To compare real-world adherence, persistence, switching, and reinitiation among patients prescribed quarterly or monthly AJOVY dosing regimens.

AJOVY (fremanezumab) is the only monoclonal antibody targeting the calcitonin gene-related peptide (CGRP) pathway that is approved for both quarterly and monthly dosing for preventive migraine treatment in adults.

Data were obtained from the Veradigm Health Insights Database. The study period was January 1, 2014–June 30, 2019. Patients were included if they were ≥18 years; had ≥1 migraine diagnosis during the study period; and had a medication record for AJOVY on or after diagnosis during the identification period (September 1, 2018–December 31, 2018).

Overall, 186 (18.8%) and 801 (81.2%) patients were prescribed quarterly and monthly AJOVY, respectively. Patients prescribed quarterly dosing were more likely to be ≥65 years (12.4% vs monthly, 6.9%, P=0.012). Prior to initiating AJOVY, patients prescribed quarterly dosing were less likely to be prescribed acute medications (31.2% vs monthly, 40.2%, P=0.023), especially triptans (30.1% vs 39.2%, P=0.021). Patients prescribed quarterly dosing were more likely to be adherent based on proportion of days covered ≥80% (82.8% vs monthly, 72.9%; P=0.005) and medication possession ratio ≥80% (84.4% vs 77.8%; P=0.045). Patients prescribed quarterly dosing were more likely to be persistent for ≥6 months (82.8% vs monthly, 73.9%, P=0.011) and less likely to discontinue AJOVY (15.6% vs 23.4%, P=0.021). Nearly 4% of patients initiating monthly AJOVY titrated to quarterly and vice versa. Of patients discontinuing AJOVY, there was no significant difference between quarterly and monthly dosing in proportions switching to other acute/preventive migraine medications (44.8% vs 44.4%), reinitiating AJOVY (6.9% vs. 10.2%) or permanently discontinuing all migraine medications (48.3% vs 47.6%; all P>0.05).

This real-world study showed treatment adherence and persistence were higher for patients prescribed quarterly versus monthly dosing, with comparable switching and reinitiation rates.