Teva Pharmaceuticals announced today that the U.S. Food and Drug Administration (FDA) has accepted its supplemental Biologics License Application (sBLA) for AJOVY® (fremanezumab-vfrm) to expand the indication to include the prevention of episodic migraine in children and adolescent patients aged 6-17 years who weigh 45 kilograms (99 pounds) or more.
If approved, AJOVY would become the first calcitonin gene-related peptide (CGRP) antagonist indicated for migraine prevention in both adults and pediatric patients, representing a significant advancement in addressing the substantial unmet need for effective migraine treatments in younger populations.
Addressing a Critical Gap in Pediatric Migraine Care
Migraine affects a considerable number of children and adolescents, causing significant disruption to their education, social development, and overall quality of life. Despite this burden, treatment options specifically approved for pediatric migraine prevention remain limited.
"Migraine is common among children and adolescents, often disrupting their education, social lives and overall well-being, yet treatment options remain limited," said Eric Hughes, MD, PhD, Executive Vice President, Global R&D and Chief Medical Officer at Teva. "As we work to bring the benefits of AJOVY to younger patients, we build upon its proven success in adults. If approved, AJOVY could be an important step toward filling the gap in pediatric migraine care, offering a much-needed solution for this underserved population."
Compelling Phase 3 Trial Results
The sBLA submission is based on positive results from the Phase 3 SPACE trial, which evaluated the efficacy and safety of fremanezumab for the prevention of episodic migraine in 237 pediatric patients aged 6 to 17 years. The multicenter, randomized, double-blind, placebo-controlled study demonstrated:
- Statistically significant reduction in monthly migraine days compared to placebo (-2.5 vs -1.4; P = .0210)
- Significant reduction in monthly headache days (-2.6 vs -1.5; P = .0172)
- A significantly higher proportion of patients achieving at least a 50% response rate on fremanezumab versus placebo (47.2% vs 27.0%; P = .0016)
- Benefits that were consistent across age subgroups (6-11 years and 12-17 years) and between boys and girls
Patricia Pozo-Rosich, MD, PhD, director of the Headache and Craniofacial Pain Clinical Unit and the Migraine Adaptive Brain Center at the Vall d'Hebron University Hospital, and a lead investigator in the SPACE trial, noted, "This is an important milestone for clinicians and young patients living with episodic migraine who currently have little treatment options available to them. This is the first Phase 3 trial of a CGRP-pathway treatment that has shown statistically superior efficacy with favorable safety and tolerability for the prevention of episodic migraine in children and adolescents."
Safety Profile Consistent with Adult Experience
The safety profile observed in the SPACE trial was favorable and consistent with that previously established in adults. The proportion of children reporting at least one adverse event was similar between the treatment group and placebo (55% vs 49%), with serious adverse events and discontinuations due to adverse events occurring in less than 3% and 1% of patients, respectively.
AJOVY's Established History in Migraine Prevention
AJOVY was initially approved by the FDA in 2018 for the preventive treatment of migraine in adults, becoming one of the first antibodies targeting the CGRP pathway—a major advancement in migraine care. It is currently the only anti-CGRP treatment for migraine prevention in adults in the U.S. that offers both quarterly (675 mg) and monthly (225 mg) dosing options, providing flexibility for patients and healthcare providers.
The medication is also approved in Europe and several other international markets, including Canada, Australia, and Japan.
Understanding Migraine in Pediatric Populations
Migraine can cause significant disability in children and adolescents, leading to school absences, impaired educational performance, and missed social activities. The condition often manifests differently in younger patients compared to adults, presenting unique challenges for diagnosis and management.
According to experts, pediatric migraine remains underdiagnosed and undertreated, with limited FDA-approved preventive options specifically for this age group. The potential approval of AJOVY for pediatric patients would provide a targeted therapy addressing the underlying pathophysiology of migraine through CGRP inhibition.
Looking at the CGRP Landscape
AJOVY belongs to a newer generation of CGRP-targeted therapies, which includes erenumab (Aimovig; Amgen), galcanezumab (Emgality; Eli Lilly), and eptinezumab (Vyepti; Lundbeck). However, if approved for the pediatric indication, AJOVY would be the first in this class to receive FDA approval for use in children and adolescents.
The FDA's review of the application is ongoing, with a decision expected in the coming months. If approved, this expanded indication would represent a significant milestone in pediatric migraine management, offering a much-needed therapeutic option for younger patients suffering from this debilitating neurological condition.
