2025 American Academy of Neurology Abstract Website

Andreas Straube¹, Gregor Broessner², Charly Gaul³, Xenia Hamann⁴, Torsten Kraya⁵, Lars Neeb⁶
¹University Clinic Munich, LMU, Neurology, Munich, Germany, ²Innsbruck Medical University, Neurology, Innsbruck, Austria, ³Headache Center Frankfurt, Frankfurt am Main, Germany, ⁴Teva GmbH, Ulm, Germany, ⁵Hospital Sankt Georg Leipzig gGmbH, Neurology, Leipzig, Germany, and University Hospital Halle, Headache Center, Neurology, Halle, Germany, ⁶Universitätsklinikum Brandenburg, Department of Neurology, Brandenburg an der Havel, Germany, and Charité – Universitätsmedizin Berlin, Neurology, Berlin, Germany

Objective:

To evaluate real-world long-term data on the effectiveness of fremanezumab in patients with migraine who switched from a previous calcitonin gene-related peptide (CGRP) pathway monoclonal antibody (mAb).

Background:

Switching from a receptor antibody to a ligand antibody, or vice versa, could be a useful therapeutic strategy for patients experiencing poor response or tolerability with one CGRP pathway mAb.

Design/Methods:

FINESSE is a 24-month, multicenter (Germany, Austria), prospective, non-interventional study in adults with episodic or chronic migraine (EM, CM). Primary endpoint: proportion of patients reaching ≥50% reduction in monthly average number of migraine days (MMD) during the 6-month period after fremanezumab initiation. Secondary endpoints included: changes from baseline in MMD; Migraine Disability Assessment (MIDAS) score; 6-Item Headache Impact Test (HIT-6) score; and days with acute medication use. This subgroup analysis of FINESSE presents long-term data in patients who had switched to fremanezumab from another CGRP pathway mAb.

Results:

Of 166 patients, 37.3% (n=62) achieved ≥50% reduction in MMD during the 6-month period after fremanezumab initiation (EM: 43.0% [n=37/86], CM: 31.3% [n=25/80]). Mean changes from baseline (±SD), at Months 6, 12, and 24, respectively, were: MMD: –6.0±5.9 (n=128), –6.0±5.0 (n=93), and –6.7±5.6 (n=66), (baseline, 13.0±6.3 [n=168]); MIDAS score: –26.2±39.2 (n=53), –34.3±48.4 (n=30), and –21.7±46.6 (n=18), (baseline, 73.9±57.3 [n=86]); HIT-6 score: –6.7±7.2 (n=59), –5.0±7.7 (n=30), and –4.5±7.1 (n=22), (baseline, 66.0±4.8 [n=98]); and days with acute medication use: –4.2±4.9 (n=128), –4.4±4.5 (n=93), and –4.5±4.7 (n=66), (baseline, 9.5±5.2 [n=168]).

Conclusions:

Overall, 37.3% of patients in this subgroup analysis achieved an MMD reduction of ≥50% within 6 months post-fremanezumab initiation. Clinically meaningful reductions in MMD, migraine and headache-related disability, and acute medication use were demonstrated over the entire 24-month treatment period. For patients experiencing inadequate effectiveness or poor tolerability with other CGRP pathway mAbs, switching to fremanezumab may be a sustained, effective treatment option.