Monthly versus quarterly fremanezumab for the prevention of migraine: a systemic review and meta-analysis from randomized controlled trials

Comment on: Gao B, Lu Q, Wan R, Wang Z, Yang Y, Chen Z, Wang Z. “Monthly versus quarterly fremanezumab for the prevention of migraine: a systemic review and meta-analysis from randomized controlled trials”. Naunyn Schmiedebergs Arch Pharmacol. 2021 Apr;394(4):819–828. Epublished November 2020

“…The recent article “Monthly versus quarterly fremanezumab for the prevention of migraine: a systemic review and meta-analysis from randomized controlled trials” by Bixi Gao and colleagues, published in the April issue of Naunyn-Schmiedeberg’s Archives of Pharmacology, concluded that monthly administration of fremanezumab shows better outcomes for preventing migraine headaches than quarterly fremanezumab (Gao et al 2021 ). We have noted a critical flaw in this meta-analysis that directly impacts the study results and conclusions.…”

“…It is interesting to note that a previously published meta-analysis by the same authors that pooled data from the three phase 3 studies plus two phase 2b studies found no significant differences in mean change in MMD from baseline to week 12 for monthly versus quarterly fremanezumab dosing ( P = 0.86) (Gao et al 2020 ). However, the authors point out in their more recent publication (Gao et al 2021 ) that the results of the prior analysis were based on comparing the two dosage regimens with placebo and did not directly compare the two dosage regimens, hence their rationale for directly comparing quarterly versus monthly dosing in the current analysis. The authors acknowledge that a difference in monthly migraine headache days less than 0.3 days is too small to be of clinical importance, a supposition supported by a lack of a statistically significant difference between quarterly and monthly dosing in the proportion of patients reporting a 50% or greater reduction in monthly migraine headache days (Gao et al 2021 ).…”