Patient Preference and Adherence (Jan 2024)
Comparison of Treatment Patterns in Patients with Migraine Initiating Calcitonin Gene-Related Peptide Monoclonal Antibodies: A Retrospective Real-World US Study
Abstract
Oralee J Varnado,1 Brenna L Brady,2 Anthony J Zagar,1 Yvonne P Robles,2 Margaret Hoyt1 1Eli Lilly and Company, Indianapolis, IN, USA; 2Merative, Ann Arbor, MI, USACorrespondence: Oralee J VarnadoValue, Evidence, and Outcomes, Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, IN, 46285, USA, Tel +1 317 277 0599, Email [email protected]: Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are indicated for migraine prevention in the United States. Limited data comparing real-world treatment patterns for CGRP mAbs are available.Objective: To compare the treatment patterns among patients with migraine initiating galcanezumab, fremanezumab, and erenumab.Methods: This retrospective study included adult patients with one or more claims for a self-injectable CGRP mAb (galcanezumab, fremanezumab, or erenumab), with continuous enrollment in medical and pharmacy benefits for 12 months pre-index and 6 and 12 months post-index using MerativeTM MarketScan® Commercial and Medicare databases from May 2017 through March 2021. Propensity-score matching was used to address confounding by observed covariates. Outcomes analyzed included proportion of days covered (PDC), medication-possession ratio (MPR), persistence (≤ 60-day gap), treatment discontinuation, and switch to a non-index drug. Descriptive X2 and t-test analyses were conducted.Results: At the 12-month follow-up, matched galcanezumab and fremanezumab cohorts each comprised 2674 patients and the galcanezumab and erenumab cohorts 3503 each. The mean (SD) PDC and MPR were both 0.6 (0.3) across all cohorts. Based on PDC ≥ 0.80 and MPR ≥ 0.80, a greater proportion of galcanezumab vs fremanezumab (46.2% vs 43.7%, p=0.053; 46.8% vs 44.3%, p=0.053) and galcanezumab vs erenumab (46.2% vs 44%, p=0.156; 46.7% vs 44.5%, p=0.262), respectively, initiators were adherent. Compared to galcanezumab, fremanezumab (248.0 days vs 236.5 days, p=0.001), and erenumab (247.8 days vs 241.7 days, p=0.061) initiators had lower mean persistence. Galcanezumab initiators were less likely to discontinue treatment than fremanezumab (47.8% vs 51.7%, p=0.005) and erenumab (47.7% vs 50.2%, p=0.040) initiators. Across cohorts, most switchers initiated onabotulinum toxin A as subsequent treatment. Similar results were observed for 6-month follow-up cohorts.Conclusion: Patients with migraine who initiated treatment with galcanezumab showed higher persistence and lower treatment discontinuation rates than those initiating either fremanezumab or erenumab.Plain Language Summary: What was known before? Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are medicines developed for migraine prevention. CGRP mAbs bind to the CGRP ligand or receptor and limit pain associated with migraine attacks. Currently, three self-injectable CGRP mAbs are approved for prevention: erenumab, fremanezumab, and galcanezumab. Use of erenumab, fremanezumab, and galcanezumab can slow or stop migraine-related symptoms and reduce migraine-related disability.What does this study add? This study describes how migraine medications are used in the US by patients with migraine who started using galcanezumab, fremanezumab, or erenumab for migraine treatment. Over a period of 12 months, patients who started treatment for migraine with galcanezumab were more likely to continue their treatment than those who started using either fremanezumab or erenumab. At 12 months, fewer patients who started galcanezumab were likely to discontinue their treatment than patients who started using either fremanezumab or erenumab. Among patients who discontinued and switched, most patients switched to Botox A, a non-CGRP treatment. Among patients who switched to a different CGRP mAb, most patients in the fremanezumab and erenumab groups switched to galcanezumab, while most patients in the galcanezumab group switched to erenumab.Interpretation: These findings suggest that patients remained on galcanezumab longer and were less likely to discontinue.Keywords: CGRP mAb, erenumab, fremanezumab, galcanezumab, treatment patterns, migraine
