CGRP Antagonist (Gepant) vs Triptan use Profiles in Individuals with Migraine: A Multicenter Electronic Medical Record Analysis of Patient Characteristics and Emergency Department Services Utilization
Victor Wang1, Steven Bieser1, Austin Lowe1, Michael Li2, Hsiangkuo Yuan3
1Neurology, 2Health Data Science, Information Services & Technology, Thomas Jefferson University Hospital, 3Jefferson Headache Center
Objective:

To characterize emergency department (ED) service utilization between calcitonin gene-related peptide (CGRP) antagonists (gepants) and triptans.

Background:
To date, no direct head-to-head effectiveness comparison between gepants and triptans is available. Real-world data on the utilization of ED services and injectable medications commonly used for migraine may be surrogate markers for assessing overall effectiveness.
Design/Methods:

Using the TriNetX® database, we compared adults (age≥18) with migraine (ICD-10 G43) between December 23, 2019 and October 11, 2022, who were prescribed gepants (rimegepant and ubrogepant) but not triptans (gepant group) against those prescribed triptans but not gepants (triptan group). Propensity score-matched cohorts were used to balance demographics, medical comorbidities, and concurrent CGRP monoclonal antibodies (mAbs). The outcome analyses included ED services and parental migraine treatments.

Results:

We identified 15672 (age 46.2±14.6; female 84.84%) in the gepant group and 725645 (age 40.7±14.1, female 83.47%) in the triptan group. Before propensity matching, comparison between the gepant and triptan groups, respectively, revealed significantly lower percentages were black (n=1788, 11.41% vs. n=91414, 12.80%, p<0.0001) and Hispanic/Latino (n=632, 4.03% vs. n=39002, 5.46%, p<0.0001). Medical comorbidity burden was higher in the gepant group for chronic migraine, mood disorders, ischemic heart diseases, hypertension, hyperlipidemia, diabetes mellitus, and BMI≥30. Medication utilization was also higher in the gepant group for opioids, dihydroergotamine, Botox, and CGRP mAbs. After propensity matching, the gepant group had a lower utilization of ED service (risk ratio [RR] 0.546, 95%CI 0.522-0.552, p<0.0001) and parenteral migraine treatments (RR 0.506, 95%CI 0.471-0.542, p<0.0001) than the triptan group.

Conclusions:
Gepants carry lower prescription rates across black and Hispanic/Latino populations while having higher rates amongst older individuals, those with increased medical comorbidities, and concurrent medications. Gepant use appears to be associated with lower ED service utilization than triptan use. This study is limited by the dependence on medical records data and the aggregate nature of the dataset.
10.1212/WNL.0000000000204267