Takeshima Takao, Yuasa Akira, Lloyd Yukie Michelle, Watanabe Louis Patrick, Kamei Kazumasa, Terasawa Akiho, Coulter Josh, Abraham Lucy, Hauber Brett, Iijima Masahiro
Department of Neurology, Headache Center, Tominaga Hospital, Osaka, Japan.
Japan Access & Value, Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
Neurol Ther. 2024 Dec;13(6):1661-1683. doi: 10.1007/s40120-024-00663-0. Epub 2024 Sep 30.
Migraine is a debilitating headache disorder with a high prevalence in Japan that imposes significant societal burden. Although the Japanese Clinical Practice Guideline for Headache Disorders 2021 recommends both acute and preventive migraine treatments, the usage of preventive treatments is still limited. Therefore, it is crucial to understand the treatment preferences of patients with migraine pertaining to both acute and preventive treatments.
A mixed-methods study including a discrete choice experiment (DCE) was conducted with Japanese patients with migraine (10 for the qualitative interviews, and 400 for the DCE) who were recruited from the Rakuten Insight panel. The DCE presented hypothetical treatment options including oral acute, oral preventive, and injectable preventive medications. Six attributes (method of delivery, reduction of pain, impact of headaches on daily routines, dosage adjustability, and temporary and persistent side effects) each with three levels were included in the survey. A hierarchical Bayesian model was used to estimate relative attribute importance scores (RAI) for all attributes.
For the 400 participants in the DCE, the most common age bracket was 40-49 years old, and the majority were female (66.75%). RAI estimates indicated that "method of delivery" was the most important attribute for patients (RAI 51.92, SD = 10.20), followed by "reduction of pain when experiencing a headache" (RAI 17.00, SD = 7.74). Oral preventive treatments were preferred over injectable preventive treatments. The qualitative interviews showed that patients prefer oral medications to injectable treatments, and a lack of awareness regarding preventive treatments.
This study found that the "method of delivery" was the most important driver of treatment preferences of patients with migraine in Japan, with oral acute medications being preferred. Oral preventive treatments were found to be preferred over injectable treatments. These results may indicate the need for increased education regarding preventive treatments, as well as the need for further development of these treatments.
偏头痛是一种使人衰弱的头痛疾病，在日本患病率很高，给社会带来了沉重负担。尽管《2021年日本头痛疾病临床实践指南》推荐了偏头痛的急性治疗和预防性治疗，但预防性治疗的使用仍然有限。因此，了解偏头痛患者在急性治疗和预防性治疗方面的治疗偏好至关重要。
对从乐天洞察面板招募的日本偏头痛患者进行了一项混合方法研究，包括离散选择实验（DCE）（定性访谈10人，DCE 400人）。DCE展示了假设的治疗方案，包括口服急性药物、口服预防性药物和注射用预防性药物。调查包括六个属性（给药方式、疼痛减轻、头痛对日常生活的影响、剂量可调整性以及暂时和持续的副作用），每个属性有三个级别。使用分层贝叶斯模型估计所有属性的相对属性重要性得分（RAI）。
在DCE的400名参与者中，最常见的年龄组是40-49岁，大多数为女性（66.75%）。RAI估计表明，“给药方式”是患者最重要的属性（RAI 51.92，标准差=10.20），其次是“头痛发作时疼痛减轻”（RAI 17.00，标准差=7.74）。口服预防性治疗优于注射用预防性治疗。定性访谈表明，患者更喜欢口服药物而非注射治疗，并且对预防性治疗缺乏认识。
本研究发现，“给药方式”是日本偏头痛患者治疗偏好的最重要驱动因素，患者更喜欢口服急性药物。发现口服预防性治疗优于注射治疗。这些结果可能表明需要加强对预防性治疗的教育，以及进一步开发这些治疗方法的必要性。
