Impact of eptinezumab on work productivity beyond reductions in monthly migraine days: Post hoc analysis of the DELIVER trial
Piero Barbanti1, Susanne F Awad2, Stephane A Regnier2, Xin Ying Lee2, Peter J Goadsby3
1Headache and Pain Unit, IRCCS San Raffaele, 2H. Lundbeck A/S, 3NIHR King’s Clinical Research Facility, and Headache Group, King’s College London
Objective:

To identify drivers of work productivity improvement in patients with 2-4 prior preventive treatment failures receiving eptinezumab for migraine prevention.

Background:

A double-blinded, randomized, controlled trial (DELIVER; NCT04418765) showed that patients treated with intravenous eptinezumab infusions (up to 2 doses) over 24 weeks reported a larger improvement in absenteeism and presenteeism on the migraine-related Work Productivity and Activity Impairment (WPAI:M) scale compared with patients receiving placebo. However, there is limited evidence on how eptinezumab improves work productivity levels.

Design/Methods:

WPAI:M absenteeism and presenteeism subscores (measured as % of work time) from DELIVER were converted into hours using 2020 average actual working hours/week in Canada (36.9 hours/week). Regression analysis explored the association between number of monthly migraine days (MMDs) and hours affected by absenteeism or presenteeism, with treatment arm as a covariate. Path analysis then identified specific factors of treatment efficacy that were mediators of improved absenteeism and presenteeism.

Results:
Eptinezumab-treated patients reported larger reductions in hours affected by absenteeism and presenteeism compared to baseline than patients receiving placebo (difference vs placebo: absenteeism, ‒7.2 hours/month, P<0.001; presenteeism, ‒21.2 hours/month, P<0.001). Independent of treatment, there was an association between MMDs and hours affected by presenteeism and absenteeism. Comparing patients with equivalent MMDs at baseline between the eptinezumab and placebo arms, eptinezumab-treated patients demonstrated, on average, lower presenteeism (76.9 hours; P<0.001) and absenteeism (17.3 hours; P<0.001) than did corresponding patients receiving placebo (76.3 and 19.0 hours, respectively). Less than 40% of presenteeism improvement can be explained by reduction in MMDs (P<0.001), while more than 50% was mainly explained by self-reported improvement in patient-identified most bothersome symptom. 
Conclusions:

Work productivity increases substantially in eptinezumab-treated patients compared to baseline and placebo. Eptinezumab reduces lost work productivity more than placebo and occurs through reduction of both migraine frequency and intensity of migraine symptoms.

 

10.1212/WNL.0000000000202965