Unmet Needs in Japanese Patients Who Report Insufficient Efficacy with Triptans for Acute Treatment of Migraine: Retrospective Analysis of Real-World Data

Hirata, Koichi; Ueda, Kaname; Komori, Mika; Ye, Wenyu; Kim, Yongin; Cotton, S; Jackson, James; Treuer, Tamás

doi:10.1007/s40122-020-00223-y

Cited by 9 publications

(14 citation statements)

References 42 publications

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“…Many of the respondents who delayed taking their medication did so in order to determine whether the attack was truly a migraine, whether it was sufficiently severe, and/or whether it might resolve without medication. This is consistent with recent analyses of both Japanese and global Adelphi study data, in which insufficient triptan responders were significantly more likely than sufficient responders to take their medication when or after the pain had started, rather than at the first sign of a migraine attack [ 21 , 22 ]. Delayed timing of taking acute medications has also been associated with insufficient response to acute treatments generally [ 21 ], so patients who have difficulty in timing their medication may benefit from novel acute treatments.…”

Section: Discussionsupporting

confidence: 90%

“…This is consistent with recent analyses of both Japanese and global Adelphi study data, in which insufficient triptan responders were significantly more likely than sufficient responders to take their medication when or after the pain had started, rather than at the first sign of a migraine attack [ 21 , 22 ]. Delayed timing of taking acute medications has also been associated with insufficient response to acute treatments generally [ 21 ], so patients who have difficulty in timing their medication may benefit from novel acute treatments. Improved patient education regarding timing of medication may also benefit this patient group.…”

Section: Discussionsupporting

confidence: 90%

“…Prior Presentation. This manuscript includes some data that were previously presented at the 62nd Annual Meeting of the Japanese Society of Neurology, Kyoto, Japan (May [19][20][21][22]2021) and at the 49th Annual Meeting of the Japanese Headache Society, Shizuoka, Japan (November 19-21, 2021).…”

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confidence: 99%

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Potential Unmet Needs in Acute Treatment of Migraine in Japan: Results of the OVERCOME (Japan) Study

et al. 2022

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Introduction: Using data from the ObserVational survey of the Epidemiology, tReatment, and Care Of MigrainE study in Japan (OVER-COME [Japan]), we describe the current status of the acute treatment of migraine in Japan. Methods: OVERCOME (Japan) was a crosssectional, observational, population-based web survey of people with migraine in Japan (met modified International Classification of Headache Disorders criteria or had a physician

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

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Potential Unmet Needs in Acute Treatment of Migraine in Japan: Results of the OVERCOME (Japan) Study

et al. 2022

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“…Previous studies indicated that insufficient response to triptans, the commonly prescribed acute treatment in migraine, could affect the quality of life of patients [ 2 , 26 – 28 ]. Furthermore, only 12.1% were currently using preventive medication within the patients who were eligible for the preventive medication [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Lasmiditan Across Patient and Migraine Characteristics in Japanese Patients with Migraine: A Secondary Analysis of the MONONOFU Trial

et al. 2022

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Introduction This MONONOFU trial subgroup analysis evaluates the efficacy of lasmiditan across patient and migraine characteristics in Japanese patients with migraine. Methods MONONOFU trial was a multicenter, randomized, double-blind, placebo-controlled study. The patients were randomly assigned in a 3:7:6:7 ratio to receive lasmiditan 50 mg, 100 mg, 200 mg, or placebo for a single migraine attack within 4 h of pain onset. Efficacy of lasmiditan vs placebo was evaluated at 2 h post dose for proportion of patients with headache pain freedom. Efficacy was assessed across patient characteristics (age, sex, body weight, cardiovascular risk factors (CVRF), and comorbidity of tension-type headache), migraine disease characteristics (history of migraine with aura, migraine prevention therapy, triptan response, and triptan use or nonuse), and migraine attack characteristics (headache severity, aggressive headache, attack during perimenstrual period, time to dosing, time of dosing, experienced treatment-emergent adverse event (TEAE) of dizziness, and experienced TEAE of somnolence). Logistic regression was used; all subgroup analyses were not analyzed with multiplicity-adjusted statistical tests. Results Treatment-by-subgroup interactions (by each arm) were not significant ( p ≥ 0.05) for pain freedom at 2 h post dose across all patient subgroups and lasmiditan doses, except for CVRF (100 mg and 200 mg), migraine with aura (50 mg), triptan response (50 mg), and time to dosing (200 mg). Treatment-by-subgroup interactions (by overall) were not significant ( p ≥ 0.05) for pain freedom at 2 h post dose across all patient subgroups, except for CVRFs. Higher proportions of patients were pain free at 2 h post dose when treated with lasmiditan (50 mg, 100 mg, and 200 mg) versus placebo, irrespective of most patient characteristics, migraine disease characteristics, and migraine attack characteristics. Conclusion Although few interactions were observed, lasmiditan could be a promising acute treatment option in a wide range of Japanese patients with migraine, as efficacy is not generally influenced by patient and migraine characteristics. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02304-0.

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“…In a Japanese Adelphi Migraine Disease Specific Programme, a cross-sectional survey study specifically looking at inefficacy of triptans, revealed that patients with triptan unresponsiveness have more frequent headache days per month (mean 5.7 vs. 4.5; p = 0.023) and migraine headache days per month (4.8 vs. 3.7; p = 0.013) than triptan responsive patients (25). This was a cross-sectional study and could not be a predictor of migraine progression; however, we cannot deny the association between higher frequency days and lack of responsiveness to acute care medication.…”

Section: Acute Care (Abortive) Treatment Of Migrainementioning

confidence: 99%

Medication “underuse” headache

Rattanawong,

Rapoport,

Srikiatkhachorn

2024

Cephalalgia

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Background Many risk factors have been associated with migraine progression, including insufficient and ineffective utilization of migraine medications; however, they have been inadequately explored. This has resulted in suboptimal usage of medications without effective altering of prescribing recommendations for patients, posing a risk for migraine chronification. Methods Our aim is to conduct a comprehensive review of the available evidence regarding the underuse of migraine medications, both acute and preventive. The term “underuse” includes, but is not limited to: ( 1 ) ineffective use of appropriate and inappropriate medication; ( 2 ) underutilization; ( 3 ) inappropriate timing of usage; and ( 4 ) patient dissatisfaction with medication. Results The underuse of both acute and preventive medications has been shown to contribute to the progression of migraine. In terms of acute medication, chronification occurs as a result of insufficient drug use, including failure of the prescriber to select the appropriate type based on pain intensity and disability, patients taking medication too late (more than 60 minutes after the onset or after central sensitization has occurred as evidenced by allodynia), and discontinuation because of lack of effect or intolerable side effects. The underlying cause of inadequate effectiveness of acute medication lies in its inability to halt the propagation of peripheral activation to central sensitization in a timely manner. For oral and injectable preventive migraine medications, insufficient efficacy and intolerable side effects have led to poor adherence and discontinuation with subsequent progression of migraine. The underlying pathophysiology here is rooted in the repetitive stimulation of afferent sensory pain fibers, followed by ascending brainstem pain pathways plus dysfunction of the endogenous descending brainstem pain inhibitory pathway. Although anti-calcitonin gene-related peptide (CGRP) medications partially address pain caused by the above factors, including decreased efficacy and tolerability from conventional therapy, some patients do not respond well to this treatment. Research suggests that initiating preventive anti-CGRP treatment at an early stage (during low frequency episodic migraine attacks) is more beneficial than commencing it during high frequency episodic attacks or when chronic migraine has begun. Conclusions The term “medication underuse” is underrecognized, but it holds significant importance. Optimal usage of acute care and preventive migraine medications could potentially prevent migraine chronification and improve the treatment of migraine attacks.

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Unmet Needs in Japanese Patients Who Report Insufficient Efficacy with Triptans for Acute Treatment of Migraine: Retrospective Analysis of Real-World Data

Cited by 9 publications

References 42 publications

Potential Unmet Needs in Acute Treatment of Migraine in Japan: Results of the OVERCOME (Japan) Study

Potential Unmet Needs in Acute Treatment of Migraine in Japan: Results of the OVERCOME (Japan) Study

Efficacy of Lasmiditan Across Patient and Migraine Characteristics in Japanese Patients with Migraine: A Secondary Analysis of the MONONOFU Trial

Medication “underuse” headache

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