Kim Gilwan, Hoyt Margaret, Zakharyan Armen, Durica Jennifer, Wallem Alexandra, Viktrup Lars
Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN, 46285, USA.
TechData Service Company, LLC, 700 American Avenue, Suite 102, King of Prussia, PA, 19406, USA.
Adv Ther. 2025 Feb;42(2):918-934. doi: 10.1007/s12325-024-03072-9. Epub 2024 Dec 16.
To date, no study has compared the healthcare resource utilization (HCRU), costs, and discontinuation of the two calcitonin gene-related peptide antagonists, galcanezumab (monoclonal antibody subcutaneously injected monthly) and rimegepant (oral gepant taken every other day), for migraine prevention. This study aimed to assess all-cause and migraine-related HCRU, costs, and treatment discontinuation at 12 months following treatment initiation in commercial/Medicare beneficiaries with episodic migraine who received galcanezumab versus rimegepant as preventive migraine treatment.
This retrospective study used the Merative™ MarketScan Research Databases (June 2020-June 2023). Adults with episodic migraine were grouped into the galcanezumab (≥ 1 claim) or rimegepant cohort (≥ 1 claim with quantity ≥ 15 during the index period). Changes from baseline in all-cause and migraine-related HCRU and cost between the propensity score-matched cohorts were determined using Wilcoxon signed rank test and chi-square test. Treatment discontinuation was assessed using Kaplan-Meier analysis and Cox proportional hazards model.
All-cause and migraine-related HCRU and costs increased over the 12-month follow-up in both cohorts. The galcanezumab cohort had a significantly lower increase in mean all-cause total medical + pharmacy costs (21% lower) and migraine-related total medical + pharmacy costs (76% lower) than the rimegepant cohort at the 12-month follow-up (p < 0.0001 for both assessments). Mean (standard deviation) number of days from initiation to discontinuation (> 60-day gap) was 244.6 (135.3) for galcanezumab cohort and 178.1 (141.1) for rimegepant cohort (p < 0.0001). Treatment discontinuation rate was 1.8 times less likely in the galcanezumab cohort than the rimegepant cohort (hazard ratio = 1.81, 95% confidence interval = 1.56-2.10). Similar trends were observed using a 30-day gap.
Among matched patients, both cohorts of patients with episodic migraine showed all-cause and migraine-related total cost increases over 12 months. However, the magnitude of the increases was significantly lower for the galcanezumab cohort than for the rimegepant cohort. Treatment discontinuation rate was significantly lower in the galcanezumab versus the rimegepant cohort.
迄今为止，尚无研究比较两种降钙素基因相关肽拮抗剂——加卡尼单抗（每月皮下注射一次的单克隆抗体）和瑞美吉泮（隔日口服的 gepant）在预防偏头痛方面的医疗资源利用（HCRU）、成本及停药情况。本研究旨在评估在接受加卡尼单抗或瑞美吉泮作为偏头痛预防性治疗的发作性偏头痛商业医保/医疗保险受益患者中，治疗开始后 12 个月内的全因及偏头痛相关 HCRU、成本和治疗停药情况。
本回顾性研究使用了默克多™市场扫描研究数据库（2020 年 6 月 - 2023 年 6 月）。将患有发作性偏头痛的成年人分为加卡尼单抗组（≥1 次理赔）或瑞美吉泮组（在索引期内≥1 次理赔且数量≥15）。使用 Wilcoxon 符号秩检验和卡方检验确定倾向得分匹配队列之间全因及偏头痛相关 HCRU 和成本相对于基线的变化。使用 Kaplan-Meier 分析和 Cox 比例风险模型评估治疗停药情况。
在 12 个月的随访中，两个队列的全因及偏头痛相关 HCRU 和成本均有所增加。在 12 个月随访时，加卡尼单抗组的平均全因总医疗 + 药房成本增加幅度（低 21%）和偏头痛相关总医疗 + 药房成本增加幅度（低 76%）均显著低于瑞美吉泮组（两项评估的 p < 0.0001）。加卡尼单抗组从开始到停药（间隔>60 天）的平均（标准差）天数为 244.6（135.3）天，瑞美吉泮组为 178.1（141.1）天（p < 0.0001）。加卡尼单抗组的治疗停药率比瑞美吉泮组低 1.8 倍（风险比 = 1.81，95%置信区间 = 1.56 - 2.10）。使用 30 天间隔时观察到类似趋势。
在匹配的患者中，两个发作性偏头痛患者队列在 12 个月内全因及偏头痛相关总成本均有所增加。然而，加卡尼单抗组的增加幅度显著低于瑞美吉泮组。加卡尼单抗组的治疗停药率显著低于瑞美吉泮组。
