Moskatel Leon S, Linfield Rebecca Y, Zhang Niushen
Department of Neurology, Stanford University, Palo Alto, CA, United States.
Department of Infectious Diseases, Stanford University, Palo Alto, CA, United States.
Front Neurol. 2025 Feb 7;16:1530499. doi: 10.3389/fneur.2025.1530499. eCollection 2025.
Understanding all factors that affect a patient's acute migraine treatment care is crucial. We sought to determine the impact of headache specialist density and the introduction of the gepants and lasmiditan on the prescription of acute treatments for migraine.
We analyzed three scenarios: first, we performed linear regression analysis with the percentage of patients with migraine prescribed an acute medication in 2023, obtained via Epic Cosmos, and the density of headache specialists at the state level. Second, we conducted interrupted time-series analysis examining the change in patients prescribed the triptans before (2016-2019) and after (2020-2023) the introduction of the gepants and lasmiditan. Finally, we used regression analysis to look at the association of one pharmaceutical company, Pfizer, payments to physicians with prescriptions for that company's gepant, rimegepant.
We included 6,559,854 patients with migraine and found that increased headache specialist density was associated with increased eletriptan, almotriptan, and naratriptan; there was no association with the other queried acute medications. In our interrupted time-series analysis, the introduction of the gepants and lasmiditan was linked to decreases in triptan utilization, except for eletriptan which remained stable, and rizatriptan which rose at a slower rate. Finally, increased Pfizer payments to physicians were associated with a higher percentage of patients prescribed rimegepant.
Our study suggests increased headache provider availability is associated with more prescriptions for naratriptan, eletriptan, and almotriptan. Additionally, the introduction of the gepants and lasmiditan broadly decreased the utilization of triptans. Critically, there was a strong association between a pharmaceutical company's, Pfizer, payments to physicians and utilization of their medication, rimegepant.
了解所有影响患者急性偏头痛治疗护理的因素至关重要。我们试图确定头痛专科医生的密度以及 gepants 和 lasmiditan 的引入对偏头痛急性治疗处方的影响。
我们分析了三种情况：首先，我们使用通过 Epic Cosmos 获取的 2023 年开具急性偏头痛药物的偏头痛患者百分比与州级头痛专科医生的密度进行线性回归分析。其次，我们进行了中断时间序列分析，研究在引入 gepants 和 lasmiditan 之前（2016 - 2019 年）和之后（2020 - 2023 年）开具曲坦类药物的患者的变化。最后，我们使用回归分析来研究辉瑞公司向医生支付的费用与该公司的 gepant（利美尼定）处方之间的关联。
我们纳入了 6,559,854 名偏头痛患者，发现头痛专科医生密度的增加与依立曲坦、阿莫曲坦和那拉曲坦处方量的增加相关；与其他查询的急性偏头痛药物无关联。在我们的中断时间序列分析中，除依立曲坦保持稳定以及利扎曲坦上升速度较慢外，gepants 和 lasmiditan 的引入与曲坦类药物的使用减少有关。最后，辉瑞公司向医生支付费用的增加与开具利美尼定处方的患者百分比更高相关。
我们的研究表明，头痛专科医生数量的增加与那拉曲坦、依立曲坦和阿莫曲坦的更多处方相关。此外，gepants 和 lasmiditan 的引入广泛降低了曲坦类药物的使用。至关重要的是，制药公司辉瑞向医生支付的费用与他们的药物利美尼定的使用之间存在强烈关联。
