Healthcare Utilization, Costs, and Treatment Discontinuation in Adults with Episodic Migraine Initiating Galcanezumab Versus Rimegepant: A US Retrospective Claims Analysis.

Abstract

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 totalmedical+pharmacycosts (21% lower) and migraine-related totalmedical+pharmacycosts (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.