April 25, 2020
Anti-CGRP Class Reduces Migraine Burden Regardless of Concomitant Therapies in US Clinical Practice
Authors: Christopher H. Gottschalk, MD, FAHS; Kristen Henn, MHS; Jennifer Robinson; Virginia R. Schobel, MSc
Assess the clinical response to anti-calcitonin gene-related peptide (CGRP) therapies across the spectrum of migraine one year after the introduction of this new class of drugs.
Since 2018, three different anti-CGRP agents have been available for migraine prevention. Whether benefit is influenced by baseline presentation or concomitant therapies is unknown.
In June 2019, 221 US neurologists and migraine specialists contributed online chart reviews of 1,016 patients currently treated with an anti-CGRP and/or onabotulinumtoxinA. We compared anti-CGRP therapy as monotherapy (monoTx; n=225), with concomitant onabotulinumtoxinA (+BTX; n=117), or with other concomitant preventive therapies (+other; n=322).
Patients in the +BTX group were older, had more comorbidities, and were less likely to rate “excellent” quality of life compared to those in the monoTx group (Table 1). At the time of most recent prescription, more +BTX patients still met criteria for chronic migraine (CM) compared to monoTx and +other patients (Figure 1); +BTX and +other patients were more likely to be considered refractory (Table 2, Figure 2). There were no significant differences across the three anti-CGRP-treated groups in measures of benefit: reduced headache days, migraine days, acute treatment use, and days with migraine-associated disability (Figure 3). Estimates of degree of reduction in migraine days (<50%, 50-74%, etc.) were also very consistent across the three groups (Figure 4). In every group, ~85% of patients were rated by physicians as “improved” on anti-CGRP therapy (Figure 5). ~20% of all patients converted from CM to episodic migraine (EM), regardless of concomitant therapy (Figure 6). MIDAS scores improved in all three groups, with a higher percentage rated mild among monoTx compared to +other patients (Figure 7). On anti-CGRP treatment, +BTX patients were still more likely to have a HIT-6 score >55 compared monoTx patients (Figure 8), and greater hospitalizations and emergency room visits, on average, compared to both other groups (Figure 9).
These data indicate that migraine patients benefit from the addition of anti-CGRPs, regardless of concomitant therapy type.
Christopher Gottschalk received consulting fees from Alder, Amgen, Novartis, Biohaven, Theranica. He has received research support from Teva, electroCore, Relivion. Speaker Bureau Member: Amgen, Eli Lilly.
Kristen Henn is an employee of Spherix Global Insights, an independent market intelligence firm, and has received no industry funding to conduct and report on this study.
Jennifer Robinson is the founder of Spherix Global Insights, an independent market intelligence firm, and has received no industry funding to conduct and report on this study.
Virginia R. Schobel is an employee of Spherix Global Insights, an independent market intelligence firm, and has received no industry funding to conduct and report on this study.
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