Long-term persistence in the use of prophylactic medications is associated with poor outcomes for patients with migraine, according to a study published in Cephalalgia.

In this retrospective cohort study, investigators used administrative claims data from 2 databases to identify patients with migraine who initiated prophylactic medication (N=147,832) between 2005 and 2014. The basis for selection was ≥1 inpatient claim, ≥1 emergency room claim or ≥2 outpatient claims with a diagnosis of migraine, ≥1 outpatient claim with a diagnosis of migraine and ≥1 outpatient pharmacy claim for a prophylactic migraine medication, or ≥2 outpatient pharmacy claims for a triptan or ergotamine and initiation of treatment with a prophylactic migraine medication. Investigators analyzed treatment patterns during the follow-up period to include the proportion of patients initiating prophylactic medication for migraine, treatment persistence (defined as continuous use without a gap of >60 days from when the previous prescription ran out), and treatment nonpersistence (defined as a gap of >60 days in supply from when the previous prescription ran out).

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Persistence of treatment was observed in 9.7% of patients (n=14,314) with a mean persistence duration of 1331.1±552.8 days. Nonpersistence was observed in 90.3% of patients (n=133,518). The reasons for nonpersistence was because of switching to a different prophylactic treatment for migraine (n=51,981), restarting treatment after a gap of >60 days (n=40,136), or discontinuation (n=41,401). In the follow-up period,

  • 59.9% of patients received triptans,
  • 66.6% received nonsteroidal anti-inflammatory drugs,
  • 77.4% received opioids, and
  • 2.6% received ergotamines.

The incidence of adverse events was analyzed for patients with acute migraine receiving treatment with opioids in the follow-up period (n=49,676). A total of 27.7% of these patients experienced adverse events related to gastrointestinal upset.

This study is potentially limited by the use of claims data and measurement error due to data having coding limitations, making it possible that patients included in this analysis may have been healthier than the total population of patients identified in this study.

These findings indicate that long-term persistence with prophylactic medications for patients with migraine is poor. To address these issues, the researchers suggested that new treatment options with improved efficacy and tolerability are warranted.

This study was funded by Amgen Inc., USA, and authors report multiple associations with Amgen Inc. Please see the original reference for a full list of authors’ disclosures.

Reference

Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine [published online February 28, 2019]. Cephalalgia. doi:10.1177/0333102419835465