Acceptance, Compliance With Migraine Drugs Higher With Two Dosing Options

A recent survey of adult migraine sufferers supports a commonly held belief among physicians that multiple dosing options will lead to an increase in compliance with new migraine medications, according to a study recently published in The Journal of Headache and Pain.

This observational study included 417 adults with migraine and 400 physicians, each of whom completed a separate 20-minute online survey. Patients in the migraine cohort had to meet the following inclusion criteria: be at least 18 years of age, have a diagnosis before 2017, experience at least one headache day every month during the previous 6 months, and have a history of headache medication use. Participants were presented with 3 scenarios: once-monthly, once-quarterly, and both dosing options for a new migraine medication.

In their survey, physicians were asked to use the 7-point Likert scale to estimate their likelihood of prescribing the medication, while those with migraine were asked to use the same scale to predict their likelihood of filling and complying with the medication over the course of a year. Because the impact of different dosing options was the primary outcome vs estimating change in potential prescribing, weighting was not performed with the quantitative survey data.

There was a marked increase in expected compliance when both dosing options were available, with 80% of those with migraine reporting that the availability of both dosing options was important. Among physicians, flexible dosing was associated with significant increases in expected compliance: from 26% to 35% among those with moderate-frequency episodic migraine, from 34% to 43% among high-frequency episodic migraine, and from 40% to 49% in chronic migraine. Individuals with migraine reported similar preference for once-monthly (35%) and once-quarterly (40%) doses, while 25% reported having no preference.

Among the 147 participants who reported a preference for monthly dosing:

• 77% were likelier to fill the prescription with only monthly dosing available
• 56% were likelier to fill the prescription with only quarterly dosing available
• 80% were likelier to comply with only monthly dosing available
• 57% were likelier to comply with only quarterly dosing available (P <.05 for all)

Among the 166 who reported a preference for quarterly dosing:

• 63% were likelier to fill the prescription with only quarterly dosing available
• 55% were likelier to fill the prescription with only monthly dosing available
• 62% were likelier to comply with only quarterly dosing available
• 54% were likelier to comply with only monthly dosing available (P <.05 for all)

Limitations to this study include a lack of investigation of variation in delivery systems and of switching between regimens.

Researchers concluded that “[the] availability of both monthly and quarterly dosing options for a therapy would benefit patients with any migraine severity. Dosing flexibility would allow patients to choose their preferred therapy based on their individual needs, with a commensurate increase in the likelihood of patients receiving and being adherent to the new migraine preventive therapy class.”

This study was funded by Teva Pharmaceuticals. Authors R Cowan, JM Cohen, and R Iyer reported financial associations with Teva and other pharmaceutical companies.

Reference
Cowan R, Cohen JM, Rosenman E, Iyer R. Physician and patient preferences for dosing options in migraine prevention [published online May 9, 2019]. J Headache Pain. doi: 10.1186/s10194-019-0998-8