Office of the Chief Medical Officer, Merck, 351 North Sumneytown Pike, Upper Gwynedd, PA 19454, USA.
Headache. 2010 Oct;50(9):1440-8. doi: 10.1111/j.1526-4610.2010.01703.x.
Although diagnostic rates for migraine have increased over the past 5 years, the proportion of migraine sufferers using triptans has remained essentially stable.
To assess the rate of onset of new triptan prescriptions among persons with migraine and the predictors of initiating therapy.
The American Migraine Prevalence and Prevention Study is a longitudinal study conducted in a representative sample of headache sufferers in the US population. Episodic migraineurs not using triptans in 2005 who continued to have migraine and provided treatment data in 2006 (n=6865) were included. We assessed predictors of triptan use in univariate and multivariate analyses, including 3 nested models. In Model 1, we adjusted for demographic variables. Model 2 added headache-related disability and cutaneous allodynia. Model 3 added depression and use of preventive headache medications.
Among individuals not using triptans in 2005, triptan use in 2006 occurred in 4.9% of the sample. In unadjusted analyses, gender and race were not associated with use of triptan. Use was lower in those aged 60 years or more vs those 18-29 (odds ratio [OR]=0.4, 95% confidence interval [CI]=0.2-0.7, P=.001). Taking individuals with no disability as the reference, mild (OR=1.44, 95% CI=1.03-2.01, P=.03), moderate (OR=1.54, 95% CI=1.1-2.2, P=.01) and severe disability (OR=2.19, 95% CI=1.55-3.09, P<.0001) predicted triptan use. In the adjusted models, age, income, insurance, disability and preventive medication use were associated with triptan use. Gender, race, education and depression were not.
New use of triptans is low in the population. Because adequacy of care was not assessed, future studies should focus on investigating whether this low rate of triptan start is proper or if it reflects an unmet treatment need.
尽管过去 5 年来偏头痛的诊断率有所上升，但使用曲坦类药物的偏头痛患者比例基本保持稳定。
评估偏头痛患者中新开曲坦类药物处方的比例以及启动治疗的预测因素。
美国偏头痛患病率和预防研究是一项在美国人群中进行的、针对头痛患者的代表性样本的纵向研究。2005 年未使用曲坦类药物且持续患有偏头痛并在 2006 年提供治疗数据的偶发性偏头痛患者（n=6865）被纳入研究。我们在单变量和多变量分析中评估了曲坦类药物使用的预测因素，包括 3 个嵌套模型。在模型 1 中，我们调整了人口统计学变量。模型 2 增加了头痛相关残疾和皮肤感觉过敏。模型 3 增加了抑郁和预防性头痛药物的使用。
在 2005 年未使用曲坦类药物的患者中，2006 年有 4.9%的患者使用了曲坦类药物。在未调整的分析中，性别和种族与曲坦类药物的使用无关。与 18-29 岁年龄组相比，60 岁及以上年龄组使用曲坦类药物的可能性较低（比值比[OR]=0.4，95%置信区间[CI]=0.2-0.7，P=.001）。以无残疾的个体为参照，轻度（OR=1.44，95% CI=1.03-2.01，P=.03）、中度（OR=1.54，95% CI=1.1-2.2，P=.01）和重度残疾（OR=2.19，95% CI=1.55-3.09，P<.0001）与曲坦类药物的使用相关。在调整后的模型中，年龄、收入、保险、残疾和预防性药物的使用与曲坦类药物的使用相关。性别、种族、教育和抑郁与曲坦类药物的使用无关。
在人群中，新使用曲坦类药物的比例较低。由于未评估治疗的充分性，未来的研究应重点调查这种低曲坦类药物起始率是否合理，或者是否反映了未满足的治疗需求。
