Persistence to anti-CGRP monoclonal antibodies and onabotulinumtoxinA among patients with migraine: a retrospective cohort study

The Journal of Headache and Pain

Research

Stephanie J. Nahas¹  Stephane A. Regnier²  Carlton Anderson³  Brian Talon³  Steven Kymes³  Seema Soni-Brahmbhatt³  Christine Sullivan³  Larry Charleston⁴ 

[1] Department of Neurology, Thomas Jefferson University, Jefferson Headache Center, 900 Walnut Steet, Suite 200, 19107-5509, Philadelphia, PA, USA;H. Lundbeck A/S, Copenhagen, Denmark;Lundbeck LLC, Deerfield, IL, USA;Michigan State University College of Human Medicine, East Lansing, MI, USA;

关键词: Migraine;    Persistence;    onabotulinumtoxinA;    Erenumab;    Fremanezumab;    Galcanezumab;    Eptinezumab;    Anti-CGRP monoclonal antibody;    Real-world evidence;   

DOI  :  10.1186/s10194-023-01636-8

 received in 2023-05-31, accepted in 2023-07-20,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundTo date, real-world evidence on persistence to anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAbs) or onabotulinumtoxinA have excluded eptinezumab. This retrospective cohort study was performed to compare treatment persistency among patients with migraine on anti-CGRP mAbs (erenumab, fremanezumab, galcanezumab, or eptinezumab) or onabotulinumtoxinA.MethodsThis retrospective study used IQVIA PharmMetrics data. Adult patients with migraine treated with an anti-CGRP mAb or onabotulinumtoxinA who had 12 months of continuous insurance enrollment before starting treatment were included. A “most recent treatment episode” analysis was used in which the most recent episode was defined as the latest treatment period with the same drug (anti-CGRP mAb or onabotulinumtoxinA) without a ≥ 15-day gap in medication supply on/after June 25, 2020, to December 31, 2021. Patients were indexed at the start of their most recent episode. Patients were considered non-persistent and discontinued the therapy associated with their most recent episode if there was ≥ 15-day gap in medication supply. A Cox proportional-hazards model estimated the discontinuation hazard between treatments. The gap periods and cohort definition were varied in sensitivity analyses.ResultsThe study included 66,576 patients (median age 46 years, 88.6% female). More eptinezumab-treated patients had chronic migraine (727/1074), ≥ 3 previous acute (323/1074) or preventive (333/1074) therapies, and more prior treatment episodes (3) than other treatment groups. Based on a 15-day treatment gap, patients on subcutaneous anti-CGRP mAbs had a 32% (95% CI: 1.19, 1.49; erenumab), 42% (95% CI: 1.27, 1.61; galcanezumab), and 58% (95% CI: 1.42, 1.80; fremanezumab) higher discontinuation hazard than those receiving eptinezumab, with this relationship attenuated, but still statistically significant based on 30-day and 60-day treatment gaps. There was no significant difference in the discontinuation hazard between eptinezumab and onabotulinumtoxinA. Based on a 15-day treatment gap among patients who newly initiated therapy, the discontinuation hazard of subcutaneous anti-CGRP mAbs remained significantly higher compared to eptinezumab and onabotulinumtoxinA.ConclusionPatients treated with eptinezumab demonstrated persistency that was higher than subcutaneous anti-CGRP mAbs and similar to onabotulinumtoxinA.Graphical Abstract

【 授权许可】

CC BY   
© The Author(s) 2023

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