Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Headache. 2022 Jul;62(7):883-889. doi: 10.1111/head.14327. Epub 2022 Jun 7.
We sought to investigate the prevalence of triptan use among patients with migraine who have contraindications to triptan usage, and to explore specifics of the medication prescribed, dosage, and route of administration.
Triptan medications are a mainstay of acute migraine therapy, but little is known about prevalence and patterns of triptan prescribing among patients with contraindications in the United States.
In this retrospective cohort study, we used data from the IBM Marketscan database to identify patients aged ≥ 18 years with migraine from January 1, 2016, to December 31, 2017, using International Classification of Diseases, Clinical Modification 10 codes. Contraindications to triptan medications were identified by review of package labels as listed on the US Food and Drug Administration website. Triptan medications were identified from the IBM Micromedex Redbook linked to prescription claims along with route of administration and dosage.
Of 1,038,472 individuals diagnosed with migraine, 400,112 (38.5%) were prescribed triptan medication, and of those who were prescribed a triptan, 55,707 (13.9%) had at least one contraindication, with the most common contraindication being cardiac arrhythmia (33,696/400,112 individuals, 8.4%) followed by cerebrovascular disease (14,787/400,112, 3.7%) and coronary artery disease (10,236/400,112, 2.6%). Sumatriptan was the most prescribed triptan (261,736/1,038,472, 25.2%), and the subcutaneous and intranasal routes were more commonly prescribed among those with contraindications compared with those without contraindications.
A substantial proportion of patients with migraine with contraindications were prescribed triptan medications. These findings call for further research on the outcomes of patients with medical contraindications who are prescribed triptan medications, and for greater clarity in prescribing guidelines about the optimal approach for acute therapy among patients with migraine.
我们旨在调查有曲坦类药物使用禁忌的偏头痛患者中曲坦类药物的使用情况，并探讨处方药物的具体信息，包括剂量和给药途径。
曲坦类药物是急性偏头痛治疗的主要药物，但在美国，对于有曲坦类药物使用禁忌的患者，人们对其使用的普遍性和模式知之甚少。
本回顾性队列研究使用 IBM Marketscan 数据库的数据，根据国际疾病分类第 10 版临床修订版代码，于 2016 年 1 月 1 日至 2017 年 12 月 31 日期间确定年龄≥18 岁的偏头痛患者。通过审查美国食品和药物管理局网站上列出的药品标签，确定曲坦类药物的使用禁忌。IBM Micromedex Redbook 通过处方索赔与给药途径和剂量相关联，识别曲坦类药物。
在 1038472 名被诊断为偏头痛的患者中，有 400112 名（38.5%）患者开具了曲坦类药物，其中 55707 名（13.9%）有至少一种禁忌证，最常见的禁忌证是心律失常（33696/400112 名患者，8.4%），其次是脑血管疾病（14787/400112 名患者，3.7%）和冠状动脉疾病（10236/400112 名患者，2.6%）。舒马曲坦是最常被开的曲坦类药物（261736/1038472 名患者，25.2%），与无禁忌证的患者相比，有禁忌证的患者更常使用皮下和鼻内途径。
有曲坦类药物使用禁忌的偏头痛患者中，有相当大比例的患者被开具了曲坦类药物。这些发现呼吁进一步研究有医疗禁忌证的患者使用曲坦类药物的结果，并在偏头痛患者的急性治疗中，制定更明确的处方指南，阐明最佳方法。
