2026 American Academy of Neurology Abstract Website

Isabel Pavão Martins¹, Dimos Dimitrios Mitsikostas², Cristina Tassorelli³, Pinar Kokturk⁴, Stefania Zuppone⁴, Mario Ortega⁵, Juline Bryson⁶, Verena Ramirez Campos⁶
¹Centro de Estudos Egas Moniz, Faculty of Medicine, University of Lisbon, Lisbon, Portugal, ²Department of First Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece, ³Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; IRCCS C. Mondino Foundation, Pavia, Italy, ⁴Teva Netherlands B.V., Haarlem, The Netherlands, ⁵Teva Pharmaceutical Industries Ltd, Parsippany, NJ, USA, ⁶Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA

Objective:

Evaluation of the impact of migraine type (episodic or chronic; EM, CM), number of prior preventive treatment failures and treatment pauses on the reduction of monthly migraine days (MMD) induced by fremanezumab treatment among adults enrolled in the 24-month, observational, prospective, Phase 4 PEARL study.

Background:

Typically, drug reimbursement criteria limit the use of calcitonin gene-related peptide pathway monoclonal antibodies to individuals for whom multiple non-migraine-specific preventive treatments have failed, and mandate a pause in treatment after one year of continuous use. Evidence on the impact of these restrictions on treatment outcomes for individuals with migraine is limited.

Design/Methods:

The primary endpoint of the PEARL study was the proportion of participants with EM or CM achieving ≥50% reduction in MMD during the 6-month period after fremanezumab initiation. Further analyses evaluated the impact of migraine type (EM, CM) and prior preventive treatment failures (0–2 or ≥3) on the ≥50% responder rate (post-hoc), and the impact of pausing fremanezumab on MMD among participants with documented treatment cessation and reinitiation.

Results:

Of 1140 participants enrolled, 1129 were included in the effectiveness analysis: 56.5% (637/1128) achieved ≥50% reduction in MMD during the 6-month period after fremanezumab initiation. A reduction of ≥50% in MMD was achieved in 68.4% of participants with EM and 0–2 treatment failures (n = 106/155), compared with 50.5% of participants with CM and ≥3 treatment failures (n = 257/509); this trend was sustained over 24 months. Among 295 participants with documented fremanezumab cessation and reinitiation, mean MMD decreased from 9.6 at baseline of reinitiation to 6.8 at Month 1 and 6.1 at Month 3 after reinitiation, both values remaining higher than before treatment discontinuation (5.9).

Conclusions:

These analyses suggest that optimal treatment efficacy occurs when fremanezumab is initiated early, prior to failure of multiple other preventive treatments, and is sustained without interruption.