Persistence to OnabotulinumtoxinA or Calcitonin Gene-Related Peptide Monoclonal Antibody Therapy Among Patients With Migraine: A Retrospective Cohort Study (P10-12.001)

Abstract

<h3>Objective:</h3> To compare treatment persistency among patients with migraine on calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs; erenumab, fremanezumab, galcanezumab, or eptinezumab) or onabotulinumtoxinA. <h3>Background:</h3> To date, real-world evidence on persistence to CGRP mAbs or onabotulinumtoxinA have excluded eptinezumab. <h3>Design/Methods:</h3> This retrospective study used IQVIA PharmMetrics data. Adult patients with migraine treated with a CGRP mAb or onabotulinumtoxinA who had 12 months of continuous insurance enrollment before starting treatment were included. A “most recent treatment episode” analysis was used in which the most recent episode was defined as the latest treatment period with the same drug (CGRP mAb or onabotulinumtoxinA) without a 15-day gap in medication supply on/after 25June2020–31December2021. Patients were indexed at the start of their most recent episode. Patients were non-persistent and discontinued the therapy associated with their most recent episode if there was ≥15-day gap in medication supply. A Cox proportional-hazards model estimated the discontinuation hazard between treatments. The gap periods and cohort definition were varied in sensitivity analyses. <h3>Results:</h3> The study included 66,576 patients (median age 46 years, 88.6% female). More eptinezumab-treated patients had chronic migraine (727/1074), ≥3 previous uses of acute (323/1074) or preventive (333/1074) therapies, and more prior treatment episodes than other treatment groups (3 [Q1–Q3, 2–5]). Based on a 15-day treatment gap, patients on subcutaneous CGRP mAbs had 32% (95%CI: 1.185, 1.494; erenumab) to 58% (95%CI: 1.418, 1.796; fremanezumab) higher discontinuation hazard than those receiving eptinezumab, with this relationship attenuated but significant with 30-day and 60-day treatment gaps. There was no significant difference in the discontinuation hazard between eptinezumab and onabotulinumtoxinA. Based on a 15-day treatment gap among patients who newly initiated therapy, the discontinuation hazard of subcutaneous CGRP mAbs remained significantly higher compared to eptinezumab and onabotulinumtoxinA. <h3>Conclusions:</h3> Eptinezumab had similar persistency with treatment to onabotulinumtoxinA, which was higher than subcutaneous CGRP mAbs. <b>Disclosure:</b> Dr. Talon has nothing to disclose. Christine Sullivan has received personal compensation for serving as an employee of Lundbeck. Meghana Karnik-Henry has received personal compensation for serving as an employee of Lundbeck. Seema Soni-Brahmbhatt has nothing to disclose. Mr. Anderson has nothing to disclose. Steven Kymes has received personal compensation for serving as an employee of Lundbeck. Steven Kymes has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Journal of Ophthalmology. Steven Kymes has received research support from Emmes Corporation. Mr. Regnier has received personal compensation for serving as an employee of Lundbeck. Mr. Regnier has received personal compensation for serving as an employee of Novartis. Mr. Regnier has stock in Novartis.