Patient characteristics and treatment utilization among patients with migraine initiating self-injectable calcitonin gene-related peptide monoclonal antibody and novel acute medication

Varnado, Oralee J; Hoyt, Maggie; Ye, Wenyu; Nicholson, Robert A.

doi:10.1080/03007995.2022.2091333

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…Additionally, the two study populations had important differences in insurance coverage. Specifically, our analysis included discount/coupon and cash coverage options, both not reported in Varnado et al [20]. Despite these differences, treatment patterns for traditional antimigraine medications during the pre-index period from Varnado et al generally aligned with results in our study.…”

Section: Discussionsupporting

confidence: 62%

Treatment patterns for patients initiating novel acute migraine specific medications (nAMSMs) in the context of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway

Zhou,

Urman,

Gill

et al. 2023

J Headache Pain

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Background New acute and preventive migraine medications are available, but data on current treatment patterns are limited. This study describes migraine treatment patterns among patients initiating novel acute migraine specific medications (nAMSMs), overall and by prior use of anti-calcitonin gene-related peptide (CGRP) pathway monoclonal antibodies (mAbs). Methods In this retrospective cohort study using IQVIA open-source pharmacy and medical claims data, we identified patients with ≥ 1 claim for a nAMSM (ubrogepant, rimegepant, lasmiditan) between 01/01/2020 and 09/30/2020 (index period). Patients were indexed on their first nAMSM claim and stratified into 2 cohorts: patients with prior mAb use (≥ 1 claim for erenumab, fremanezumab, galcanezumab in the 6-month pre-index period) or patients without prior mAb use. Treatment patterns were assessed during the 6-month post-index period. Results Overall, 78,574 patients were identified (63% indexed on ubrogepant, 34% on rimegepant, and 3% on lasmiditan) with 26,656 patients (34%) having had prior mAb use. In the pre-index period, 79% of patients used non-mAb preventive medications and 75% of patients used acute medications. Following the index nAMSM claim, 65% of patients had ≥ 1 refill and 21% had ≥ 4 refills of their index nAMSM; 10% of patients switched to another nAMSM. Post-index mAb use was observed in 82% of patients with a prior mAb and 15% of patients without. Among patients with pre- and post-index use of acute medications, 38% discontinued ≥ 1 acute medication class in the post-index period. Among patients with concomitant use of traditional preventive medications at index, 30% discontinued ≥ 1 concomitant preventive anti-migraine medication in the post-index period. Conclusions Most patients initiating nAMSMs had prior treatment with acute and preventive medications. Approximately one-third of patients had prior treatment with anti-CGRP pathway mAbs. After starting nAMSMs, more than one-third of patients discontinued at least one traditional acute medication and one-third of patients discontinued at least one traditional preventive medication. Despite nAMSM initiation, most patients with prior anti-CGRP pathway mAb use continued mAb use. Around 15% of patients without a prior mAb newly started a mAb. These results provide insight into how nAMSMs and mAbs have been integrated into clinical management of migraine in the real-world.

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Section: Discussionsupporting

confidence: 62%

Treatment patterns for patients initiating novel acute migraine specific medications (nAMSMs) in the context of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway

Zhou,

Urman,

Gill

et al. 2023

J Headache Pain

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“…However, there are limited real-world studies assessing treatment patterns, HCRU, and direct costs in this population. 16 To bridge this gap, this study aimed to describe the treatment patterns, HCRU, and direct costs among people with migraine who initiated self-injectable CGRP mAb and novel acute migraine medications concomitantly.…”

Section: Introductionmentioning

confidence: 99%

“…medications that bind to the CGRP 16 Data from two small clinical studies and a real-world study have reported favorable safety and tolerability for this combination. 18,19 However, our study did not assess safety or tolerability of concomitant CGRP mAb and novel acute migraine medications.…”

mentioning

confidence: 99%

“…There is limited real-world evidence on treatment patterns for CGRP mAb. 16,20,21 Those studies have reported adherence rates of 31% (PDC ≥ 80%) and 42% (MPR ≥ 80%) for erenumab at 6 months of follow-up, and 73% to 83% (PDC ≥ 80%) and 78% to 84% (MPR ≥ 80%) for monthly/quarterly fremanezumab at 6-month follow-up. 20,21 Among patients who discontinued their index CGRP mAb treatment, most patients switched to other non-CGRP mAb preventive treatments and very few restarted their index CGRP mAb treatment.…”

mentioning

confidence: 99%

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Treatment Patterns, Healthcare Resource Utilization, and Direct Costs Among Patients Initiating Concomitant Use of a Calcitonin Gene-Related Peptide Monoclonal Antibody (CGRP mAb) and Novel Acute Medication in the United States

Varnado,

Gulati,

Wheeler

et al. 2023

PPA

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To describe treatment patterns, all-cause and migraine-related healthcare resource utilization (HCRU), and direct costs among people with migraine treated with concomitant calcitonin gene-related peptide monoclonal antibody (CGRP mAb) and novel acute migraine medications (ubrogepant, rimegepant, lasmiditan) in the United States (US). Patients and Methods: This retrospective, observational cohort study utilized data from the IBM MarketScan ® Research Databases and included adults initiating CGRP mAb or novel acute migraine medication as index medications between May 01, 2018, and Feb 28, 2021. All-cause and migraine-related HCRU (number of visits) and costs at baseline (12 months pre-index) and at follow-up (12 months post-index) were descriptively analyzed; differences between values at follow-up and baseline were reported. Results: Of 4,167 included in the analysis (mean [SD] age: 43.7 [11.2] years), 89.2% were women, and 59.7% had chronic migraine. Adherence to the indexed CGRP mAb was 47% (using proportion of days covered [PDC]) and 80.1% (using medication possession ratio [MPR]); mean (SD) persistence was 273.4 (115.3) days). At follow-up, 43.9% of the patients discontinued their index preventive medication of which 80.2% switched to a different preventive migraine medication; 17.0% restarted their index preventive medication. Reductions in all-cause inpatient HCRU, all-cause inpatient and outpatient costs, and migraine-related outpatient HCRU were observed at follow-up vs. baseline, whereas increases in all-cause outpatient HCRU, all-cause medication costs, migraine-related inpatient HCRU, and migraine-related inpatient, outpatient, and medication costs were observed. Conclusion: In this study, observed treatment patterns with the indexed CGRP mAb were consistent with prior reports. Concomitant treatment with CGRP mAb and novel acute migraine medications led to reductions in some outcomes of HCRU and direct costs, however, increases were also observed. Treatment utilization, reductions in HCRU and cost savings identified in this study in favor of concomitant CGRP mAb and novel acute medications may help clinicians and other healthcare decision makers assessing appropriate therapeutic options for migraine management.

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Pharmacological management of migraine: current strategies and future directions

Pellesi,

Do,

Hougaard

2024

Expert Opinion on Pharmacotherapy

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Patient characteristics and treatment utilization among patients with migraine initiating self-injectable calcitonin gene-related peptide monoclonal antibody and novel acute medication

Cited by 4 publications

References 25 publications

Treatment patterns for patients initiating novel acute migraine specific medications (nAMSMs) in the context of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway

Treatment patterns for patients initiating novel acute migraine specific medications (nAMSMs) in the context of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway

Treatment Patterns, Healthcare Resource Utilization, and Direct Costs Among Patients Initiating Concomitant Use of a Calcitonin Gene-Related Peptide Monoclonal Antibody (CGRP mAb) and Novel Acute Medication in the United States

Pharmacological management of migraine: current strategies and future directions

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