Introduction

Fremanezumab (trade name: Ajovy) has been approved in Germany since March 2019 for the prevention of migraine. It is an option for adults who have migraine attacks on at least four days a month.

Migraine attacks start suddenly with severe pain, often on only one side of your head. They are much worse than normal headaches and are described as throbbing or pounding. Migraine attacks are usually accompanied by additional symptoms such as nausea, vomiting or sensitivity to light and noise. Left untreated, the symptoms last between four hours and three days. Migraine can greatly affect everyday life.

Fremanezumab is an antibody. It inhibits the effect of a certain protein (calcitonin gene-related peptide, CGRP) that plays a role in triggering migraine attacks. This aims to prevent migraine attacks.

Application

Fremanezumab is injected under the skin, either once a month at a dose of 225 mg or every three months at a dose of 675 mg. The success of the treatment should be assessed within three months in order to decide whether it should be continued.

Other treatments

For patients who haven't had treatment before or who didn't tolerate or didn't benefit enough from at least one type of preventive treatment, the treatment options generally include the drugs metoprolol, propranolol, flunarizine, topiramate and amitriptyline. If these drugs aren't effective either, further options include valproic acid or, for certain patients, clostridium botulinum toxin type A. If none of these treatments is suitable, best supportive care (BSC) is an option. This treatment should be tailored to the patient's individual needs, with the aim of relieving symptoms and improving quality of life.

Assessment

In 2019, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of fremanezumab compared with the standard treatments for the prevention of migraine attacks.

But the manufacturer didn’t provide any suitable data with which to do the assessment.

More information

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of fremanezumab (Ajovy).