Triptans Treatment Patterns Among First-Time Users. A Real-World Retrospective Cohort Study
Yael Barer1, Danna Davidovici2, Erel Domany3, Matanya Tirosh2, Moshe Hoshen1, Sivan Gazit1, Amnon Mosek4
1Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, 2Pfizer Pharmaceuticals Israel Ltd., 3Department of Neurology and Headache Clinic Rambam Medical Center, 4Headache and Facial Pain Clinic
Objective:
This study aims to evaluate real-world triptan treatment patterns.
Background:
Migraine is a prevalent and debilitating neurological disorder with substantial impact on an individual quality of life and on the healthcare system. Triptans are established as the standard of care for moderate-to-severe acute migraines for over two decades.
Design/Methods:
This retrospective cohort study utilizing deidentified data from the second-largest healthcare provider in Israel. Eligible patients were members aged 21 years or older who had an index-date (first prescription/ dispensation) between 2012 and 2022 and were followed until end of 2023. Triptan discontinuation was defined as the absence of additional dispensations between last dispensation date (plus 90 days) and the end of follow-up period, except where treatment cessation was due to contraindications. Time to discontinuation was analyzed using Kaplan-Meier curves.
Results:
Of 2.5 million adult health-plan members, we identified 41,297 adults with first triptan's dispensation during 2012-2022 (age at index-date: 38.4 years [inter-quartile range: 28.2;48.0], 75.6% females). Among those, 28,920 (70%) discontinued their triptan use, with 23,054 (79.7% of those who discontinued) ceasing after using one generic ingredient. The median time to discontinuation was 0.644 years (95% CI: 0.592;0.696). When excluding patients with only one dispensation, 57% of patients (n = 21,393) discontinued, and the median use time was 4.6 years (95% CI: 4.46;4.73).
Conclusions:
This study indicates a low treatment rate (assuming 10% migraine prevalence rate) and among the treated population, a high discontinuation rate. This may suggest potentially suboptimal response or tolerability issues with current standard of care. Additional research is needed to understand these phenomena and to identify risk markers for treatment failure which may enable physicians to recommend acute therapies more effectively.
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