April 15, 2021
Understanding the Impact of Sex and Race on the Migraine Patient’s Journey in the United States: Analyses From an Annual Cross-Sectional Patient Chart Audit
Authors: Robert P. Cowan, MD, FAAN; Meg M. Stabb; Nicholas W. Robinson, PhD; Virginia R. Schobel, MSc
To determine whether subgroup disparities recognized in general society are reflected in subpopulations with migraine.
It has been widely observed that disparities exist between various sub-groups in the U.S., including commonly noted disparities based on sex and race.
In May/June 2020, 230 US physicians contributed chart review data for 1,003 patients recently prescribed a calcitonin gene-related peptide monoclonal antibody or onabotulinumtoxinA. Subgroups were defined by sex (female n=710; male n=293) and race (Caucasian [n=765] or minority [African-American, Latino/Hispanic, Asian, other; n=238]).
Females were younger at first migraine episode (22.7 vs. 29.1 years) and diagnosis (26.1 vs. 32.0 years) than males; Caucasians were younger than minorities at both events. More males are managed by migraine specialists (52% vs. 36%), especially minority males (56%) versus white females (35%). Minorities, especially minority females, were more likely covered by Medicaid (15% vs. 7%). More females were diagnosed with chronic migraine (41% vs. 24%), while more males were diagnosed with low frequency episodic migraine (28% vs. 16%). Comorbid hypertension was more common among males (21% vs. 13%) and minorities (21% vs. 13%), with highest rates among Caucasian males (23%) and minority females (24%). Females were more often diagnosed with anxiety (17% vs. 8%) and depression (27% vs. 21%).
Whereas 68% of females had previously failed ≥2 previous preventive therapies, 51% of males had failed one preventive therapy and were more likely to have recently been prescribed fremanezumab (22% vs. 17%) or eptinezumab (9% vs. 5%). Patient request (32% vs. 24%), efficacy onset speed expectation (29% vs. 22%), family planning consideration (12% vs. 3%), and non-adherence concern (11% vs. 5%) more often influenced therapy selection among minority patients.
Subgroup disparities reported for the general US population exist and are even more significant in the migraine community. Stakeholders in migraine care should acknowledge and address these disparities.
Robert Cowan consults or serves on scientific advisory boards for all four CGRP mAb manufacturers providing product in the U.S.
Virginia Schobel, Nick Robinson, and Meg Stabb are employees of Spherix Global Insights, an independent market intelligence firm, and has received no industry funding to conduct and report on this study.
Archived AAN Abstracts:
- Patients with Not Active Progressive Multiple Sclerosis in the United States: Profiling an Underserved Segment
- Anti-CGRP Class Reduces Migraine Burden Regardless of Concomitant Therapies in US Clinical Practice
- Changing Patterns in Disease-Modifying Therapy Selection for Treatment-Naive Multiple Sclerosis in the United States
- Evolving Diagnosis and Treatment of Secondary Progressive Multiple Sclerosis in the United States
- Multiple Sclerosis Disease-Modifying Therapy: Recent Switch Patterns Among United States Neurologists