OBJECTIVES: Real-world data are limited on use of fremanezumab, a fully-humanized monoclonal antibody (IgG2Δa) that targets calcitonin gene-related peptide (CGRP), in migraine patients with acute medication overuse (AMO). This retrospective US claims database analysis evaluated migraine-related healthcare resource utilization (HCRU) and costs for patients with potential AMO initiating fremanezumab treatment.

METHODS: Adult patients (≥18 years) initiating fremanezumab treatment between September 1, 2018–June 30, 2019 (date of earliest claim=index date) were identified from the IBM/MarketScan Commercial and Medicare supplemental database, a US-based retrospective database of healthcare service and outpatient prescription data from a convenience sample of individuals with employer-sponsored health insurance. Other inclusion criteria were 12 months of continuous database enrollment pre-index, ≥6 months of data post-index, and evidence of pre-index common comorbidities, AMO, or difficult-to-treat migraine (DTTM) (defined by inadequate response to multiple prior migraine preventive treatment classes). Migraine-related HCRU and costs were analyzed in a subgroup with potential AMO (NSAIDs, acetaminophen, or aspirin, ≥15 pills/month; triptans, ergots, opioids, or combination medications, ≥10 pills/month) in the 90 days pre-index.

RESULTS: 46% (1,458/3,193) of patients with comorbidities, AMO, or DTTM who initiated fremanezumab during the study period had potential AMO. Post-index versus pre-index, mean(SD) migraine-related HCRU per-patient-per-month (PPPM) was significantly lower for migraine-related acute medication claims (1.33[0.98] vs 1.50[0.99], P<0.001) and outpatient office visits (0.35[0.33] vs 0.37[0.32], P=0.013) and was lower for neurologist office visits (0.14[0.18] vs 0.15[0.17]; P=0.236). Mean(SD) migraine-related costs PPPM were significantly lower post-index versus pre-index for neurologist office visits ($17[23] vs $19[23]), outpatient office visits ($41[44] vs $46[45]), and acute medications ($114[287] vs $139[287], all P<0.001). Excluding fremanezumab costs, overall migraine-related healthcare costs PPPM were also lower ($561[1,142] vs $602[994], P=0.156).