Prevalence, characteristics and management of migraine patients with triptan failure in primary care: the EMR France-Mig study.

BACKGROUND

The most used treatments for migraine attacks are triptans, yet a considerable proportion of the population develops treatment failure over time due to ineffectiveness, side effects, and/or contraindications. The aim of the France-Mig study was to quantify the population with triptan failure due to ineligibility or resistance, in the primary care setting, and describe their therapeutic management.

METHODS

The France-Mig study was a retrospective analysis of a cohort of patients suffering from migraine in 2022 identified using data from the IQVIA electronic medical records (EMR). Patients were identified using either a migraine diagnosis (ICD-10 G43) or a prescription for migraine-specific drugs. Triptan failure was defined as patients with triptan ineligibility (having a contraindication listed in the summary of product characteristics of triptan or aged over 65 years old) or triptan resistance (unsuccessful intake of two different triptans, following the 2022 European Headache Federation consensus definition).

RESULTS

A total of 16,888 adult patients with migraine diagnosis or migraine-specific treatment prescribed in 2022 and with at least 5 years of look back period were included (after extrapolation, it was estimated that 1,440,169 adults consulted a general practitioner in primary care for migraine in 2022 in metropolitan France, which corresponds to 2.78% of the French population). Among the 16,888 patients fulfilling inclusion criteria, 4,509 (26.7%) were identified as having triptan failure, including 4,024 (23.8%) ineligible patients (1,364 [8.1%] with cardiovascular contraindications for triptans, 700 [4.1%] with non-cardiovascular contraindications, 2,055 [12.2%] with age superior or equal to 65 years) and 604 (3.6%) with triptan resistance. A total of 1,384 (53.9%) patients with ineligibility were prescribed a triptan (after their ineligibility). Among patients with triptan resistance, 273 (45.2%) were prescribed at least 3 different triptan molecules and 41 (6.8%) were prescribed at least 4 different triptan molecules.

CONCLUSIONS

Triptans failed in more than a quarter of patients. The high proportion of patients treated with triptan despite contraindication showed a substantial unmet therapeutic need, warranting further research and tailored approaches to improve patient outcomes.