Impact of erenumab on acute medication usage and health care resource utilization among migraine patients: a US claims database study

Abstract

Background Migraine is one of the leading causes of disability worldwide. Erenumab is a fully human monoclonal antibody that targets the calcitonin gene-related peptide (CGRP) receptor. This study aimed to evaluate real-world evidence on the impact of erenumab on acute medication usage and health care resource utilization (HCRU) among migraine patients. Methods This retrospective effectiveness study utilized the US Optum’s de-identified Clinformatics® Data Mart database to identify migraine patients initiating erenumab between May 1, 2018 and September 30, 2019. Patients had to be at least 18 years old, with a minimum of three doses for erenumab in the 6-month post-index period and continuous medical/pharmacy coverage in the 12-month pre- and 6-month post-index period. The date of the first claim for erenumab served as the index date. Use of acute medications overall and at different drug class level, and HCRU were compared during the 6-month pre- vs. post-index period. Impact of erenumab on a composite endpoint of three possible events: 1) outpatient visit with a diagnosis of migraine and an associated acute medication claim within 7 days of the visit, 2) hospital admission with a primary diagnosis for migraine, or 3) emergency room visit with a primary diagnosis for migraine (any events that occurred ≤3 days apart were counted only once) was also evaluated. Results The analysis included 3171 identified patients. At 6 months, following initiation of erenumab, acute medication use including the number of types of acute medication, number of claims of each medication and % of patients who received acute medication, and HCRU were significantly decreased. For the composite outcome, the mean number of events decreased from 1.03 to 0.77 (rate ratio: 0.75; 95% CI: 0.71 to 0.79; P < 0.0001). A decrease in the proportion of patients with any of the three events was also observed (52.7% vs. 39.5%, P < 0.0001). Conclusion In this retrospective analysis, erenumab was associated with significantly reduced acute medication use and HCRU in a real-world setting, hence significantly reducing the burden of the disease. A composite endpoint could be used as a proxy to evaluate the burden of migraine attacks; however, further research is needed.

Long-Term Effectiveness of Three Anti-CGRP Monoclonal Antibodies in Resistant Chronic Migraine Patients Based on the MIDAS score

“…A similar reduction in outcome measures was observed in medication-overuse and non-medication-overuse patients (Table 2 ). These data are in line with recent open-label studies [ 9 , 14 , 29 ] and a subgroup analysis of one RCT, and with results from administrative databases [ 33 , 34 ]. In addition to the commonly used measure for medication overuse, we evaluated the absolute number of analgesics per month.…”

Reduction in acute migraine-specific and non-specific medication use in patients treated with erenumab: post-hoc analyses of episodic and chronic migraine clinical trials

“…In a retrospective longitudinal cohort study involving patients with ≥ 1 erenumab claim over a period of 12 months, acute medication was generally discontinued within 5–7 months as a result of erenumab initiation [ 28 ]. Additionally, retrospective analyses of patients identified from the Optum De-identified Electronic Health Record database in the US have shown a decrease in acute medication use over time [ 29 ] as well as significant decreases in the number of types of acute medication used, and the number of claims of each medication, over a period of 6 months following erenumab initiation [ 30 ]. Other analyses of patients with CM, including an Italian observational study, revealed that a monthly, six-dose course of erenumab (70 mg or 140 mg) resulted in a reduction in analgesic use and triptan use [ 31 ].…”

Monoclonal Antibodies Against Calcitonin Gene-related Peptide for Migraine Prophylaxis: A Systematic Review of Real-world Data

“…An exact breakdown of the search results can be seen in Figure 1. We classified these articles into pharmacoepidemiologic studies (n=8) [32][33][34][35][36][37][38][39], clinicbased studies (n=63) , case reports (n=30) and other articles (n=3) [133][134][135]. Seventy-three articles were retrospective and 31 prospective .…”

“…Five studies assessed the prescription of acute migraine medications six to twelve months before and six to twelve months after first administration of an anti-CGRP-mab. [32,33,35,37,38] The different methods of data representations do not allow to calculate direct comparisons or summaries of data. Comparing baseline to treatment with Erenumab, the prescription of acute migraine medications decreased by 49 % [35] and by 23 % [38], respectively; and the proportion of patients using no prescription acute medication at all or only one type increased [33].…”