Objective:

To understand the real-world treatment switch rates of atogepant versus calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) using claims data from the United States.

Background:

CGRP mAbs and atogepant, an oral CGRP antagonist, are approved in the US and EU for the preventive treatment of migraine. Switching treatments is an indicator of unmet treatment needs and associated with incremental direct medical costs.

Design/Methods:

Adult migraine patients newly initiating atogepant or a CGRP mAb between 10/2022 and 6/2023 were identified from the Merative MarketScan database. The earliest treatment claim was the index date. Patients were excluded if they had ≥1 claim for atogepant, rimegepant, BOTOX for migraine, or a CGRP mAb in the 12 months preceding the index date. A switch was defined by the occurrence of  ≥1 claim for a different branded preventive treatment (atogepant, CGRP mAb, or BOTOX) during the 12 months following the index date. Multivariable logistic regression models were used to compare odds of switching between atogepant and CGRP mAbs. 

Results:

Based on a 12-month follow-up, the study included 641 patients who initiated treatment with atogepant and 3,594 with a CGRP mAb (26 eptinezumab, 1,041 erenumab, 917 fremanezumab, and 1,610 galcanezumab). Baseline demographics and clinical characteristics were comparable across treatments; 37% of atogepant and 42% of CGRP mAb users had a chronic migraine diagnosis. At 12 months follow-up, 13.4% of atogepant users and 21.1% of CGRP mAb users (23.1% eptinezumab, 26.5% erenumab, 19.6% fremanezumab, 18.4% galcanezumab) initiated a different branded preventive. Patients taking CGRP mAbs had significantly higher odds of switching to another branded preventive compared to patients taking atogepant (Odds Ratio 1.72, 95% CI: 1.35, 2.21). 

Conclusions:

Compared with atogepant users, CGRP mAb users were significantly more likely to switch to another branded preventive treatment within 1 year of treatment initiation.