Fremanezumab for migraine in children and adolescents: A promising option for Pakistan

Abstract

Dear Madam,

In Pakistan, migraine affects an estimated 22.5% of the population, which is notably higher than the global annual prevalence of 15%. ^[1] Among children and adolescents, the prevalence of migraine is approximately 11%^, with rates increasing with age.^[2] In paediatric migraine prophylaxis, commonly used pharmacologic agents, including B-blockers (propranolol), anticonvulsants (topiramate), tricyclic antidepressants, and calcium channel blockers, along with dietary supplements, are generally supported by limited and inconsistent evidence of efficacy. ^[3]

In a phase 3, multicenter, randomised, double-blind, three-month trial, fremanezumab was studied for its efficacy in children and adolescents with episodic migraine (defined as migraine of <14 headache days for >6 months). Participants were assigned in a 1:1 ratio to receive monthly subcutaneous fremanezumab or matching placebo, and were permitted to use acute migraine medications (excluding opiates and barbiturates). Reduction in mean monthly migraine days from baseline (the primary endpoint) was greater in the fremanezumab group (2.5 days) than in the placebo group (1.4 days) (P = 0.02). Secondary outcomes also favoured fremanezumab, including a greater reduction in monthly days with headache of at least moderate severity (2.6 vs. 1.5 days; P = 0.02). Additionally, a higher proportion of participants achieved a >50% reduction in monthly migraine days (47.2% vs. 27%), and the mean number of days requiring acute migraine medication was lower in the fremanezumab group (2.1 days vs. 1 day with placebo). Injection site erythema was the most commonly reported side effect in both groups. ^[4]

In Pakistan, where youth constitute a large proportion of the population, the burden of migraine and its impact on daily functioning require urgent attention. As a major contributor to school absenteeism and impaired quality of life, this issue must be addressed proactively. Increasing public awareness about effective preventive therapies, such as fremanezumab, is important to improve migraine burden and its impact. However, its accessibility, cost-effectiveness, and long-term safety in resource-limited settings remain uncertain. Further local research, along with increased physician and public awareness, is essential to improve early diagnosis, enhance treatment adherence, ensure affordability, and ultimately achieve better clinical outcomes.