OBJECTIVES: There are limited real-world data on fremanezumab, a fully-humanized monoclonal antibody (mAb; IgG2Δa) that selectively targets calcitonin gene-related peptide (CGRP), in patients with prior exposure to other CGRP pathway-targeted mAbs such as erenumab. A US retrospective claims database study evaluated migraine-related healthcare resource utilization (HCRU) and costs for patients initiating fremanezumab treatment with common comorbidities, acute medication overuse (AMO), or difficult-to-treat migraine (DTTM) and prior erenumab exposure.

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 retrospective, US-based database containing healthcare service and outpatient prescription data from 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 comorbidities, AMO, or DTTM (defined by presence of certain comorbidities; potential AMO; or inadequate response to multiple prior migraine preventive treatment classes). Migraine-related HCRU and costs were analyzed in patients with ≥1 erenumab claim any time pre-index.

RESULTS: 13% (422/3,193) of patients with comorbidities, AMO, or DTTM who initiated fremanezumab during the study period had prior erenumab exposure. Post-index versus pre-index, mean(SD) migraine-related HCRU per-patient-per-month (PPPM) was significantly lower for migraine-related acute medication claims (1.03[0.96] versus 1.15[0.97]), neurologist office visits (0.18[0.22] versus 0.24[0.26]), and outpatient office visits (0.39[0.37] versus 0.49[0.40]; all P<0.001). Mean(SD) migraine-related costs PPPM were significantly lower post-index versus pre-index for outpatient office visits ($49[54] vs $64[64]), neurologist office visits ($23[33] vs $32[48]), and overall migraine-related healthcare costs (excluding fremanezumab; $784[1,386] vs $973[1,198]; all P≤0.001). Acute medication costs PPPM were also lower ($126[325] vs $143[327]; P=0.061).

CONCLUSIONS: There were statistically significant reductions in migraine-related HCRU and healthcare costs in patients with common comorbidities, AMO, or DTTM and prior erenumab exposure initiating fremanezumab treatment.