Identifying Risk Markers for High Likelihood of Triptan-Failure 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 assess risk markers for high likelihood of triptan-failure.
Background:
Migraine is a debilitating neurological disorder with substantial impact on an individual's quality of life and on healthcare systems costs. Triptans are established as the standard of care for acute migraines, despite having a high failure rate.
Design/Methods:
This retrospective cohort study utilizing deidentified data from the second-largest healthcare provider in Israel identified members aged 21 years or older who had at least one prescription or dispensation of triptans. Eligible patients had an index-date (first prescription/ dispensation) between 2012 and 2022 and were followed until end of 2023. Users were classified as "high-likelihood for triptan-failure" (aka, "triptan-failure") if they used two generic ingredients but had a discontinuation or used three or more generic ingredients, regardless of discontinuation status. Otherwise, patients were classified as "low likelihood for triptan-failure". Markers for triptan-failure were identified using a logistic regression with an AIC based stepwise variables selection. Sensitivity analysis was performed requiring three years of potential follow-up (i.e., index-date prior 2020).
Results:
We identified 41,297 health-plan members who met the study criteria (age at index-date = 38.4 years [inter-quartile range: 28.2;48.0], 75.6% females). Of those, 33,941 were classifies as low likelihood for triptan-failure and 7,356 were triptan-failure. Markers for triptan-failure included younger age of treatment initiation, female sex, medium-high socio-economic status, and diagnosis of cervical pain prior to triptan initiation. When requiring three years potential follow-up period (low likelihood: 22,328, triptan-failure: 5,649), a diagnosis of fibromyalgia prior to triptan initiation was also found to be a marker for triptan-failure.
Conclusions:
We found that younger age, female sex, cervical pain, and fibromyalgia may predict triptan-failure. Identifying patients at high risk for triptan-failure may enable physicians to recommend alternative acute therapies more effectively.
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