Long-Term Efficacy of Fremanezumab in Patients with Chronic Migraine: a Systematic Review and Single-Arm Meta-Analysis
Oguz Kagan Sahin1, Luana Makita2, Aishwarya Koppanatham3, Murilo Cruccioli4, Letícia Campos5, Pedro Teixeira6, Nathalia Gregorio Barbosa Tavares7
1Acibadem University, Turkey, 2Federal University of Parana, Brazil, 3Andhra Medical College, India, 4Evangelical University of Goiás, Brazil, 5University of Ribeirão Preto, Brazil, 6University of Santo Amaro, Brazil, 7Faculty of Medical Sciences of São José dos Campos - Humanitas, Brazil
Objective:
This study aimed to assess the long-term efficacy of fremanezumab in patients with chronic migraine.
Background:
Fremanezumab, a humanized monoclonal antibody targeting the calcitonin gene-related peptide (CGRP), is FDA-approved for the preventive treatment of migraine. While short-term benefits of fremanezumab have been demonstrated in several meta-analyses, evidence regarding its long-term efficacy remains limited.
Design/Methods:
A systematic search was conducted using PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCT) and cohort studies evaluating the long-term (≥1 year) efficacy of fremanezumab in patients with chronic migraine. Data were analyzed using mean difference and event proportions. Heterogeneity was assessed with I² statistics. Generative AI was used solely to enhance scientific writing and improve clarity. The authors critically evaluated each AI intervention to ensure accuracy.
Results:
Five studies, including one RCT and four cohort studies, met the inclusion criteria for this meta-analysis. A total of 1,501 patients with chronic migraine were included, with 86,41% (n=1,297) of them receiving fremanezumab for at least one year. The treatment duration across studies ranged from 48 to 52 weeks. Pooled analysis of 1,243 patients from one RCT and three cohort studies revealed a mean monthly migraine day (MMD) reduction of -11.67 days (95% CI: -14.93, -8.42; I²: 97%). Additionally, the pooled analysis of 1,274 patients demonstrated that 64.98% (95% CI: 49.23%, 80.74%; I²: 95%) achieved at least a 50% reduction in the average number of monthly migraine days. The mean reduction in the monthly use of any analgesic medications was -10.32 days (95% CI: -15.43, -5.22, I²: 97%).
Conclusions:
Fremanezumab demonstrated sustained long-term efficacy in reducing both the frequency of migraine episodes and the use of analgesics in patients with chronic migraine. These findings support the favorable safety and efficacy profile of fremanezumab for long-term use. However, further well-designed, large-scale studies are necessary to strengthen these conclusions.
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