysis from randomized controlled trials" which concluded that monthly administration of fremanezumab led to significant reduction in monthly migraine days (MMD) when compared to quarterly fremanezumab. We have noted a critical flaw in Gao et al. meta-analysis wherein the authors have mistakenly utilized standard error values in place of standard deviation values in performing their pooled analyses. This error directly impacts the study results and conclusions. In this brief communication, we present revised analysis using correct methods. Using the correct SD values, our pooled analysis showed no significant difference in mean change from baseline in MMD between the two fremanezumab dosing regimens (P = 0.17). Furthermore, in the corrected subgroup analyses by type of migraine, there were no significant differences in mean change from baseline in MMD between monthly fremanezumab and quarterly fremanezumab (chronic migraine, P = 0.50; episodic migraine, P = 0.69). Overall, results from our corrected meta-analyses show that there is no significant difference in migraine prevention efficacy between monthly and quarterly fremanezumab dosing.
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Affiliation(s)
- Steve Barash
- Teva Pharmaceutical Industries Ltd., West Chester, PA, USA.
| | | | - Xiaoping Ning
- Teva Pharmaceutical Industries Ltd., West Chester, PA, USA
| | | | | | - Karen Carr
- Teva Pharmaceutical Industries Ltd., West Chester, PA, USA
| | - Joshua M Cohen
- Teva Pharmaceutical Industries Ltd., West Chester, PA, USA
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Ashina S, Campos VR, Cohen J, Janka L, Krasenbaum LJ. Reversion from medication overuse with fremanezumab treatment in patients with inadequate response to multiple migraine preventive medication classes. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cohen JM, Ning X, Kessler Y, Rasamoelisolo M, Campos VR, Seminerio MJ, Krasenbaum LJ, Shen H, Stratton J. Immunogenicity of biologic therapies for migraine: a review of current evidence. J Headache Pain 2021; 22:3. [PMID: 33413094 PMCID: PMC7791637 DOI: 10.1186/s10194-020-01211-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background Monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway have been shown to be effective in migraine prevention. Eptinezumab, erenumab, fremanezumab, and galcanezumb have shown efficacy in clinical trials along with favorable safety and tolerability profiles. Although erenumab is a human mAb and the others have been humanized to varying degrees, they all have the capacity to provoke immune reactions. The present review article aims to discuss the current relationship between mAbs targeting the CGRP pathway (CGRP mAbs) and immunogenicity and their potential clinical implications. Findings The incidence of patients developing anti-drug antibodies (ADAs), their titer, and clinical significance are highly variable and depend on a variety of different drug and patient factors. Neutralizing ADAs (NAbs) bind to and inhibit or reduce the pharmacologic activity of the biologic drug molecule, whereas non-neutralizing antibodies (Non-NAbs) bind to the biologic drug molecule without affecting pharmacologic activity in an in vitro test, although pharmacokinetics and drug clearance may be affected. A direct comparison of immunogenicity data across clinical trials with different biologics is not possible due to a lack of standardized assays. Several phase 2, phase 3, and long-term studies evaluating CGRP mAbs for migraine prevention have reported immunogenicity data (5 studies each for eptinezumab, erenumab, fremanezumab, and galcanezumab). Across these studies, prevalence of ADAs varied, ranging from < 1% to ~ 18%. Neutralizing ADAs were slightly less common, with a prevalence ranging from 0 to 12%. Adverse events related to ADA formation were rare. Conclusions As more CGRP mAb studies are conducted and more long-term follow-up data become available, evidence is increasing that immunogenicity rates of biologic therapies for migraine are low, and adverse events related to ADAs are rare. Taken together, these results add to the growing body of evidence for the safety and tolerability of this class of migraine medications.
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Affiliation(s)
- Lynda J Krasenbaum
- New York Headache Center, 30 East 76th Street, Floor 2, New York, NY 10021, USA
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Krasenbaum LJ. A Review of Migraine Prophylaxis and Acute Treatment Patterns Among Commercially Insured Patients in the United States. Headache 2017; 57:1451-1452. [DOI: 10.1111/head.13181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Lynda J. Krasenbaum
- New York Headache Center; 30 East 76th Street, Floor 2, New York NY, 10021 USA
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Krasenbaum LJ. A Review of Complementary and Alternative Medicine Use Among U.S. Adults with Headache or Migraine: Results from the 2012 National Health Interview Survey. Headache 2017; 57:1284-1285. [DOI: 10.1111/head.13163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
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15
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Krasenbaum LJ. A Review of Allodynia Is Associated With Initial and Sustained Response to Acute Migraine Treatment: Results From the American Migraine Prevalence and Prevention Study. Headache 2017; 57:1156-1157. [DOI: 10.1111/head.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022]
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16
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Krasenbaum LJ. A Review of Vomiting and Migraine-Related Clinical Parameters in Pediatric Migraine. Headache 2017; 57:979-980. [DOI: 10.1111/head.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lynda J. Krasenbaum
- New York Headache Center, 30 East 76th Street, Floor 2; New York NY 10021 USA
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17
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Krasenbaum LJ. A Review of Radiofrequency for Arteriovenous Malformations and the Impact on Headache. Headache 2017; 57:812-813. [PMID: 28444946 DOI: 10.1111/head.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Lynda J Krasenbaum
- Associate Director, New York Headache Center, 30 East 76th Street, Floor 2, New York, NY, 10021, USA
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18
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Affiliation(s)
- Lynda J Krasenbaum
- Associate Director, New York Headache Center; 30 East 76th Street, Floor 2 New York NY 10021 USA
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19
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Krasenbaum LJ. A Review of “Untangling the Association Between Migraine, Pain, and Anxiety: Examining Migraine and Generalized Anxiety Disorders in a Canadian Population Based Study”. Headache 2017; 57:500-501. [DOI: 10.1111/head.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Lynda J. Krasenbaum
- From the New York Headache Center; 30 East 76 Street, Floor 2 New York NY 10021 USA
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20
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Krasenbaum LJ. A Review of “Hormonal Contraceptives and Migraine With Aura - Is There Still a Risk?”. Headache 2017; 57:313. [DOI: 10.1111/head.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Lynda J Krasenbaum
- New York Headache Center; 30 East 76th Street, Floor 2 New York NY 10021 USA
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21
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Krasenbaum LJ. A Review of "Peripheral Nerve Blocks for the Treatment of Headache in Older Adults: A Retrospective Study". Headache 2016; 57:128. [PMID: 27933611 DOI: 10.1111/head.13001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Lynda J Krasenbaum
- Associate Director, New York Headache Center, 30 East 76th Street, Floor 2, New York, NY 10021, USA
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