Physician University of Cincinnati Mason, OH, United States
One Sentence Summary : This retrospective claims analysis exploring prescribing patterns based on US real world evidence indicates that nearly half of newly diagnosed migraine patients received no acute or preventive migraine prescription medications within 3 years of diagnosis, and non migaine-specific prescriptionos were common.
Background: Treatment options in patients with migraine have recently expanded with the introduction of oral calcitonin gene-related peptide (CGRP) antagonists (gepants), CGRP monoclonal antibodies (mAbs), and the 5-HT1F agonist lasmiditan. The objective of this study was to describe real-world treatment patterns in patients newly diagnosed with migraine between 2018-2021.
Methods: This retrospective cohort study was conducted using healthcare claims data from the Optum Market Clarity database, which contains medical and pharmacy insurance claims and electronic health records for over 86 million patients in the United States. The study included patients with a first migraine diagnosis (≥1 inpatient or ≥2 outpatient claims with an International Classification of Diseases, 10th Revision, Clinical Modification [ICD-10-CM] code of migraine), between July 1, 2018 and June 30, 2021. In addition, patients were required to be ≥18 years old at the first migraine diagnosis (index date). Patients were excluded if they had a migraine diagnosis or migraine-specific medication during the 12-month pre-index period or had < 12 months of pre-index or < 36 months of post-index continuous claims enrollment. Prescribing patterns were evaluated over a 3-year period following the index migraine diagnosis. Study outcomes included population demographics and clinical characteristics, utilization of acute migraine treatments (ergots, gepants, isometheptene combinations, lasmiditan, triptans), migraine-specific preventive treatments (CGRP mAbs, gepants, onabotulinumtoxin A), and other preventive treatments (beta-blockers, angiotensin converting enzyme inhibitors [ACEis], angiotensin receptor blockers [ARBs], anticonvulsants, memantine, serotonin-norepinephrine reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs]). Use of analgesics such as butalbital was also described.
Results: : A total of 165,281 patients who had a first migraine diagnosis within the study period were included. The study population was predominantly female (81.3%), and Caucasian (68.4%). Median age was 46 years (range, 18 to 85 years). During the 3-year follow-up period, 88,175 (53.3%) patients received at least one prescription medication for acute or preventive treatment of migraine. Median time from first migraine diagnosis to any prescription medication fill was 153 days (range, 0-1,095 days), and the most frequent specialties prescribing the first migraine medication were primary care (55.9%) and neurology (21.8%). The first migraine prescription was an acute treatment in 38,801 (23.5%) patients, preventive in 53,985 (32.7%), and both acute and preventive initiated concurrently in 4,611 (2.8%). A total of 50,229 patients (30.4%) received any acute treatment during the 3-year follow-up period, of which 44,913 (89.4%) received a triptan, 10,147 (20.2%) received a gepant indicated for acute treatment, 270 (0.5%) received lasmiditan, and 408 (0.8%) received an ergot. During the follow-up period, patients received a mean (standard deviation) of 1.3 (0.6) unique acute migraine medications. A total of 67,169 (40.6%) received any preventive treatment, of which the most common classes were beta-blockers (13.5%), anticonvulsants (12.1%), SNRIs (10.5%), TCAs (9.9%), and ACEi/ARBs (5.2%). Migraine-specific preventive therapies were used less frequently (overall, 8.3%), with 6.6% of patients prescribed anti-CGRP mAbs, 1.7% prescribed gepants indicated for preventive treatment, and 0.9% prescribed onabotulinumtoxin A. At least one butalbital prescription was filled by 12.8% of patients during the follow-up period.
Conclusion: Despite widely available migraine treatment guidelines, nearly half of patients newly diagnosed with migraine received no acute or preventive migraine prescription medications within 3 years of diagnosis. Prescribing non migraine-specific medications is common, with newer drug classes used infrequently.
Learning Objectives:
To describe the real-world diagnostic journey and treatment patterns in individuals newly diagnosed with migraine between 2018-2021
