Patients opted for nontriptan acute medications such as opioids and nonsteroidal anti-inflammatory drugs instead of staying on triptans at 12- and 24-month follow-ups.
Richard B. Lipton, MD
A study examining the treatment patterns of initial triptan prescription and refill rates demonstrated that more than half of those who were initially prescribed a triptan for acute migraine did not refill their initial prescription, and less than 1 in 10 used 2 or more triptans within 12 months.
The retrospective cohort analysis compiled medical, pharmacy, and enrollment information of new initiators of a triptan using data spanning from 2012 to 2015 from the Optum Clinformatics Data Mart (CDM). Patients included in the study were at least 18 years of age with at least 1 prescription claim for a triptan and have at least 1 medical claim with a migraine diagnosis.
Researchers defined the date of the first triptan claim as the index date, ranging between January 1, 2013 and December 31, 2013. Inclusion was limited to those with no fills for a triptan in the 12 months prior to index date, as well as the continuous enrollment in the 12 months pre- and 24 months post-index date. The triptans included in the analysis were almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, sumatriptan combinations, and zolmitriptan.
The primary outcome of the study was to evaluate the pattern of triptan, more specifically, the number refills for the index triptan over the 12-month and 24-month post-index periods. The use of multiple triptan agents over the 12-month and 24-month post-index periods were recorded as secondary outcomes. Lastly, the researchers compiled data on the use of non-triptan acute migraine medications over the 12-month and 24-month post-index periods.
A total of 10,509 patients met all inclusion criteria and were included in the analysis. The demographic of the study showed that 12.5% of the patients were between the ages of 18 and 24 years, 35% were 45 years or older, and 82% of the population were female.
At initial triptan prescription, 58.5% of patients received 4 pills or fewer, while 35.9% received 5 to 12 pills and 5.6% received 13 or more pills. Researchers found that about half (50.8%) of the sample population had no triptan refills over 12 months of follow-up. At 24 months, investigators noted a slight decrease, with 43.6% of patients acquiring triptan refills.
Patients who used only 1 type of triptan accounted for 90.5% of all patients at 12 months post-index, compared to 8.4% who used 2 different triptan agents and 1.0% that used 3 or more different triptan agents. Similar results were found at 24 months post-index, with 86.1%, 12.0%, and 2.0% using 1, 2, and 3 or more triptan agents, respectively.
Other non-triptan, acute treatments such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs) were the most commonly used for patients with no refill of their index triptan, accounting for 39% and 22% of patients in the 12-month post-index period and 53% and 33% at 24-month post-index period, respectively. Of the 38.8% of those with no refills of their index triptan, 43% had no use of any opioid in the 12 months pre-index. Additionally, 60% of patients who did not refill their index triptan and had a migraine-related opioid prescription had no migraine-related opioid prescriptions in the 12 months pre-index.
“These findings, combined with the high rates of opioid use among these patients, potentially suggest insufficient response or tolerability issues with the current standard of care. Future research should examine the health resource utilization and costs associated with these suboptimal treatment patterns,” the study authors concluded.
Lipton RB, Marcus ST, Shewale AR, Dodick DW, Viswanathan HN, Doshi JA. Acute treatment patterns in patients with migraine newly initiating a triptan. Cephalalgia. Published online March 5, 2020. doi:10.1177/0333102420905307