Messoud Ashina (Copenhagen/ DK), Dimos Mitsikostas (Athens/ GR), Faisal Mohammad Amin (Copenhagen/ DK), Pinar Kokturk (Amsterdam/ NL), Anne C. Poole (Oslo/ NO), Gurdal Sahin (Lund/ SE), Christoph Schankin (Bern/ CH), Tomas Nezadal (Prague/ CZ), Isabel Pavão Martins (Lisbon/ PT), Patricia Pozo-Rosich (Barcelona/ ES), Paul Dorman (Newcastle upon Tyne/ GB), Marja-Liisa Sumelahti (Tampere/ FI), Leonidas Lyras (Amsterdam/ NL), Cristina Tassorelli (Pavia/ IT)
Abstract text (incl. figure legends and references)
Objective: Fremanezumab, a humanised monoclonal antibody selectively targeting calcitonin gene-related peptide (CGRP), is approved for preventive treatment of episodic and chronic migraine (EM, CM) in adults with ≥4 monthly migraine days. This interim analysis of the ongoing PEARL study aims to provide real-world data on preventive migraine medication use in patients initiating fremanezumab treatment.
Methods: PEARL is a 24-month, pan-European, prospective, observational study in patients (≥18 years) diagnosed with EM or CM and initiating fremanezumab. This study analysed past preventive treatment classes (PPT) used before fremanezumab. Medical history of patients was documented at baseline, including PPT class, duration of PTT, and reason for discontinuation.
Results: 574 pts (EM, 26%; CM, 74%) were included in analysis. The proportion of patients taking each PPT was as follows; anticonvulsants, 64.8% (mean±standard deviation [SD] duration of treatment, 9.7±13.00 months); beta-blockers, 60.8% (8.6±10.88 months); tricyclic antidepressants (TCA), 50.9% (9.4±11.37 months); onabotulinumtoxinA, 38.0% (19.4±17.07 months); calcium channel blockers, 28.2% (7.1±8.75 months); angiotensin II receptor blockers, 23.0% (8.7±12.25 months); erenumab 11.5% (11.0±10.42 months); valproic acid 11.1% (7.1±10.35 months); galcanezumab 0.3% (4.5±2.12 months). PPT discontinuation was most commonly due to lack of efficacy across all classes (42.4%-83.9%), while discontinuation due to lack of tolerability ranged from 0% to 39.2% across all classes.
Conclusion: In this interim analysis, most patients had received PPTs before fremanezumab initiation, most commonly anticonvulsants, beta-blockers, or TCA, with treatment durations of approximately 9 to 10 months. PPT discontinuation was generally due to lack of efficacy.