Objective:

To describe how prescription medications for migraine are combined in real-world toolkits and how intranasal (IN) treatments fit into these toolkits.

Background:

While migraine may be adequately controlled with monotherapy in some patients, combination therapy is not uncommon. Little is known about the current prevalence and composition of combination toolkits.

Design/Methods:

Medical and prescription claims for migraine patients were analyzed from an open US-based medical and prescription claims dataset (IQVIA LAAD) from November 1, 2015–July 31, 2022. Inclusion required ≥1 ICD-10 migraine diagnosis and ≥1 prescription fill in the 3 months prior to July 31, 2022 (L3M) for ≥1 of the following classes: triptan, lasmiditan, CGRP receptor antagonist (gepant), CGRP monoclonal antibody (mAb), and dihydroergotamine (DHE). L3M fills were analyzed by class and by route of delivery for triptans and DHE.

Results:

1,329,668 patients were included. Of these, 184,095 (13.8%) filled prescriptions in ≥2 studied classes. Four combinations accounted for 96.9% of multi-drug toolkits: triptan + mAb (n= 75,918; 42.2%), mAb + gepant (n= 45,138; 25.2%), triptan + gepant (n= 43,148; 24.1%), and triptan + mAb + gepant (n= 14,106; 7.9%). IN medication was included in 28,314 (2.1%) patient toolkits; IN-triptans (n= 24,683) were observed 6.6x more frequently than IN-DHE (n= 3,732). Of toolkits containing IN medication, 11,942 (42.2%) combined IN medication with non-IN medication(s). The most frequent such IN/non-IN combinations were with oral triptan (n= 6,675; 55.9%), mAb (n= 4,791; 40.1%), gepant (n= 4,174; 35.0%), or ≥2 non-IN medications (n= 3,400; 28.5%).

Conclusions:

More than 1 in 8 patients using migraine-specific prescription medications used a toolkit combining multiple classes. Patients using IN medication were more likely than the overall included population to use a combination toolkit and frequently combined medications across classes or in the same class with different routes of delivery.