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    Clinical Trial Results:
    A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study Comparing the Efficacy and Safety of 2 Dose Regimens of Subcutaneous Administration of TEV-48125 Versus Placebo for the Preventive Treatment of Chronic Migraine

    Summary
    EudraCT number
    2015-004549-23
    Trial protocol
    DE   CZ   ES   FI   DK  
    Global end of trial date
    10 Apr 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    15 Jun 2018
    First version publication date
    15 Jun 2018
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    TV48125-CNS-30049
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02621931
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Teva Branded Pharmaceutical Products R&D, Inc
    Sponsor organisation address
    41 Moores Road, Frazer, Pennsylvania, United States, 19355
    Public contact
    Director, Clinical Research, Teva Branded Pharmaceutical Products R&D, Inc., 1 215-591-3000, Info.era-clinical@teva.de
    Scientific contact
    Director, Clinical Research, Teva Branded Pharmaceutical Products R&D, Inc., 1 215-591-3000, Info.era-clinical@teva.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    19 Sep 2017
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    10 Apr 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    • to demonstrate the efficacy of 2 dose regimens of TEV-48125, as assessed by the decrease in the monthly average number of headache days of at least moderate severity during the 12-week period after the 1st dose of study drug relative to the baseline period • to evaluate the safety and tolerability of 2 dose regimens of TEV-48125 in the preventive treatment of chronic migraine (CM)
    Protection of trial subjects
    This study was conducted in full accordance with the International Council on Harmonisation (ICH) Good Clinical Practice (GCP) Consolidated Guideline (E6) and any applicable national and local laws and regulations (eg, Code of Federal Regulations Title 21, Parts 50, 54, 56, 312, and 314; European Union Directive 2001/20/EC on the approximation of the laws, regulations, and administrative provisions of the Member States relating to the implementation of GCP in the conduct of clinical trials on medicinal products for human use). Each investigator was responsible for performing the study in accordance with the protocol, ICH guidelines, and GCP, and for collecting, recording, and reporting the data accurately and properly. Agreement of each investigator to conduct and administer this study in accordance with the protocol was documented in separate study agreements with the sponsor and other forms as required by national authorities in the country where the study center is located. Written and/or oral information about the study was provided to all patients in a language understandable by the patients. The information included an adequate explanation of the aims, methods, anticipated benefits, potential hazards, and insurance arrangements in force. Written informed consent was obtained from each patient before any study procedures or assessments were done. It was explained to the patients that they were free to refuse entry into the study and free to withdraw from the study at any time without prejudice to future treatment. Each patient’s willingness to participate in the study was documented in writing in a consent form that was signed by the patient with the date of that signature indicated. Each investigator kept the original consent forms, and copies were given to the patients.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    22 Mar 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 28
    Country: Number of subjects enrolled
    Spain: 14
    Country: Number of subjects enrolled
    Czech Republic: 47
    Country: Number of subjects enrolled
    Finland: 36
    Country: Number of subjects enrolled
    Canada: 39
    Country: Number of subjects enrolled
    Israel: 20
    Country: Number of subjects enrolled
    Japan: 109
    Country: Number of subjects enrolled
    Russian Federation: 41
    Country: Number of subjects enrolled
    United States: 796
    Worldwide total number of subjects
    1130
    EEA total number of subjects
    125
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    1106
    From 65 to 84 years
    24
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 3148 patients with migraine provided written informed consent and were screened for entry into either Study TV48125-CNS-30049 or Study TV48125-CNS-30050. Of the 3148 patients screened, 1130 met the entry criteria, including diagnostic criteria for CM and diary compliance during the run-in period, and were randomized into this study.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst
    Blinding implementation details
    The sponsor, investigators, study staff (except for staff involved in bioanalytical analyses), and patients were blinded to treatment assignment.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    Patients who were randomized to receive placebo received three 1.5-mL placebo injections at Day 0 and a single 1.5-mL placebo injection at Days 28 and 56 .
    Arm type
    Placebo

    Investigational medicinal product name
    placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Placebo 2.25-mL pre-filled syringes identical in appearance to active intervention. Patients were dosed once approximately every 28 days for a total of 3 times. Study drug was administered at the clinical site.

    Arm title
    Fremanezumab 675 mg/placebo/placebo
    Arm description
    Patients who were randomized to receive fremanezumab 675 mg/placebo/placebo received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0, and placebo as a single 1.5-mL injection on Days 28 and 56.
    Arm type
    Experimental

    Investigational medicinal product name
    placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Placebo 2.25-mL pre-filled syringes identical in appearance to active intervention. Patients were dosed with placebo on Days 28 and 56. Study drug was administered at the clinical site.

    Investigational medicinal product name
    Fremanezumab
    Investigational medicinal product code
    Other name
    TEV-48125, anti-calcitonin gene-related peptide (anti-CGRP)
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Fremanezumab was provided as a sterile, unpreserved, aqueous solution for injection, supplied in a 2.25-mL pre-filled syringe for single-use administration. The 675 mg dose on Day 0 was given as 3 injections. Study drug was administered at the clinical site.

    Arm title
    Fremanezumab 675/225/225 mg
    Arm description
    Patients who were randomized to receive fremanezumab 675/225/225 mg received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0 and 225 mg of fremanezumab as 1 active injection (225 mg/1.5 mL) on Days 28 and 56.
    Arm type
    Experimental

    Investigational medicinal product name
    Fremanezumab
    Investigational medicinal product code
    Other name
    TEV-48125, anti-calcitonin gene-related peptide (anti-CGRP)
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Fremanezumab was provided as a sterile, unpreserved, aqueous solution for injection, supplied in a 2.25-mL pre-filled syringe for single-use administration. The 675 mg dose on Day 0 was given as 3 injections; doses of 225 mg on Days 28 and 56 were given as a single injection. Study drug was administered at the clinical site.

    Number of subjects in period 1
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Started
    375
    376
    379
    Safety and ITT population
    375
    376
    379
    Full analysis set (FAS)
    371
    375
    375
    Completed
    342
    349
    343
    Not completed
    33
    27
    36
         Adverse event, serious fatal
    -
    1
    -
         Consent withdrawn by subject
    12
    10
    11
         Adverse event, non-fatal
    8
    5
    7
         Pregnancy
    2
    -
    -
         non-compliance to study procedures
    -
    1
    2
         Lost to follow-up
    8
    7
    10
         Protocol deviation
    2
    2
    2
         not specified
    1
    1
    3
         Lack of efficacy
    -
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Patients who were randomized to receive placebo received three 1.5-mL placebo injections at Day 0 and a single 1.5-mL placebo injection at Days 28 and 56 .

    Reporting group title
    Fremanezumab 675 mg/placebo/placebo
    Reporting group description
    Patients who were randomized to receive fremanezumab 675 mg/placebo/placebo received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0, and placebo as a single 1.5-mL injection on Days 28 and 56.

    Reporting group title
    Fremanezumab 675/225/225 mg
    Reporting group description
    Patients who were randomized to receive fremanezumab 675/225/225 mg received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0 and 225 mg of fremanezumab as 1 active injection (225 mg/1.5 mL) on Days 28 and 56.

    Reporting group values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg Total
    Number of subjects
    375 376 379 1130
    Age categorical
    Units: Subjects
        18-45 years
    229 218 248 695
        46-65 years
    143 149 123 415
        >65 years
    3 9 8 20
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    41.4 ± 12.03 42.0 ± 12.37 40.6 ± 11.95 -
    Gender categorical
    Units: Subjects
        Female
    330 331 330 991
        Male
    45 45 49 139
    Race
    Units: Subjects
        White
    303 293 297 893
        Black
    29 33 37 99
        Asian
    40 40 41 121
        American Indian or Alaskan Native
    0 4 2 6
        Native Hawaiian or Other Pacific Islander
    1 2 0 3
        Other
    2 4 2 8
    Ethnicity
    Units: Subjects
        Not Hispanic or Latino
    343 352 338 1033
        Hispanic or Latino
    32 22 41 95
        Unknown
    0 1 0 1
        Not reported
    0 1 0 1
    Preventive Medication Use During Baseline
    Eligible patients entered a 28-day run-in/baseline period during which headache information was captured daily throughout study participation using the electronic headache diary device. During randomization, patients were stratified based on sex, country, and baseline preventive migraine medication use (yes, no) to ensure balance for the covariates.
    Units: Subjects
        Yes
    77 77 85 239
        No
    298 299 294 891
    Weight
    Units: kg
        arithmetic mean (standard deviation)
    72.6 ± 15.58 72.4 ± 15.79 72.5 ± 16.36 -
    Time Since Initial Migraine
    Units: years
        arithmetic mean (standard deviation)
    19.9 ± 12.86 19.7 ± 12.84 20.1 ± 11.98 -
    Total Number of Headache Days of Any Duration And Any Severity During the 28 Day Baseiine Period
    Eligible patients entered a 28-day run-in/baseline period during which headache information was captured daily throughout study participation using the electronic headache diary device.
    Units: days
        arithmetic mean (standard deviation)
    20.3 ± 4.19 20.4 ± 3.93 20.3 ± 4.26 -
    Number of Headache Days of At Least Moderate Severity
    Eligible patients entered a 28-day run-in/baseline period during which headache information was captured daily throughout study participation using the electronic headache diary device. Headache severity was subjectively rated by the patient as mild, moderate or severe.
    Units: days
        arithmetic mean (standard deviation)
    13.3 ± 5.82 13.2 ± 5.47 12.8 ± 5.80 -
    Number of Migraine Days
    Eligible patients entered a 28-day run-in/baseline period during which headache information was captured daily throughout study participation using the electronic headache diary device. Migraine headaches are as defined in The International Classification of Headache Disorders 3rd edition (ICHD-3).
    Units: days
        arithmetic mean (standard deviation)
    16.4 ± 5.15 16.2 ± 4.88 16.0 ± 5.19 -
    Number of Days of Use of Any Acute Headache Medications
    Eligible patients entered a 28-day run-in/baseline period during which headache information (including information about use of headache medications) was captured daily throughout study participation using the electronic headache diary device.
    Units: days
        arithmetic mean (standard deviation)
    13.0 ± 6.92 13.1 ± 6.79 13.1 ± 7.20 -
    Headache Impact Test (HIT-6) Disability Score
    Eligible patients entered a 28-day run-in/baseline period during which headache information was captured daily throughout study participation using the electronic headache diary device. HIT-6 measures the adverse impact of headache on social functioning, role functioning, vitality, cognitive functioning, and psychological distress. It also assesses headache severity. Scores range from 36 to 78, where a higher score indicates a greater impact of headache on the daily life of the patient. Scores ≥60 indicate severe impact.
    Units: units on a scale
        arithmetic mean (standard deviation)
    64.1 ± 4.80 64.3 ± 4.74 64.6 ± 4.42 -

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Patients who were randomized to receive placebo received three 1.5-mL placebo injections at Day 0 and a single 1.5-mL placebo injection at Days 28 and 56 .

    Reporting group title
    Fremanezumab 675 mg/placebo/placebo
    Reporting group description
    Patients who were randomized to receive fremanezumab 675 mg/placebo/placebo received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0, and placebo as a single 1.5-mL injection on Days 28 and 56.

    Reporting group title
    Fremanezumab 675/225/225 mg
    Reporting group description
    Patients who were randomized to receive fremanezumab 675/225/225 mg received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0 and 225 mg of fremanezumab as 1 active injection (225 mg/1.5 mL) on Days 28 and 56.

    Subject analysis set title
    Fremanezumab
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The first dose was 675 mg by subcutaneous injection for both fremanezumab treatment groups; therefore the data from both groups were combined for this comparison during the first 4 weeks of treatment.

    Subject analysis set title
    Placebo: no concomitant preventive migraine meds
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Patients who were randomized to receive placebo received three 1.5-mL placebo injections at Day 0 and a single 1.5-mL placebo injection at Days 28 and 56. Patients in this sub-group did not receive concomitant preventive migraine medication during the study.

    Subject analysis set title
    Active 675/placebo/p: no concomitant preventive migraine meds
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Patients who were randomized to receive fremanezumab 675 mg/placebo/placebo received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0, and placebo as a single 1.5-mL injection on Days 28 and 56. Patients in this sub-group did not receive concomitant preventive migraine medication during the study.

    Subject analysis set title
    Active 675/225/225: no concomitant preventive migraine meds
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Patients who were randomized to receive fremanezumab 675/225/225 mg received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0 and 225 mg of fremanezumab as 1 active injection (225 mg/1.5 mL) on Days 28 and 56. Patients in this sub-group did not receive concomitant preventive migraine medication during the study.

    Primary: Change from Baseline in the Monthly Average Number of Headache Days of At Least Moderate Severity During the 12-Week Period After the First Dose of Study Drug

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    End point title
    Change from Baseline in the Monthly Average Number of Headache Days of At Least Moderate Severity During the 12-Week Period After the First Dose of Study Drug
    End point description
    Headaches were subjectively rated by participants as mild, moderate or severe. A headache day of at least moderate severity was defined as a calendar day (00:00 to 23:59) where the patient (using the electronic headache diary device) reports: - a day with headache pain that lasts ≥4 hours with a peak severity of at least moderate severity or - a day when the patient used acute migraine-specific medication (triptans or ergots) to treat a headache of any severity or duration. Monthly averages are derived and normalized to 28 days equivalent by the following formula: (# days of efficacy variable over relevant period / # days with assessments recorded in the e-diary over the relevant period) * 28. The change is calculated as postbaseline value – baseline value. Full analysis set (FAS) included those in the ITT population who received at least 1 dose of study drug and had at least 10 days of post-baseline efficacy assessments on the primary endpoint.
    End point type
    Primary
    End point timeframe
    Baseline (Days -28 to Day -1), Treatment (Days 1 – Week 12)
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    371 [1]
    375 [2]
    375 [3]
    Units: headache days
        median (inter-quartile range (Q1-Q3))
    -2.5 (-5.6 to 0.0)
    -4.2 (-7.7 to -1.7)
    -4.5 (-7.8 to -1.7)
    Notes
    [1] - FAS
    [2] - FAS
    [3] - FAS
    Statistical analysis title
    Primary: Active 675/placebo/placebo to Placebo
    Statistical analysis description
    Due to the deviation from the normal distribution assumption of the data, the primary analysis was conducted using the Wilcoxon rank-sum test as outlined in the SAP.
    Comparison groups
    Placebo v Fremanezumab 675 mg/placebo/placebo
    Number of subjects included in analysis
    746
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [4]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [4] - 0.05 level of significance
    Statistical analysis title
    Primary: Active 675/225/225 to Placebo
    Statistical analysis description
    Due to the deviation from the normal distribution assumption of the data, the primary analysis was conducted using the Wilcoxon rank-sum test as outlined in the SAP.
    Comparison groups
    Placebo v Fremanezumab 675/225/225 mg
    Number of subjects included in analysis
    746
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [5]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [5] - 0.05 level of significance

    Primary: Participants with Adverse Events (AEs)

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    End point title
    Participants with Adverse Events (AEs) [6]
    End point description
    An adverse event was defined as any untoward medical occurrence that develops or worsens in severity during the conduct of a clinical study and does not necessarily have a causal relationship to the study drug. Severity was rated by the investigator on a scale of mild, moderate and severe, with severe= an AE which prevents usual activities. Relationship of AE to treatment was determined by the investigator. Serious AEs include death, a life-threatening adverse event, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability or incapacity, a congenital anomaly or birth defect, OR an important medical event that jeopardized the patient and required medical intervention to prevent the previously listed serious outcomes.
    End point type
    Primary
    End point timeframe
    Day 1 to Week 12
    Notes
    [6] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No intention to make inference based on stat analysis; the intent is to support clinical judgement.
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    375 [7]
    376 [8]
    379 [9]
    Units: participants
        Any AEs
    240
    265
    270
        Severe AEs
    20
    14
    15
        Treatment-related AEs
    159
    186
    194
        Serious adverse events
    6
    3
    5
        Deaths
    0
    1
    0
        Discontinued from study due to AE
    8
    5
    7
    Notes
    [7] - Safety population
    [8] - Safety population
    [9] - Safety population
    No statistical analyses for this end point

    Secondary: Change from Baseline in the Monthly Average Number of Migraine Days During the 12-Week Period After the First Dose of Study Drug

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    End point title
    Change from Baseline in the Monthly Average Number of Migraine Days During the 12-Week Period After the First Dose of Study Drug
    End point description
    A migraine day was defined as when at least 1 of the following situations occurred: - a calendar day (0:00 to 23:59) demonstrating at least 4 consecutive hours of a headache endorsing criteria for migraine with or without aura - a calendar day (0:00 to 23:59) demonstrating at least 4 consecutive hours of a headache endorsing criteria for probable migraine, a migraine subtype where only 1 migraine criterion is missing - a calendar day (0:00 to 23:59) demonstrating a headache of any duration that was treated with migraine-specific medications (triptans and ergot compounds) Monthly averages are derived and normalized to 28 days equivalent by the following formula: (# days of efficacy variable over relevant period / # days with assessments recorded in the e-diary over the relevant period) * 28. The change is calculated as postbaseline value – baseline value.
    End point type
    Secondary
    End point timeframe
    Baseline (Days -28 to Day -1), Treatment (Days 1 – Week 12)
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    371 [10]
    375 [11]
    375 [12]
    Units: migraine days / month
        least squares mean (standard error)
    -3.2 ± 0.35
    -4.9 ± 0.35
    -5.0 ± 0.35
    Notes
    [10] - FAS
    [11] - FAS
    [12] - FAS
    Statistical analysis title
    Active 675/placebo/placebo to Placebo
    Comparison groups
    Placebo v Fremanezumab 675 mg/placebo/placebo
    Number of subjects included in analysis
    746
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [13]
    Method
    ANCOVA
    Parameter type
    LSM difference
    Point estimate
    -1.7
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.48
         upper limit
    -0.97
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.39
    Notes
    [13] - 0.05 level of significance
    Statistical analysis title
    Active 675/225/225 to Placebo
    Comparison groups
    Placebo v Fremanezumab 675/225/225 mg
    Number of subjects included in analysis
    746
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [14]
    Method
    ANCOVA
    Parameter type
    LSM difference
    Point estimate
    -1.8
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.61
         upper limit
    -1.09
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.39
    Notes
    [14] - 0.05 level of significance

    Secondary: Percentage of Participants With At Least 50% Reduction In Monthly Average Number of Headache Days of At Least Moderate Severity

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    End point title
    Percentage of Participants With At Least 50% Reduction In Monthly Average Number of Headache Days of At Least Moderate Severity
    End point description
    Responder rates were defined as the percentage of total subjects who reached at least a 50% reduction in the monthly average of headache days (as subjectively reported by participants in the study diary) of at least moderate severity relative to the baseline period. For the overall analysis (Month 1-3), patients who discontinued early were considered nonresponders. Monthly averages are derived and normalized to 28 days equivalent by the following formula: (# days of efficacy variable over relevant period / # days with assessments recorded in the e-diary over the relevant period) * 28. The percentage reduction in monthly average is calculated as: ((baseline value - postbaseline value) / baseline value) * 100
    End point type
    Secondary
    End point timeframe
    Baseline (Days -28 to Day -1), Treatment: Month 1, Month 2, Month 3, Month 1-3 (Days 1 – Week 12)
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    370 [15]
    375 [16]
    374 [17]
    Units: percentage of total participants
    number (not applicable)
        Month 1 (n=370, 375, 374)
    21.6
    41.3
    40.0
        Month 2 (n=355, 365, 361)
    24.3
    39.7
    41.9
        Month 3 (n=342, 350, 345)
    26.4
    40.5
    44.5
        Overall - Months 1-3 (n=370, 375, 374)
    18.1
    37.6
    40.8
    Notes
    [15] - FAS minus one subject who had 0 headache days of >= moderate severity during baseline and treatment
    [16] - FAS
    [17] - FAS minus one subject who had 0 headache days of >= moderate severity during baseline and treatment
    Statistical analysis title
    Month 1: Active 675/placebo/placebo to Placebo
    Statistical analysis description
    P-value based on Cochran-Mantel-Haenszel test stratified by baseline preventive medication use.
    Comparison groups
    Placebo v Fremanezumab 675 mg/placebo/placebo
    Number of subjects included in analysis
    745
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [18]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [18] - 0.05 level of significance
    Statistical analysis title
    Month 1: Active 675/225/225 to Placebo
    Statistical analysis description
    P-value based on Cochran-Mantel-Haenszel test stratified by baseline preventive medication use.
    Comparison groups
    Placebo v Fremanezumab 675/225/225 mg
    Number of subjects included in analysis
    744
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [19]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [19] - 0.05 level of significance
    Statistical analysis title
    Month 2: Active 675/placebo/placebo to Placebo
    Statistical analysis description
    P-value based on Cochran-Mantel-Haenszel test stratified by baseline preventive medication use.
    Comparison groups
    Placebo v Fremanezumab 675 mg/placebo/placebo
    Number of subjects included in analysis
    745
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [20]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [20] - 0.05 level of significance
    Statistical analysis title
    Month 2: Active 675/225/225 to Placebo
    Statistical analysis description
    P-value based on Cochran-Mantel-Haenszel test stratified by baseline preventive medication use.
    Comparison groups
    Placebo v Fremanezumab 675/225/225 mg
    Number of subjects included in analysis
    744
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [21]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [21] - 0.05 level of significance
    Statistical analysis title
    Month 3: Active 675/placebo/placebo to Placebo
    Statistical analysis description
    P-value based on Cochran-Mantel-Haenszel test stratified by baseline preventive medication use.
    Comparison groups
    Placebo v Fremanezumab 675 mg/placebo/placebo
    Number of subjects included in analysis
    745
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [22]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [22] - 0.05 level of significance
    Statistical analysis title
    Month 3: Active 675/225/225 to Placebo
    Statistical analysis description
    P-value based on Cochran-Mantel-Haenszel test stratified by baseline preventive medication use.
    Comparison groups
    Placebo v Fremanezumab 675/225/225 mg
    Number of subjects included in analysis
    744
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [23]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [23] - 0.05 level of significance
    Statistical analysis title
    Overall: Active 675/placebo/placebo to Placebo
    Statistical analysis description
    P-value based on Cochran-Mantel-Haenszel test stratified by baseline preventive medication use. For the overall analysis, patients who discontinued early were considered nonresponders.
    Comparison groups
    Placebo v Fremanezumab 675 mg/placebo/placebo
    Number of subjects included in analysis
    745
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [24]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [24] - 0.05 level of significance
    Statistical analysis title
    Overall: Active 675/225/225 to Placebo
    Statistical analysis description
    P-value based on Cochran-Mantel-Haenszel test stratified by baseline preventive medication use. For the overall analysis, patients who discontinued early were considered nonresponders.
    Comparison groups
    Placebo v Fremanezumab 675/225/225 mg
    Number of subjects included in analysis
    744
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [25]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [25] - 0.05 level of significance

    Secondary: Change from Baseline in the Monthly Average Number of Days of Use of Any Acute Headache Medicine During the 12 Week Period After the First Dose of Study Drug

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    End point title
    Change from Baseline in the Monthly Average Number of Days of Use of Any Acute Headache Medicine During the 12 Week Period After the First Dose of Study Drug
    End point description
    Patients recorded any migraine medications (name of drug, number of tablets/capsules, and the dose in milligrams per tablet/capsule) taken on each day in their electronic headache diary device. Acute migraine-specific medication included triptans or ergots. Monthly averages are derived and normalized to 28 days equivalent by the following formula: (# days of efficacy variable over relevant period / # days with assessments recorded in the e-diary over the relevant period) * 28. The change is calculated as postbaseline value – baseline value.
    End point type
    Secondary
    End point timeframe
    Baseline (Days -28 to Day -1), Treatment (Days 1 – Week 12)
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    371 [26]
    375 [27]
    375 [28]
    Units: days
        median (inter-quartile range (Q1-Q3))
    -2.0 (-5.3 to 0.2)
    -3.6 (-7.3 to -0.7)
    -4.2 (-7.6 to -1.1)
    Notes
    [26] - FAS
    [27] - FAS
    [28] - FAS
    Statistical analysis title
    Active 675/placebo/placebo to Placebo
    Statistical analysis description
    Due to the deviation from the normal distribution assumption of the data, the primary analysis was conducted using the Wilcoxon rank-sum test as outlined in the SAP.
    Comparison groups
    Fremanezumab 675 mg/placebo/placebo v Placebo
    Number of subjects included in analysis
    746
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [29]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [29] - 0.05 level of significance
    Statistical analysis title
    Active 675/225/225 to Placebo
    Statistical analysis description
    Due to the deviation from the normal distribution assumption of the data, the primary analysis was conducted using the Wilcoxon rank-sum test as outlined in the SAP.
    Comparison groups
    Placebo v Fremanezumab 675/225/225 mg
    Number of subjects included in analysis
    746
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [30]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [30] - 0.05 level of significance

    Secondary: Change from Baseline in the Number of Headache Days of At Least Moderate Severity During the 4 Week Period After the First Dose of Study Drug

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    End point title
    Change from Baseline in the Number of Headache Days of At Least Moderate Severity During the 4 Week Period After the First Dose of Study Drug [31]
    End point description
    Headaches were subjectively rated by participants as mild, moderate or severe. A headache day of at least moderate severity was defined as a calendar day (00:00 to 23:59) where the patient (using the electronic headache diary device) reports: - a day with headache pain that lasts ≥4 hours with a peak severity of at least moderate severity or - a day when the patient used acute migraine-specific medication (triptans or ergots) to treat a headache of any severity or duration. The change is calculated as postbaseline value – baseline value. Full analysis set (FAS) included those in the ITT population who received at least 1 dose of study drug and had at least 10 days of post-baseline efficacy assessments on the primary endpoint.
    End point type
    Secondary
    End point timeframe
    Baseline (Days -28 to Day -1), Treatment (Days 1 – Week 4)
    Notes
    [31] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: This warning is a system artifact since there is a statistical analysis that compares the Placebo treatment group to the combined Fremanezumab analysis set.
    End point values
    Placebo Fremanezumab
    Number of subjects analysed
    371 [32]
    750 [33]
    Units: days
        least squares mean (standard error)
    -2.3 ± 0.33
    -4.6 ± 0.27
    Notes
    [32] - FAS
    [33] - FAS
    Statistical analysis title
    Change in Headache Days Over 4 Weeks
    Comparison groups
    Placebo v Fremanezumab
    Number of subjects included in analysis
    1121
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [34]
    Method
    ANCOVA
    Parameter type
    LSM difference
    Point estimate
    -2.3
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.95
         upper limit
    -1.73
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.31
    Notes
    [34] - 0.05 level of significance

    Secondary: Change from Baseline in the Monthly Average Number of Headache Days of At Least Moderate Severity During the 12 Week Period After the First Dose of Study Medication in Patients Not Receiving Concomitant Preventive Migraine Medications

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    End point title
    Change from Baseline in the Monthly Average Number of Headache Days of At Least Moderate Severity During the 12 Week Period After the First Dose of Study Medication in Patients Not Receiving Concomitant Preventive Migraine Medications
    End point description
    A subset of patients (specified in the protocol not to exceed 30%) were allowed to use 1 concomitant migraine preventive medication. This outcome only includes those participants who did not take concomitant preventive migraine medication during this study. Headaches were subjectively rated by participants as mild, moderate or severe. A headache day of >= moderate severity was defined as a calendar day where the patient (using the electronic headache diary device) reports: - a day with headache pain that lasts ≥4 hours with a peak severity of >= moderate severity or - a day when the patient used acute migraine-specific medication (triptans or ergots) to treat a headache of any severity or duration. Monthly averages are derived and normalized to 28 days equivalent by the following formula: (# days of efficacy variable over relevant period / # days with assessments recorded in the e-diary over the relevant period) * 28. Change is postbaseline value – baseline value
    End point type
    Secondary
    End point timeframe
    Baseline (Days -28 to Day -1), Treatment (Days 1 – Week 12)
    End point values
    Placebo: no concomitant preventive migraine meds Active 675/placebo/p: no concomitant preventive migraine meds Active 675/225/225: no concomitant preventive migraine meds
    Number of subjects analysed
    294 [35]
    298 [36]
    290 [37]
    Units: days
        median (inter-quartile range (Q1-Q3))
    -2.4 (-5.3 to 0.0)
    -4.4 (-8.0 to -1.7)
    -4.6 (-7.8 to -1.5)
    Notes
    [35] - FAS
    [36] - FAS
    [37] - FAS
    Statistical analysis title
    Active 675/placebo/placebo to Placebo
    Statistical analysis description
    Due to the deviation from the normal distribution assumption of the data, the primary analysis was conducted using the Wilcoxon rank-sum test as outlined in the SAP.
    Comparison groups
    Placebo: no concomitant preventive migraine meds v Active 675/placebo/p: no concomitant preventive migraine meds
    Number of subjects included in analysis
    592
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [38]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [38] - 0.05 level of significance
    Statistical analysis title
    Active 675/225/225 to Placebo
    Statistical analysis description
    Due to the deviation from the normal distribution assumption of the data, the primary analysis was conducted using the Wilcoxon rank-sum test as outlined in the SAP.
    Comparison groups
    Placebo: no concomitant preventive migraine meds v Active 675/225/225: no concomitant preventive migraine meds
    Number of subjects included in analysis
    584
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [39]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [39] - 0.05 level of significance

    Secondary: Change from Baseline in Migraine-Related Disability Score, As Measured by the 6-Item Headache Impact Test (HIT) At Week 12

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    End point title
    Change from Baseline in Migraine-Related Disability Score, As Measured by the 6-Item Headache Impact Test (HIT) At Week 12
    End point description
    The HIT-6 was developed by Kosinski et al (2003) as a short form for reliably assessing the adverse headache impact in clinical practice and clinical research settings. The questionnaire measures the adverse impact of headache on social functioning, role functioning, vitality, cognitive functioning, and psychological distress. It also assesses headache severity. Scores range from 36 to 78, where a higher score indicates a greater impact of headache on the daily life of the patient, ie, scores ≤49 represent little or no impact, scores between 50 and 55 represent some impact, scores between 56 and 59 represent substantial impact; and scores ≥60 indicate severe impact. Negative change from baseline values indicate less adverse impact of headache.
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0), Treatment Week 12 (4 weeks after the 3rd dose)
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    371 [40]
    375 [41]
    375 [42]
    Units: units on a scale
        median (inter-quartile range (Q1-Q3))
    -4.0 (-7.0 to 0.0)
    -5.0 (-10.0 to -2.0)
    -6.0 (-11.0 to -2.0)
    Notes
    [40] - FAS
    [41] - FAS
    [42] - FAS
    Statistical analysis title
    HIT-6: Active 675/placebo/placebo to Placebo
    Statistical analysis description
    Due to the deviation from the normal distribution assumption of the data, the primary analysis was conducted using the Wilcoxon rank-sum test as outlined in the SAP.
    Comparison groups
    Fremanezumab 675 mg/placebo/placebo v Placebo
    Number of subjects included in analysis
    746
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0004 [43]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [43] - 0.05 level of significance
    Statistical analysis title
    HIT-6: Active 675/225/225 to Placebo
    Statistical analysis description
    Due to the deviation from the normal distribution assumption of the data, the primary analysis was conducted using the Wilcoxon rank-sum test as outlined in the SAP.
    Comparison groups
    Fremanezumab 675/225/225 mg v Placebo
    Number of subjects included in analysis
    746
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [44]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [44] - 0.05 level of significance

    Secondary: Electrocardiogram (ECG) Findings Shifts From Baseline to Overall

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    End point title
    Electrocardiogram (ECG) Findings Shifts From Baseline to Overall
    End point description
    12-lead ECGs were performed before other assessments (eg, blood draws and administration of questionnaires) and performed in triplicate. The worst postbaseline finding for the patient is summarized. Only patients with both baseline and postbaseline ECGs are included. The ECG was evaluated by the investigator at the time of recording (signed and dated), and the printout was kept in the source documentation file. When potentially clinically significant findings were detected by the investigator, a cardiologist at a central diagnostic center was consulted for a definitive interpretation. Any ECG finding that was judged by the investigator as a potentially clinically significant change (worsening) compared with a baseline value was considered an adverse event. NCS = abnormal, not clinically significant CS= abnormal, clinically significant Shift format is: baseline finding / worst postbaseline finding
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0), Treatment Week 12 (or endpoint)
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    360 [45]
    361 [46]
    362 [47]
    Units: participants
        Normal / Normal
    215
    220
    223
        Normal / NCS
    54
    48
    43
        Normal / CS
    1
    0
    0
        NCS / Normal
    31
    34
    34
        NCS / NCS
    59
    59
    62
        NCS / CS
    0
    0
    0
        CS / Normal
    0
    0
    0
        CS / NCS
    0
    0
    0
        CS / CS
    0
    0
    0
    Notes
    [45] - Safety population of participants with both baseline and posttreatment ECGs
    [46] - Safety population of participants with both baseline and posttreatment ECGs
    [47] - Safety population of participants with both baseline and posttreatment ECGs
    No statistical analyses for this end point

    Secondary: Participants With Vital Signs Potentially Clinically Significant Abnormal Values

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    End point title
    Participants With Vital Signs Potentially Clinically Significant Abnormal Values
    End point description
    Vital signs were performed before other assessments (eg, blood draws and administration of questionnaires). Vital signs with potentially clinically significant abnormal findings included: - Pulse Rate High: >=120 and increase of >=15 beats per minute - Pulse Rate Low: <=50 and decrease of >=15 beats per minute - Systolic Blood Pressure Low: <=90 mmHg and decrease of >=20 mmHg - Diastolic Blood Pressure High: >=105 mmHg and increase of >=15 mmHg - Diastolic Blood Pressure Low: <=50 mmHg and decrease of >=15 mmHg - Respiratory Rate Low: <10 breaths / minute
    End point type
    Secondary
    End point timeframe
    Treatment Days 28, 56 and 84 (or endpoint). Changes from previous reading may reflect the baseline reading performed on Day 0.
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    366 [48]
    373 [49]
    372 [50]
    Units: participants
        Patients with at least 1 abnormality
    7
    10
    14
        Pulse Rate High
    0
    0
    1
        Pulse Rate Low
    1
    1
    0
        Systolic Blood Pressure Low
    2
    4
    6
        Diastolic Blood Pressure High
    1
    2
    3
        Diastolic Blood Pressure Low
    0
    1
    2
        Respiratory Rate Low
    3
    2
    3
    Notes
    [48] - Safety population of participants with both baseline and posttreatment values for each vital sign.
    [49] - Safety population of participants with both baseline and posttreatment values for each vital sign.
    [50] - Safety population of participants with both baseline and posttreatment values for each vital sign.
    No statistical analyses for this end point

    Secondary: Participants with Serum Chemistry and Hematology Potentially Clinically Significant Abnormal Results

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    End point title
    Participants with Serum Chemistry and Hematology Potentially Clinically Significant Abnormal Results
    End point description
    Serum chemistry and hematology laboratory tests with potentially clinically significant abnormal findings included: - Blood Urea Nitrogen (BUN) High: >=10.71 mmol/L - Creatinine High: >=177 umol/L - Bilirubin High: >=34.2 umol/L - Alanine Aminotransfrase (ALT): >=3*upper limit of normal (ULN) - Aspartate Aminotransferase (AST): >=3*upper limit of normal (ULN) - Gamma Glutamyl Transferase (GGT): >=3*upper limit of normal (ULN) - Hemoglobin: Male: <115 g/L or Female: <=95 g/L - Hematocrit: Male: <0.37 L/L or Female: <0.32 L/L - Leukocytes: >=20*10^9/L or <=3*10^9/L - Eosinophils/Leukocytes: >=10% - Platelets: >=700*10^9/L or <=75*10^9/L
    End point type
    Secondary
    End point timeframe
    Treatment Days 28, 56 and 84 (or endpoint).
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    366 [51]
    373 [52]
    371 [53]
    Units: participants
        BUN
    1
    1
    1
        Creatinine
    2
    0
    0
        Bilirubin
    0
    2
    0
        ALT
    2
    2
    7
        AST
    0
    3
    4
        GGT
    7
    7
    8
        Hemoglobin
    2
    5
    3
        Hematocrit
    8
    9
    7
        Leukocytes
    2
    9
    5
        Eosinophils/Leukocytes
    4
    5
    4
        Platelets
    1
    2
    0
    Notes
    [51] - Safety population of participants with at least one postbaseline result for the tests.
    [52] - Safety population of participants with at least one postbaseline result for the tests.
    [53] - Safety population of participants with at least one postbaseline result for the tests.
    No statistical analyses for this end point

    Secondary: Participants with Urinalysis Laboratory Tests Potentially Clinically Significant Abnormal Results

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    End point title
    Participants with Urinalysis Laboratory Tests Potentially Clinically Significant Abnormal Results
    End point description
    Urinalysis with potentially clinically significant abnormal findings included: - Blood: >=2 unit increase from baseline - Urine Glucose (mg/dL): >=2 unit increase from baseline - Ketones (mg/dL): >=2 unit increase from baseline - Urine Protein (mg/dL): >=2 unit increase from baseline
    End point type
    Secondary
    End point timeframe
    Treatment Days 28, 56 and 84 (or endpoint). Changes from previous reading reflect the baseline reading performed on Day 0.
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    365 [54]
    373 [55]
    372 [56]
    Units: participants
        Patients with at least 1 abnormality
    78
    57
    68
        Blood
    33
    32
    35
        Urine Glucose
    7
    7
    5
        Ketones
    7
    7
    7
        Urine Protein
    40
    19
    34
    Notes
    [54] - Safety population of participants with at least one postbaseline result for the tests.
    [55] - Safety population of participants with at least one postbaseline result for the tests.
    [56] - Safety population of participants with at least one postbaseline result for the tests.
    No statistical analyses for this end point

    Secondary: Prothrombin Time Shifts from Baseline to Endpoint

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    End point title
    Prothrombin Time Shifts from Baseline to Endpoint
    End point description
    Shifts in prothrombin time from baseline to endpoint were summarized using patient counts grouped into three categories: - Low (below normal range) - Normal (within the normal range of 9.4 to 12.5 seconds) - High (above normal range) Shift format is: baseline finding / endpoint finding
    End point type
    Secondary
    End point timeframe
    Baseline (Day 0), Treatment Endpoint (Week 12)
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    366 [57]
    373 [58]
    370 [59]
    Units: participants
        Low / Low
    0
    0
    0
        Low / Normal
    2
    0
    1
        Low / High
    0
    0
    0
        Normal / Low
    0
    1
    2
        Normal / Normal
    330
    318
    327
        Normal / High
    13
    17
    19
        High / Low
    0
    0
    0
        High / Normal
    14
    19
    12
        High / High
    7
    18
    9
    Notes
    [57] - Safety population of participants with both baseline and posttreatment values
    [58] - Safety population of participants with both baseline and posttreatment values.
    [59] - Safety population of participants with both baseline and posttreatment values.
    No statistical analyses for this end point

    Secondary: Injection Site Reaction Adverse Events

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    End point title
    Injection Site Reaction Adverse Events
    End point description
    Counts of participants who reported treatment-emergent injection site reactions as AEs are summarized. Preferred terms from MedDRA version 18.1 are offered without a threshold applied.
    End point type
    Secondary
    End point timeframe
    Day 1 to Week 12
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    375 [60]
    376 [61]
    379 [62]
    Units: participants
        Patients with at least 1 injection site reaction
    151
    176
    183
        Injection site pain
    104
    114
    99
        Injection site induration
    68
    74
    90
        Injection site erythema
    60
    80
    75
        Injection site haemorrhage
    10
    7
    8
        Injection site pruritus
    0
    6
    8
        Injection site rash
    0
    4
    3
        Injection site bruising
    2
    1
    2
        Injection site swelling
    0
    2
    1
        Injection site dermatitis
    0
    1
    0
        Injection site discomfort
    0
    1
    0
        Injection site haematoma
    0
    0
    1
        Injection site hypoaesthesia
    0
    0
    1
        Injection site inflammation
    0
    0
    1
        Injection site oedema
    0
    1
    0
        Injection site paraesthesia
    0
    0
    1
        Injection site urticaria
    2
    0
    1
        Injection site warmth
    2
    0
    1
    Notes
    [60] - Safety
    [61] - Safety
    [62] - Safety
    No statistical analyses for this end point

    Secondary: Participants with Positive Electronic Columbia Suicide Severity Rating Scale Results After the First Dose of Study Drug

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    End point title
    Participants with Positive Electronic Columbia Suicide Severity Rating Scale Results After the First Dose of Study Drug
    End point description
    The electronic Columbia-Suicide Severity Rating Scale (eC-SSRS) was used to assess the patient’s suicidal ideation (severity and intensity) and behavior (Posner et al 2011). The eC-SSRS Baseline/Screening version was completed by the patient at visit 2, and the eC-SSRS Since Last Visit version was completed by the patient at all other time points. Any positive findings on the eC-SSRS Since Last Visit version required evaluation by a physician or doctoral-level psychologist. Findings after the first dose of study drug using the eC-SSRS Since Last Visit version are summarized.
    End point type
    Secondary
    End point timeframe
    Day 1 to Week 12
    End point values
    Placebo Fremanezumab 675 mg/placebo/placebo Fremanezumab 675/225/225 mg
    Number of subjects analysed
    375 [63]
    376 [64]
    379 [65]
    Units: participants
        Participants with positive eC-SSRS responses
    1
    1
    1
        Specific finding: interrupted suicide attempt
    1
    1
    0
        Specific finding: suicidal ideation
    0
    0
    1
    Notes
    [63] - Safety
    [64] - Safety
    [65] - Safety
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Day 1 to Week 12
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.1
    Reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Patients who were randomized to receive placebo received three 1.5-mL placebo injections at Day 0 and a single 1.5-mL placebo injection at Days 28 and 56 .

    Reporting group title
    Fremanezumab 675/225/225 mg
    Reporting group description
    Patients who were randomized to receive fremanezumab 675/225/225 mg received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0 and 225 mg of fremanezumab as 1 active injection (225 mg/1.5 mL) on Days 28 and 56.

    Reporting group title
    Fremanezumab 675 mg/placebo/placebo
    Reporting group description
    Patients who were randomized to receive fremanezumab 675 mg/placebo/placebo received 675 mg of fremanezumab as 3 active injections (225 mg/1.5 mL) on Day 0, and placebo as a single 1.5-mL injection on Days 28 and 56.

    Serious adverse events
    Placebo Fremanezumab 675/225/225 mg Fremanezumab 675 mg/placebo/placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 375 (1.60%)
    5 / 379 (1.32%)
    3 / 376 (0.80%)
         number of deaths (all causes)
    0
    0
    1
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Uterine leiomyoma
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Wrist fracture
         subjects affected / exposed
    0 / 375 (0.00%)
    0 / 379 (0.00%)
    1 / 376 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Road traffic accident
         subjects affected / exposed
    0 / 375 (0.00%)
    0 / 379 (0.00%)
    1 / 376 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Clavicle fracture
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Accident
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ulna fracture
         subjects affected / exposed
    0 / 375 (0.00%)
    1 / 379 (0.26%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Radius fracture
         subjects affected / exposed
    0 / 375 (0.00%)
    1 / 379 (0.26%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fall
         subjects affected / exposed
    0 / 375 (0.00%)
    1 / 379 (0.26%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Hypertensive crisis
         subjects affected / exposed
    0 / 375 (0.00%)
    1 / 379 (0.26%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Migraine
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Oedema peripheral
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune system disorders
    Drug hypersensitivity
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Eye disorders
    Diplopia
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    0 / 375 (0.00%)
    0 / 379 (0.00%)
    1 / 376 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Asthma
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Dyspnoea
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Psychiatric disorders
    Suicidal ideation
         subjects affected / exposed
    0 / 375 (0.00%)
    1 / 379 (0.26%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Nephrolithiasis
         subjects affected / exposed
    1 / 375 (0.27%)
    0 / 379 (0.00%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Calculus urinary
         subjects affected / exposed
    0 / 375 (0.00%)
    1 / 379 (0.26%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    0 / 375 (0.00%)
    1 / 379 (0.26%)
    0 / 376 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    0 / 375 (0.00%)
    0 / 379 (0.00%)
    1 / 376 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Placebo Fremanezumab 675/225/225 mg Fremanezumab 675 mg/placebo/placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    160 / 375 (42.67%)
    178 / 379 (46.97%)
    185 / 376 (49.20%)
    General disorders and administration site conditions
    Injection site pain
         subjects affected / exposed
    104 / 375 (27.73%)
    99 / 379 (26.12%)
    114 / 376 (30.32%)
         occurrences all number
    288
    271
    296
    Injection site induration
         subjects affected / exposed
    68 / 375 (18.13%)
    90 / 379 (23.75%)
    74 / 376 (19.68%)
         occurrences all number
    130
    196
    159
    Injection site erythema
         subjects affected / exposed
    60 / 375 (16.00%)
    75 / 379 (19.79%)
    80 / 376 (21.28%)
         occurrences all number
    129
    166
    172
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    20 / 375 (5.33%)
    15 / 379 (3.96%)
    19 / 376 (5.05%)
         occurrences all number
    24
    16
    20

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    29 Mar 2016
    Amendment 1 to the protocol was issued while 3 patients were enrolled into the study. The following major procedural changes (not all-inclusive) were made to the protocol: - incorporation of required revisions based on health authority input from the European Medicines Agency, FDA, and Pharmaceuticals and Medical Devices Agency - provision of clarifying language for the inclusion and exclusion criteria - clarification of allowed and disallowed preventive medications - revision of protocol-defined adverse events of special interest and addition of clinical criteria for diagnosing anaphylaxis - update and/or clarification of versions of certain exploratory endpoints, including the EQ-5D (now -5L) and PGIC

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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