Monthly and quarterly fremanezumab injections were equally effective for migraine prevention after 6 months, though monthly dosing showed a slight edge in the first 3 months.
Equal at 6 monthsMonthly and quarterly fremanezumab produced equivalent migraine reduction by 6 months, despite a slight early advantage for monthly dosing
What the researchers found
Both monthly (225 mg) and quarterly (675 mg) fremanezumab significantly reduced migraine days, headache days, and disability scores, with equivalent outcomes at 6 months despite a slight monthly advantage in the first quarter.
Why it matters
Choosing between monthly and quarterly injections affects patient convenience and adherence. Real-world evidence that quarterly dosing matches monthly dosing by 6 months gives migraine patients a less burdensome option without sacrificing effectiveness.
The numbers in context
95 patients enrolled across Italian centers; 225 mg monthly vs. 675 mg quarterly over 3 months of treatment.
How the study worked
Prospective, multicenter, real-life Italian study. 95 migraine patients (49 monthly, 46 quarterly) assessed at baseline, 3 months, and 6 months. Measured monthly migraine days, headache days, acute medication use, HIT-6, MIDAS, and NRS scores. 79 patients completed 6-month follow-up.
Who was studied
95 Italian migraine patients comparing monthly vs. quarterly fremanezumab
What this study cannot tell us
Non-randomized design — patients chose or were assigned regimens based on clinical judgment, so groups may differ. Moderate sample size (95 patients). Single-country study from Italian centers. Only 6 months of follow-up. No blinding or placebo control.
How to read the evidence
Moderate evidence: prospective multicenter real-world study with validated outcome measures, but limited by non-randomized design and moderate sample size.
When this study was published
Published in 2024. Reflects current real-world CGRP antibody prescribing practices.
The bigger picture
CGRP-targeting antibodies are revolutionizing migraine treatment, but practical questions about dosing frequency matter for patient adherence and quality of life. This real-world comparison suggests patients can choose the schedule that best fits their lifestyle without compromising treatment outcomes.
Questions still open
- Does the slight early advantage of monthly dosing matter for patients with very frequent migraines who need rapid relief?
- Would patient preference data show a strong preference for quarterly injections despite the potential first-quarter trade-off?
- Do these real-world findings hold in longer follow-up periods beyond 6 months?
Common questions
Should I choose monthly or quarterly fremanezumab injections?
What side effects should I expect from fremanezumab?
Read the original research
Effectiveness and safety of monthly versus quarterly fremanezumab for migraine prevention: An Italian, multicenter, real-life study.
European journal of neurology, 31(12), e16410
Citation
Zanandrea, Laura; Messina, Roberta; Cetta, Ilaria; Genovese, Federica; Guerrieri, Simone; Vernieri, Fabrizio; Altamura, Claudia; Cevoli, Sabina; Favoni, Valentina; Colombo, Bruno; Filippi, Massimo. (2024). Effectiveness and safety of monthly versus quarterly fremanezumab for migraine prevention: An Italian, multicenter, real-life study.. European journal of neurology, 31(12), e16410. https://doi.org/10.1111/ene.16410