Department of Health Economics and Outcomes Research, IQVIA Inc., Plymouth Meeting, PA, USA.
Department of Global Health Economics, Amgen Inc., Thousand Oaks, CA, USA.
Headache. 2021 Apr;61(4):590-602. doi: 10.1111/head.14068. Epub 2021 Feb 16.
To describe patient characteristics, adherence, and treatment patterns, among adult migraine patients in the United States prescribed erenumab.
Migraine is a highly prevalent and debilitating disease characterized by recurrent attacks of moderate to severe headache accompanied by non-headache symptoms. Erenumab is a first-in-class calcitonin gene-related peptide receptor (CGRP-R) antagonist indicated for migraine prophylaxis in adults.
This retrospective longitudinal cohort study used IQVIA's open-source longitudinal pharmacy (LRx) and medical (Dx) claims databases to identify adult migraine patients with an initial claim (index date) for erenumab between May 1, 2018 and April 30, 2019. Patients were required to have ≥180 days of follow-up. Erenumab dosing patterns, persistence, and adherence (using medication possession ratio [MPR] and proportion of days covered [PDC]), and discontinuation of other commonly prescribed acute and prophylactic anti-migraine therapies were assessed. Dose changes in acute therapies after initiation of erenumab were assessed in a subset of patients with an adequate trial of erenumab (≥2 additional erenumab claims within the 80 days following the index claim).
A total of 64,174 patients met the study criteria. Mean (SD) age was 48 (13) years and 85.2% (n = 54,656) were female. The initial erenumab dose was 70 mg for the majority of patients (65.1%; n = 41,790); most (81.4%; n = 34,019) maintained their index dose during follow-up. Overall, 30.8% (n = 19,797) of patients had a PDC ≥ 0.80 and 41.7% (n = 26,769) had a MPR ≥ 0.80. Discontinuation rates of acute and other prophylactic migraine therapies after initiation of erenumab (among users of the respective therapies) were 48.7% (22,965/47,190) and 36.1% (16,602/46,006), respectively. Dose decreases among triptan, ergot compound, opioid, and barbiturate users were observed after initiation of erenumab.
Almost all patients had prior use of acute or preventive therapy. Adherence to erenumab was higher than traditional oral prophylactic migraine therapies; however, overall adherence was still suboptimal. The decrease in use of acute and preventive prescription medications following initiation of erenumab suggests effectiveness in the real-world setting.
描述美国接受依瑞奈玛（erenumab）治疗的成年偏头痛患者的患者特征、依从性和治疗模式。
偏头痛是一种高发性和使人虚弱的疾病，其特征是反复发作中度至重度头痛，并伴有非头痛症状。依瑞奈玛是一种首创的降钙素基因相关肽受体（CGRP-R）拮抗剂，用于成人偏头痛的预防治疗。
这项回顾性纵向队列研究使用了 IQVIA 的开源纵向药房（LRx）和医疗（Dx）索赔数据库，以确定在 2018 年 5 月 1 日至 2019 年 4 月 30 日期间首次使用依瑞奈玛的成年偏头痛患者（索引日期）。患者需要有≥180 天的随访。评估了依瑞奈玛的剂量模式、持久性和依从性（使用药物占有比[MPR]和覆盖率[PDC]），以及其他常用的急性和预防性抗偏头痛治疗药物的停药情况。在接受依瑞奈玛充分治疗的患者亚组中（在索引索赔后的 80 天内至少有 2 次额外的依瑞奈玛索赔），评估了急性治疗药物剂量变化情况。
共有 64174 名患者符合研究标准。平均（SD）年龄为 48（13）岁，85.2%（n=54656）为女性。大多数患者（65.1%；n=41790）初始依瑞奈玛剂量为 70mg；大多数患者（81.4%；n=34019）在随访期间维持了其初始剂量。总体而言，30.8%（n=19797）的患者 PDC≥0.80，41.7%（n=26769）的患者 MPR≥0.80。依瑞奈玛治疗开始后，急性和其他预防性偏头痛治疗药物的停药率分别为 48.7%（22965/47190）和 36.1%（16602/46006）（在各自治疗药物的使用者中）。依瑞奈玛治疗开始后，曲普坦类、麦角生物碱类、阿片类和巴比妥类药物的使用者减少了药物剂量。
几乎所有患者都曾使用过急性或预防性治疗药物。依瑞奈玛的依从性高于传统的口服预防性偏头痛治疗药物；然而，总体依从性仍不理想。依瑞奈玛治疗开始后，急性和预防性处方药物使用量减少，表明其在真实环境中具有疗效。
