Spherix Global Insights

June 03, 2021

Physician Assessment of Patients’ COVID-19 Risk and Impact on Lasmiditan, Ubrogepant, or Rimegepant Prescription Decisions: Analysis from a Cross-Sectional, Retrospective US Patient Chart Audit

Authors: Shirley Ju, MD; Vanessa Cooper, MD; P. Christopher H. Gottschalk, MD, FAHS; Virginia R. Schobel, MSc

Your Resource for Headache Info | American Headache Society

Examine patient characteristics that influence physicians’ perceptions of patient COVID-19 risk and how such risk categorizations influence acute migraine therapy selection.

Many factors influence prescribers’ decisions, including familiarity with treatment options and assessment of risk. In the midst of the pandemic, we sought to establish how physicians’ assessment of COVID-19 risk at the individual patient level influenced their decisions to prescribe one of the newly available acute migraine drugs.

Fielded in September 2020, 214 US neurologists and migraine specialists completed an online survey and contributed chart review data for a retrospective, cross-sectional audit of 1,048 patients recently (≤3 months) prescribed lasmiditan, ubrogepant, or rimegepant for the acute treatment of migraine. Quotas were not placed on the number of chart reviews for each therapy. Characterization of low, moderate, or high risk of complications/death if infected with coronavirus at the time of prescribing was based on physicians’ subjective assessment.

Physicians considered 28% (n=289) of patients recently prescribed lasmiditan, ubrogepant, or rimegepant to be at moderate or high risk of complications/death if infected with the coronavirus (MHR subgroup) (Figure 1). Compared to patients with low risk (LR), MHR patients were more likely to be male (34% vs. 25%), African-American (16% vs. 10%) or Latino/Hispanic (14% vs. 7%), and older (46 vs. 37 years) (Figures 2,3;Table 1). BMI was higher among MHR compared to LR patients (29.4 vs. 26.6) (Table 1). More MHR patients presented with at least one comorbidity in addition to their migraine diagnosis (81% vs. 62%), with depression (34% vs. 23%), hypertension (29% vs. 11%), obesity (23% vs. 9%), diabetes (16% vs. 4%), obstructive sleep apnea (12% vs. 2%), asthma (10% vs. 6%), coronary heart disease (9% vs. <1%), pain disorders (7% vs. 2%), stoke/sub-clinical vascular brain lesion history (2% vs. <1%), and chronic obstructive pulmonary disorder (2% vs. <1%) significantly more prevalent among MHR patients (Figure 4). MHR patients were more likely to be diagnosed with chronic migraine (32% vs. 22%) and less likely with low frequency episodic migraine (22% vs. 33%) (Figure 5), with the first migraine episode occurring at an older age (26 vs. 23 years old), compared to LR patients (Table 1).

Recently prescribed acute therapy did not differ significantly between MHR and LR subgroup (Figure 6). However, prescribing physicians reported at least a moderate impact of COVID-19 on the current acute therapy selection (44% vs. 27%) (Figure 7) and initial prescribing of the therapy as part of a telemedicine visit (34% vs. 28%) for more of their MHR versus LR patients (Figure 8). MHR therapy selection was also more frequently influenced by the therapy’s safety profile (32% vs. 21%) and mechanism of action (53% vs. 45%) and less frequently by the physician’s comfort/familiarity with the therapy (36% vs. 48%) (Figure 9). Compared to LR patients, MHR patients were more likely to be prescribed concomitant prescription combination pain reliever (17% vs. 10%), opioid medication (12% vs. 7%), and/or rimegepant (2% vs. <1%), and less likely a triptan (41% vs. 48%) or prescription strength NSAID (20% vs. 27%) (Figure 10).

Physician assessment of COVID-19-related risk of complication appears influenced by key patient characteristics, including sex, race, age, comorbidity burden, and migraine severity. For these higher risk patients, recent prescribing decisions of acute migraine therapies are more influenced by safety considerations and mechanism of action than physicians’ own familiarity with the therapy. With these considerations in mind, prescribing volume of the newly approved therapies did not differ, but triptans were less likely to be used as an alternative acute therapy.

SJ, VC, PCHG: Division of Headache Medicine (Neurology), Yale University, New Haven, CT, USA

VRS: Spherix Global Insights, Exton, PA, USA

Archived AHS Abstracts: