Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
OBJECTIVE: The objective of this systematic EBM review is to determine “Are quarterly fremanezumabinjections as effective as monthly fremanezumab injections at reducing the number of migraine days per month in adults with chronic migraines?”
STUDY DESIGN: A systematic review of three randomized controlled trials (RCTs) that were peer reviewed and published in English after 2015 comparing quarterly versus monthly fremanezumab injections in adults 18-70 with chronic migraines.
DATA SOURCE: Three RCTs were obtained from PubMed and selected based on their relevance to the clinical question and if the RCTs addressed patient oriented outcomes.
OUTCOMES: The three selected RCTs for review, the outcome measured was the mean change from baseline in the average number of migraine days per month during the 12-week treatment period after the first dose of fremanezumab using self-reported electronic headache diary entries by study participants.
RESULTS: All three studies found that quarterly fremanezumab injections were less efficacious at reducing the mean number of migraine days per month than monthly injections. Silberstein et al. (2017) reported a reduction from baseline in monthly average migraine days of -4.9 (+/- 0.4) with quarterly injections and -5.0 (+/- 0.4) with monthly injections. Ferrari et al. (2019) reported a reduction from baseline in monthly average migraine days of -3.9 ± 0.3 with quarterly injections and -4.5 ± 0.3 with monthly injections. Goadsby et al. (2020) reported a reduction from baseline in monthly average migraine days of -6.0 ± 0.3 with quarterly injections -6.0 ± 0.3 with monthly injections.
CONCLUSIONS: The results of these three studies showed that quarterly fremanezumab is not as effective as monthly fremanezumab injections at reducing the number of migraine days per month for individuals with a diagnosis of chronic migraines. However, the difference in mean reduction of migraine days between the quarterly and monthly injections was less than one day in all three studies - Silberstein (2017): 0.1 days, Ferrari (2019): 0.6 days, Goadsby (2020): 0.5 days
Due to these results, a conversation with patients pursuing this treatment and shared decision making would be appropriate regarding whether a monthly or quarterly injection would be most beneficial on a case-by-case basis.
Mellinger, Elaine, "Are quarterly fremanezumab injections as effective as monthly fremanezumab injections at reducing the number of migraine days per month in adults with chronic migraines?" (2022). PCOM Physician Assistant Studies Student Scholarship. 632.