Real-world Treatment Combinations of Migraine-specific Prescription Medications (P11-12.006)

Abstract

<h3>Objective:</h3> To describe how prescription medications for migraine are combined in real-world toolkits and how intranasal (IN) treatments fit into these toolkits. <h3>Background:</h3> While migraine may be adequately controlled with monotherapy in some patients, combination therapy is not uncommon. Little is known about the current prevalence and composition of combination toolkits. <h3>Design/Methods:</h3> Medical and prescription claims for migraine patients were analyzed from an open US-based medical and prescription claims dataset (IQVIA LAAD) from November 1, 2015–July 31, 2022. Inclusion required ≥1 ICD-10 migraine diagnosis and ≥1 prescription fill in the 3 months prior to July 31, 2022 (L3M) for ≥1 of the following classes: triptan, lasmiditan, CGRP receptor antagonist (gepant), CGRP monoclonal antibody (mAb), and dihydroergotamine (DHE). L3M fills were analyzed by class and by route of delivery for triptans and DHE. <h3>Results:</h3> 1,329,668 patients were included. Of these, 184,095 (13.8%) filled prescriptions in ≥2 studied classes. Four combinations accounted for 96.9% of multi-drug toolkits: triptan + mAb (n= 75,918; 42.2%), mAb + gepant (n= 45,138; 25.2%), triptan + gepant (n= 43,148; 24.1%), and triptan + mAb + gepant (n= 14,106; 7.9%). IN medication was included in 28,314 (2.1%) patient toolkits; IN-triptans (n= 24,683) were observed 6.6× more frequently than IN-DHE (n= 3,732). Of toolkits containing IN medication, 11,942 (42.2%) combined IN medication with non-IN medication(s). The most frequent such IN/non-IN combinations were with oral triptan (n= 6,675; 55.9%), mAb (n= 4,791; 40.1%), gepant (n= 4,174; 35.0%), or ≥2 non-IN medications (n= 3,400; 28.5%). <h3>Conclusions:</h3> More than 1 in 8 patients using migraine-specific prescription medications used a toolkit combining multiple classes. Patients using IN medication were more likely than the overall included population to use a combination toolkit and frequently combined medications across classes or in the same class with different routes of delivery. <b>Disclosure:</b> Dr. Mohajer has received personal compensation for serving as an employee of Qral Group, LLC. Gilbert J. L’Italien has received personal compensation for serving as an employee of Biohaven Pharmaceuticals. Gilbert J. L’Italien has received stock or an ownership interest from biohaven pharmaceuticals. Ms. Harris has received personal compensation for serving as an employee of Biohaven Pharmaceuticals. Ms. Harris has received stock or an ownership interest from Biohaven Pharmaceuticals.