Monthly Versus Quarterly Fremanezumab in Real Life: A Comparison of Effectiveness, Tolerability, and Adherence

Background: While clinical trials have shown no differences between monthly and quarterly regimens of fremanezumab, limited real‐life data exist for comparison. This study is aimed at comparing treatment regimens in real life. Methods: This observational, multicentre study conducted a retrospective analysis of patients initiating monthly or quarterly fremanezumab. Primary endpoints were the comparison of monthly migraine days’ reduction, adverse effects, and treatment discontinuation rates at 3 and 6 months. Secondary endpoints included changes in headache and medication intake frequencies, response rates, and patient‐reported outcomes. Results: One hundred and eleven patients were included, with a median age of 48.5 years, 91% women, and 54.1% with chronic migraine. Sixty‐four patients received a monthly regimen and 47 a quarterly. Baseline characteristics were similar. Reductions in monthly migraine days did not differ between treatment regimens (−5 [IQR −9, −1] for monthly versus −6 [IQR −8, −3] for quarterly at 3 months, p = 0.867, and −5 [IQR −10, −2] versus −5.5 [IQR −8.5, −3] at 6 months, p = 0.666, respectively). Adverse effects and discontinuation rates were similar between groups. Secondary endpoints were comparable, except for a higher PGIC scale for the quarterly group at 6 months (6 [IQR 4–6] versus 4 [IQR 2–6], p = 0.007). No differences were observed in the subgroup analysis of episodic or chronic migraine. Conclusions: Monthly and quarterly fremanezumab demonstrated comparable effectiveness, tolerability, and adherence in real life. Quarterly regimen may result in a more favorable global impression of change.