Abstract
Fremanezumab is a monoclonal antibody inhibiting the CGRP signaling leading to migraine prophylaxis. Its efficacy and potential safety concerns are updated here. All available data on fremanezumab were searched in PubMed with emphasis on the mechanisms of action, efficacy, tolerability, and safety. There is class I evidence for the efficacy of fremanezumab in the prophylaxis of both EM and CM, by reducing 1 to 2 monthly migraine days over placebo, but in real-world studies the magnitude of efficacy was greater. Though the size of efficacy looks like that of some repurposed anti-migraine treatments, its excellent tolerably highly improves the likelihood to help versus harm outcome over all traditional medications. Fremanezumab works in people with migraine and medication overuse, in people with previous treatment failures, as well as in people with concomitant depression, improving both migraine and depression measures. The latest data, along with the recent approval for use in children and adolescents, are unique among all migraine treatments. Alone or in combination with botulinumtoxin A may improve resistance to migraine. Mild reactions at the injection site are the most common side effects. Thus, fremanezumab represents an optimal treatment for people with migraine and should be considered as first-line choice.