Objective:

To describe patient treatment satisfaction (PTS) with onabotulinumtoxinA versus topiramate for chronic migraine (CM).

Background:

FORWARD (NCT02191579) evaluated the comparative effectiveness (blend of efficacy and tolerability) and safety of onabotulinumtoxinA and topiramate in individuals with CM. FORWARD demonstrated that onabotulinumtoxinA had greater clinical utility than topiramate based on primary and secondary endpoints.

Design/Methods:

FORWARD was a US, multicenter, randomized, parallel-group, open-label, prospective study. Adults (18-65 years) with CM (≥15 headache days/month) were randomized to 155 U of onabotulinumtoxinA for 3 treatment cycles or up to 50-100 mg/day of topiramate. The PTS questionnaire, which measured overall treatment satisfaction and satisfaction based on headache frequency, headache severity, and ability to perform daily activities, was completed by participants at weeks 6, 18, and 30. Each question was rated on a 5-point Likert scale (extremely satisfied to extremely dissatisfied). The proportions of participants recommending their treatment was evaluated.

Results:

282 participants were enrolled (onabotulinumtoxinA, n=140; topiramate, n=142). Higher proportions of participants receiving onabotulinumtoxinA versus topiramate reported overall satisfaction at week 6 (55.7% vs 28.2%), week 18 (65.0% vs 17.6%), and week 30 (59.3% vs 16.2%). Similar trends were observed for satisfaction with reduction in headache frequency (week 6: 55.7% vs 31.6%; week 18: 62.9% vs 17.6%; week 30: 59.3% vs 16.2%), headache severity (week 6: 54.2% vs 30.9%; week 18: 61.5% vs 19.0%; week 30: 57.1% vs 15.5%), and ability to perform daily activities (week 6: 59.3% vs 31.0%; week 18: 62.8% vs 18.3%; week 30: 59.3% vs 16.9%). More participants would recommend onabotulinumtoxinA versus topiramate (week 6: 60.0% vs 44.4%; week 18: 75.7% vs 19.7%; week 30: 67.1% vs 16.9%).

Conclusions:

OnabotulinumtoxinA treatment was associated with higher treatment satisfaction and willingness to recommend treatment than topiramate. Results are consistent with overall study findings where onabotulinumtoxinA had greater effectiveness (higher efficacy and tolerability) and clinical utility than topiramate.