Mayo Clinic, Phoenix, AZ, USA.
AbbVie, Irvine, CA, USA.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720963680. doi: 10.1177/2150132720963680.
Triptans, the most commonly prescribed acute treatments for migraine attacks are, per FDA labeling, contraindicated in cardiovascular (CV) disease patients and have warnings and precautions for those with CV risk factors.
Headache specialists, cardiologists, and health economics and outcomes researchers convened to identify diagnostic codes for: (1) CV diseases contraindicating triptans based on FDA labeling; (2) conditions comprising "other significant underlying CV disease"; and (3) CV risk factors included as warnings and precautions for triptans. A retrospective, cross-sectional analysis of commercially insured adult US migraine patients in the 2017 Optum Clinformatics Data Mart (CDM) and the 2017 IBM Watson Health MarketScan Commercial Claims database was used to estimate the proportion of migraine patients with CV contraindications and warnings and precautions to triptans.
Of the 56,662 migraine patients analyzed from Optum CDM, 13.5% had ≥1 CV disease as specified in triptan labeling and an additional 8.5% had ≥1 "other CV disease" judged by the panel to constitute a "significant underlying CV disease" (total: 22.0% migraine patients). Of 176 724 migraine patients analyzed from MarketScan, 12.2% had ≥1 CV disease as specified in the labeling and an additional 8.0% had ≥1 "other significant underlying CV disease" (total: 20.2% of migraine patients). An additional 25.4% and 25.1% of migraine patients had ≥2 CV risk factors in Optum CDM and MarketScan. In total, 47.4% and 45.3% of migraine patients in both databases had a CV disease specified as a contraindication, an "other CV disease" endorsed as significant, or ≥2 CV risk factors identified as warnings and precautions to triptans.
Analyses of more than 230,000 people with migraine showed that ≥20% of commercially insured US migraine patients have a CV condition that specifically contraindicates triptan treatment, and an additional 25% have ≥2 CV risk factors identified as warnings and precautions to triptans.
曲坦类药物是偏头痛发作最常开的急性治疗药物，根据 FDA 标签，其在心血管疾病患者中被禁用，并对有心血管风险因素的患者有警告和注意事项。
头痛专家、心脏病专家以及健康经济学和结果研究人员聚集在一起，确定以下诊断代码：（1）根据 FDA 标签，有 CV 疾病的患者禁用曲坦类药物；（2）构成“其他重要潜在 CV 疾病”的情况；（3）包括曲坦类药物警告和注意事项的 CV 风险因素。使用 2017 年 Optum Clinformatics Data Mart（CDM）和 2017 年 IBM Watson Health MarketScan 商业索赔数据库中的商业保险成年美国偏头痛患者的回顾性、横断面分析，估计偏头痛患者中具有 CV 禁忌和曲坦类药物警告和注意事项的比例。
从 Optum CDM 分析的 56662 例偏头痛患者中，有 13.5%的患者有 ≥1 种 CV 疾病，符合曲坦类药物标签规定，另有 8.5%的患者有 ≥1 种“其他 CV 疾病”，专家组判断这些疾病构成“重要潜在 CV 疾病”（总共：22.0%的偏头痛患者）。从 MarketScan 分析的 176724 例偏头痛患者中，有 12.2%的患者有 ≥1 种 CV 疾病，符合标签规定，另有 8.0%的患者有 ≥1 种“其他重要潜在 CV 疾病”（总共：偏头痛患者的 20.2%）。Optum CDM 和 MarketScan 中还有 25.4%和 25.1%的偏头痛患者有 ≥2 种 CV 风险因素。总的来说，两个数据库中都有 47.4%和 45.3%的偏头痛患者有 CV 疾病被指定为禁忌，一种“其他 CV 疾病”被认为是严重的，或有 ≥2 种 CV 风险因素被认为是曲坦类药物的警告和注意事项。
对超过 230000 名偏头痛患者的分析表明，≥20%的商业保险美国偏头痛患者有 CV 状况，具体来说，曲坦类药物治疗是禁忌的，另外 25%的患者有 ≥2 种 CV 风险因素，被认为是曲坦类药物的警告和注意事项。
