A Real‐World Analysis of Patient Characteristics, Treatment Patterns, and Level of Impairment in Patients With Migraine Who are Insufficient Responders vs Responders to Acute Treatment

Abstract

Objective The objective of this study was to examine if patients with migraine who responded sufficiently to acute treatment were significantly different from those who did not in terms of patient characteristics, treatment patterns, and patient level of impairment, and to identify characteristics associated with insufficient response. Background Migraine is highly prevalent and impacts functional ability substantially. Current treatment approaches are not sufficiently meeting the needs of patients, and inadequate response to acute treatment is reported by at least 56% of patients with migraine in the United States. Methods Data were obtained from the 2014 Adelphi Migraine Disease‐Specific Program, a cross‐sectional survey. Using logistic regression, we assessed the association between patient factors and insufficient response. Responders were defined as patients with migraine who achieved pain freedom within 2 hours of acute treatment in ≥4 of 5 attacks, while insufficient responders achieved it in ≤3 of 5 attacks. Results Of 583 patients included, insufficient responders to acute treatment constituted 34.3% (200/583) of the study population. A statistically significantly larger proportion of insufficient responders vs responders had ≥4 migraine headache days/month (46.3% [88/190] vs 31% [114/368]), had ever been prescribed ≥3 unique preventive treatment regimens (11.7% [21/179] vs 6.3% [22/347]), and had chronic migraine, medication‐overuse headaches, and comorbid depression (all P values ≤.05). Patient level of impairment was statistically significantly greater among insufficient responders vs responders. Factors associated with insufficient response after adjusting for covariates included Migraine Disability Assessment total score (odds ratio [OR] = 1.04, 95% CI [1.02, 1.05]), time of administration of acute treatment (OR = 1.83, 95% CI [1.15, 2.92]), depression (OR = 1.98, 95% CI [1.21, 3.23]), sensitivity to light not listed as current most troublesome symptom (OR = 2.30, 95% CI [1.21, 4.37]), and change in the average headache days per month before being prescribed an acute treatment vs now (OR = 1.75, 95% CI [1.05, 2.90]). Conclusions Clinical characteristics, treatment patterns, and health‐related quality of life measures are statistically significantly different between insufficient responders and responders to acute treatment in patients with migraine.

Factors associated with insufficient response to acute treatment of migraine in Japan: analysis of real-world data from the Adelphi Migraine Disease Specific Programme

“…However, insufficient responders to acute treatment were more likely than sufficient responders to exhibit greater migraine severity, as indicated by the higher proportions of insufficient responders with a clinical diagnosis of chronic migraine or medication-overuse or tension-type headache and the greater requirements of insufficient responders for extra doses of prescribed acute medication to relieve pain symptoms or symptoms of a migraine attack. Headache-related disability was also significantly greater and HRQoL significantly lower in Japanese insufficient responders to acute treatment than in sufficient responders, and similar findings have been reported in the overall 2017 analysis of Adelphi Migraine DSP data from USA, France, Germany, Italy, Spain, and the UK [20] and in the 2014 US Adelphi Migraine DSP [19].…”

“…Factors associated with insufficient response to prescribed acute treatment identified in the logistic model of this analysis of real-world data from Japan included taking acute prescribed medication when/after pain started versus at first sign of migraine, seeing a neurologist rather than an internist, having cardiovascular disease, and a higher MIDAS score. Few previous studies have investigated factors associated with response to acute therapy in people with migraine, but similar findings were reported in an analysis of the 2014 US Adelphi Migraine Specific DSP data [19]. In that analysis, taking acute medication when/after pain started (vs. at first sign of migraine) and higher MIDAS total scores were also associated with insufficient response to acute treatment.…”

“…In that analysis, taking acute medication when/after pain started (vs. at first sign of migraine) and higher MIDAS total scores were also associated with insufficient response to acute treatment. The study additionally identified depression as significantly associated with insufficient response [19], a finding also reported by the US AMPP population-based study [25].…”

“…Our findings support those of other real-world studies, including Adelphi Migraine DSPs conducted using the same methodology as that used in the current study. A 2014 US Adelphi Migraine DSP found that insufficient responders to acute therapy comprised 34% of the study population [19], and the same percentage of insufficient responders to acute treatment with triptans (34%) was found in a recent analysis of data from a 2017 Adelphi Migraine DSP conducted in the USA, France, Germany, Italy, Spain, and the UK [20].…”

“…Comparison of the Japan and US Adelphi Migraine DSP insufficient responder data reveals notably lower mean MIDAS scores in the Japanese cohort (12.7 vs. 21.0, indicating less migraine-related disability) and more frequent reports of little or no disability (69.1% vs. 31.5%) [19]. One reason for these differences could be that the proportion of insufficient responders experiencing a low frequency (0-3) of migraine headache days per month was higher in the Japanese cohort than in the corresponding US cohort (59.9% vs. 53.7%) [19]. Additionally, these findings are possibly indicative of cultural differences between Japan and the USA.…”