Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA.
Pharmacoepidemiol Drug Saf. 2019 Mar;28(3):322-329. doi: 10.1002/pds.4723. Epub 2019 Jan 31.
Population-based data are sparse on utilization of prophylactic versus acute therapies for newly diagnosed migraine. We examined initial migraine treatment patterns and associated patient characteristics in Denmark.
We used population-based health databases to assemble a nationwide cohort of adult migraine patients in 2005 to 2013. Migraine was defined as a first hospital diagnosis of migraine or a second redeemed outpatient prescription for triptans, ergots, pizotifen, or flunarizine. We classified the initial migraine treatment received after migraine onset as "no treatment," "acute only," "prophylactic only," and "both acute and prophylactic" and described distributions of sex, age, comorbidities, and comedications.
Among 97 431 migraine patients (78% women, median age of 41 y [interquartile range of 32-50 y]), the initial migraine treatments received were "acute only" (88.2%), "prophylactic only" (1.9%), and "both acute and prophylactic" (5.2%) whereas 4.6% had no record of treatment. Initiators of prophylactic treatment-with or without acute treatment-were less likely than initiators of acute treatment to be women (71% and 77% versus 79%), were older (median ages: 45 and 44 y versus 41 y), and had more comorbidities (including hypertension [31% and 24% versus 7%] and diabetes [6% and 5% versus 3%]). Nonpersistence with initial prophylactic treatment was common: within the first year, 35% of initiators stopped therapy fully, 50% stopped and restarted, and 15% switched drugs.
For 88% of patients with incident migraine, the initial migraine treatment was acute treatment only. Use of prophylactic medication as initial treatment was low and correlated with higher age and comorbidity.
新诊断偏头痛患者预防性治疗与急性治疗的应用，基于人群的资料较为匮乏。我们研究了丹麦初始偏头痛治疗模式及相关患者特征。
我们使用基于人群的健康数据库，于 2005 年至 2013 年组建了一个全国性偏头痛成年患者队列。偏头痛的定义为首次医院诊断为偏头痛，或第二次凭处方领取曲坦类、麦角生物碱、哌唑嗪或氟桂利嗪。我们将偏头痛发作后接受的初始偏头痛治疗分为“无治疗”、“仅急性治疗”、“仅预防性治疗”和“急性和预防性治疗”，并描述了性别、年龄、合并症和合并用药的分布情况。
在 97431 例偏头痛患者中（78%为女性，中位年龄 41 岁[32-50 岁的四分位间距]），初始偏头痛治疗分别为“仅急性治疗”（88.2%）、“仅预防性治疗”（1.9%）和“急性和预防性治疗”（5.2%），而 4.6%无治疗记录。与急性治疗相比，预防性治疗的起始者（无论是否合并急性治疗）更可能为男性（71%和 77%比 79%）、年龄更大（中位数年龄分别为 45 岁和 44 岁比 41 岁）、合并症更多（包括高血压[31%和 24%比 7%]和糖尿病[6%和 5%比 3%]）。初始预防性治疗的非持续性很常见：在最初的 1 年内，35%的起始者完全停止治疗，50%停止并重新开始，15%更换药物。
88%的新发偏头痛患者的初始偏头痛治疗仅为急性治疗。预防性药物作为初始治疗的应用率较低，与较高的年龄和合并症相关。
