VALENCIA, SPAIN – How dissatisfied are migraine patients with their prophylactic medication options?
Here’s a clue: Roughly two-thirds of migraine patients who initiate topiramate, a beta-blocker, or a tricyclic antidepressant for prophylaxis have given up on prophylactic therapy altogether within 9 months, Dr. Robert Lenz reported at the International Headache Congress.
Dr. Robert Lenz
Moreover, treatment gaps longer than 90 days in duration are the rule rather than the exception within the first year after starting prophylactic therapy. Seventy-eight percent of patients who start on topiramate for migraine prophylaxis have such a gap in therapy within the first year, as do 80% who start on a beta-blocker, and 85% on a tricyclic antidepressant. These prolonged treatment gaps occur early: a mean of 95 days after commencing treatment. And only 9%-12% of patients restart prophylaxis after a gap, added Dr. Lenz of Amgen in Thousand Oaks, Calif.
He presented an analysis of patterns of prophylaxis use in 107,122 migraine patients who initiated therapy during 2008-2011. Forty-nine percent went on topiramate for this purpose, 30% on a tricyclic antidepressant, and 21% on a beta-blocker. The researchers used Medicare claims data as well as information from the Truven Health Analytics MarketScan Commercial Claims and Encounters database.
Despite the generally poor persistence with prophylactic therapy documented in this study, few patients were interested in switching to a different preventive medication or adding a second one. Indeed, only 12%-14% of patients did so within the first year after starting prophylaxis, Dr. Lenz noted at the meeting, which was sponsored by the International Headache Society and the American Headache Society.
Eighty-one percent of patients who started on migraine prophylaxis also used acute migraine medications during the first year. Forty-eight percent of the study population filled an average of 4.4 prescriptions for a triptan during that period, whereas 38% used a triptan in the year prior to going on prophylaxis.
More disturbingly, Dr. Lenz said, 53% of patients who initiated prophylactic migraine therapy also received opioids during that first year; indeed, they filled an average of 6.1 prescriptions for opioids during the year. However, upon exclusion of patients who carried a diagnosis of another chronic pain condition, such as low back pain, arthritis, or neuropathic pain, 40% of the remaining patients who started migraine prophylaxis received opioids during the study year, filling an average of 3.8 prescriptions.
The study was funded by Dr. Lenz’ employer, Amgen, which is among the pharmaceutical companies developing a new class of monoclonal antibodies to calcitonin gene-related peptide (CGRP) for the prevention of migraine.