CGRP-Blocking Migraine Drug Fremanezumab Reduces ER Visits, Medication Use, and Costs in Complex Patients

What the researchers found

Among 3,193 eligible patients, fremanezumab initiation was associated with significant reductions in: acute medication claims (0.97 to 0.86 PPPM, p<0.001), preventive medication claims excluding fremanezumab (0.94 to 0.81 PPPM, p<0.001), outpatient visits, neurologist visits, ER visits, and other outpatient services (all p<0.001). Total migraine-related healthcare costs decreased from $541 to $490 PPPM (p=0.003). Adherence was good with mean proportion of days covered of 0.71 and persistence duration of 160.3 days at 6 months.

Why it matters

Migraine patients with comorbidities and failed prior treatments are the hardest and most expensive to manage. Showing that fremanezumab reduces their healthcare utilization and costs — not just in clinical trials but in real-world practice — supports its value for this difficult-to-treat population and helps justify its cost to insurers and healthcare systems.

How the study worked

Retrospective US insurance claims analysis using Merative MarketScan databases. Adults with migraine who initiated fremanezumab between September 2018 and June 2019 were included if they had ≥12 months pre-index data and ≥6 months post-index follow-up, plus qualifying comorbidities (depression, anxiety, cardiovascular disease), acute medication overuse, or unsatisfactory prior preventive response. Pre vs post comparisons assessed medication use, healthcare resource utilization, and costs.

What this study cannot tell us

This is a retrospective claims study without a control group, so changes cannot be definitively attributed to fremanezumab versus natural disease fluctuation or regression to the mean. Claims data lack clinical outcomes like migraine frequency or severity. The $51 monthly cost reduction may not offset fremanezumab's drug cost. The study was funded by Teva Pharmaceuticals, the manufacturer of fremanezumab.

How to read the evidence

This is a large retrospective claims analysis providing real-world evidence. While the sample size is substantial, the lack of a control group and reliance on claims data (without clinical outcomes) limit the strength of causal conclusions. Industry funding adds a potential bias consideration.

When this study was published

Published in 2024 using data from 2018–2019, this study captures the early real-world experience with fremanezumab shortly after its market launch.

The bigger picture

CGRP-targeting antibodies (fremanezumab, erenumab, galcanezumab) have transformed migraine prevention. As these relatively expensive biologics compete for formulary placement, real-world evidence on cost offsets and healthcare utilization becomes crucial for justifying their use, particularly in patients with complex migraine who drive disproportionate healthcare spending.

Questions still open

• Does fremanezumab's cost savings offset its drug acquisition cost in these complex patients when total spending is considered?
• How do the real-world HCRU reductions with fremanezumab compare to those seen with competing CGRP antibodies like erenumab or galcanezumab?
• Would longer follow-up show sustained or increasing benefits, or do effects plateau over time?

Common questions

Read the original research

Real-world Impact of Fremanezumab on Migraine-Related Health Care Resource Utilization in Patients with Comorbidities, Acute Medication Overuse, and/or Unsatisfactory Prior Migraine Preventive Response.

Pain and therapy, 13(3), 511-532

Citation

Buse, Dawn C; Krasenbaum, Lynda J; Seminerio, Michael J; Packnett, Elizabeth R; Carr, Karen; Ortega, Mario; Driessen, Maurice T. (2024). Real-world Impact of Fremanezumab on Migraine-Related Health Care Resource Utilization in Patients with Comorbidities, Acute Medication Overuse, and/or Unsatisfactory Prior Migraine Preventive Response.. Pain and therapy, 13(3), 511-532. https://doi.org/10.1007/s40122-024-00583-9