TY - JOUR
T1 - Real-world Persistence and costs among Patients with chronic migraine treated with onabotulinumtoxinA or calcitonin gene-related PePtide monoclonal antibodies
AU - Schwedt, Todd J.
AU - Lee, Jae
AU - Knievel, Kerry
AU - McVige, Jennifer
AU - Wang, Weiying
AU - Wu, Zheng
AU - Gillard, Patrick
AU - Shah, Darshini
AU - Blumenfeld, Andrew M.
N1 - Publisher Copyright:
© 2023 Academy of Managed Care Pharmacy (AMCP). All rights reserved.
PY - 2023/10
Y1 - 2023/10
N2 - BACKGROUND: Chronic migraine (CM) is a common neurologic disorder that imPoses substantial burden on Payers, Patients, and society. Low rates of Persistence to oral migraine Preventive medications have been Previously documented; however, less is known about Persistence and costs associated with innovative nonoral migraine Preventive medications. OBJECTIVE: To evaluate real-world Persistence and costs among adults with CM treated with onabotulinumtoxinA (onabotA) or calcitonin gene-related PePtide monoclonal antibodies (CGRP mAbs). METHODS: This was a retrosPective, longitudinal, observational study analyzing the IBM MarketScan Commercial and Medicare databases. The study samPle included adults with CM initiating treatment with either onabotA or a CGRP mAb on or after January 1, 2018. Persistence and costs over 12 months after treatment initiation were evaluated using chisquare and Student's t-Tests. Persistence to onabotA was comPared with CGRP mAbs as a weighted average of the class and by individual CGRP mAbs. Mean Pharmacy (acute and Preventive), medical (inPatient, emergency dePartment, and outPatient), and total costs are rePorted. Multivariate regression analyses were conducted to generate adjusted estimates of Persistence and costs after controlling for Potential confounders (age, sex, region, insurance tyPe, number of baseline comorbidities, Charlson Comorbidity Index, and number of Previously used oral migraine Preventive medications). RESULTS: Of 66,303 individuals with onabotA or CGRP mAb claims, 2,697 with CM met the inclusion/exclusion criteria. In the total PoPulation, individuals were Primarily female (85.5%), lived in the South (48.5%), and had a mean (SD) age of 44 (12) years, which was consistent across the onabotA and CGRP mAb cohorts. Common comorbid conditions included anxiety (23.9%), dePression (18.2%), hyPertension (16.5%), and sleeP disorders (16.9%). After adjusting for Potential confounding variables, Persistence to onabotA during the 12-month follow-uP Period was 40.7% vs 27.8% for CGRP mAbs (odds ratio [OR] = 0.683; 95% CI = 0.604-0.768; P < 0.0001). Persistence to erenumab, fremanezumab, and galcanezumab was 25.5% (OR = 0.627; 95% CI = 0.541-0.722; P < 0.0001), 30.3% (OR = 0.746; 95% CI = 0.598-0.912; P = 0.0033), and 33.7% (OR = 0.828; 95% CI = 0.667-1.006; P = 0.058). All-cause ($18,292 vs $18,275; P = 0.9739) and migraine-related ($8,990 vs $9,341; P = 0.1374) costs were comParable between the onabotA and CGRP mAb grouPs. CONCLUSIONS: Among adults with CM receiving onabotA and CGRP mAbs, individuals initiating onabotA treatment had higher Persistence comPared with those receiving CGRP mAbs. Total allcause and migraine-related costs over 12 months were comParable between those receiving onabotA and CGRP mAbs.
AB - BACKGROUND: Chronic migraine (CM) is a common neurologic disorder that imPoses substantial burden on Payers, Patients, and society. Low rates of Persistence to oral migraine Preventive medications have been Previously documented; however, less is known about Persistence and costs associated with innovative nonoral migraine Preventive medications. OBJECTIVE: To evaluate real-world Persistence and costs among adults with CM treated with onabotulinumtoxinA (onabotA) or calcitonin gene-related PePtide monoclonal antibodies (CGRP mAbs). METHODS: This was a retrosPective, longitudinal, observational study analyzing the IBM MarketScan Commercial and Medicare databases. The study samPle included adults with CM initiating treatment with either onabotA or a CGRP mAb on or after January 1, 2018. Persistence and costs over 12 months after treatment initiation were evaluated using chisquare and Student's t-Tests. Persistence to onabotA was comPared with CGRP mAbs as a weighted average of the class and by individual CGRP mAbs. Mean Pharmacy (acute and Preventive), medical (inPatient, emergency dePartment, and outPatient), and total costs are rePorted. Multivariate regression analyses were conducted to generate adjusted estimates of Persistence and costs after controlling for Potential confounders (age, sex, region, insurance tyPe, number of baseline comorbidities, Charlson Comorbidity Index, and number of Previously used oral migraine Preventive medications). RESULTS: Of 66,303 individuals with onabotA or CGRP mAb claims, 2,697 with CM met the inclusion/exclusion criteria. In the total PoPulation, individuals were Primarily female (85.5%), lived in the South (48.5%), and had a mean (SD) age of 44 (12) years, which was consistent across the onabotA and CGRP mAb cohorts. Common comorbid conditions included anxiety (23.9%), dePression (18.2%), hyPertension (16.5%), and sleeP disorders (16.9%). After adjusting for Potential confounding variables, Persistence to onabotA during the 12-month follow-uP Period was 40.7% vs 27.8% for CGRP mAbs (odds ratio [OR] = 0.683; 95% CI = 0.604-0.768; P < 0.0001). Persistence to erenumab, fremanezumab, and galcanezumab was 25.5% (OR = 0.627; 95% CI = 0.541-0.722; P < 0.0001), 30.3% (OR = 0.746; 95% CI = 0.598-0.912; P = 0.0033), and 33.7% (OR = 0.828; 95% CI = 0.667-1.006; P = 0.058). All-cause ($18,292 vs $18,275; P = 0.9739) and migraine-related ($8,990 vs $9,341; P = 0.1374) costs were comParable between the onabotA and CGRP mAb grouPs. CONCLUSIONS: Among adults with CM receiving onabotA and CGRP mAbs, individuals initiating onabotA treatment had higher Persistence comPared with those receiving CGRP mAbs. Total allcause and migraine-related costs over 12 months were comParable between those receiving onabotA and CGRP mAbs.
UR - http://www.scopus.com/inward/record.url?scp=85174080514&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85174080514&partnerID=8YFLogxK
U2 - 10.18553/jmcP.2023.29.10.1119
DO - 10.18553/jmcP.2023.29.10.1119
M3 - Article
C2 - 37776119
AN - SCOPUS:85174080514
SN - 2376-0540
VL - 29
SP - 1119
EP - 1128
JO - Journal of Managed Care and Specialty Pharmacy
JF - Journal of Managed Care and Specialty Pharmacy
IS - 10
ER -