Nevertheless, findings additionally revealed sufferers largely continued to be managed by way of a polypharmacy strategy after remedy initiation.
As a result of erenumab was accepted in 2018, few information can be found on its affect in real-world settings. To deal with this data hole, researchers “aimed to characterize the real-world remedy profiles, medical outcomes, and healthcare useful resource utilization of sufferers prescribed erenumab from choose main US headache facilities.”
This retrospective chart evaluation included information from sufferers handled at 5 US headache facilities between April 2019 and April 2020. The index date was outlined because the date of first prescription fill of erenumab, whereas the baseline interval was thought of the three months previous to the index date.
All sufferers included (n = 1034) had identified migraine, had been handled with erenumab for a minimum of 3 consecutive months, and had been 18 years or older on the index date. The imply affected person age was 48 years, 86% had been feminine, and most (79%) had been White. Frequent comorbidities included melancholy, nervousness, and sleep problems. Sufferers used erenumab for a imply of 9.3 months.
- Sufferers had a imply of 5 preventive remedy failures previous to erenumab initiation
- Sufferers used a imply of two preventive remedies (excluding erenumab) and a pair of acute remedies in the course of the baseline and examine durations
- Among the many 793 (77%) sufferers who initiated erenumab at 70 mg, 572 (72%) sufferers later escalated to 140 mg
- Amongst sufferers with effectiveness information, 45% had enchancment in physician-reported migraine severity and 35% skilled a minimum of 50% discount in imply headache/migraine days per 30 days
- Imply headache/migraine days per 30 days decreased by a imply of 5.6 days, from 18.3 days at baseline to 12.7 days in the course of the examine interval
- Common variety of month-to-month outpatient visits was 0.43 and 0.30 earlier than and after erenumab initiation, respectively
On the finish of the examine interval, 790 (76%) sufferers continued with erenumab whereas 244 stopped remedy. The primary causes for discontinuation included lack of effectiveness, adversarial occasions, and insurance coverage reimbursement.
As well as, “At baseline, 50% of sufferers had migraine categorised as ‘extreme’ and 37% had migraine categorised as ‘reasonable’ on the idea of doctor evaluation of severity,” the authors wrote. “After erenumab initiation, solely 19% had migraine categorised as ‘extreme’ and 49% had migraine categorised as ‘reasonable.’ Among the many 877 (85%) sufferers with this info out there in each baseline and examine durations, 397 (45%) improved in severity after erenumab initiation.”
Twenty-three sufferers reported constipation previous to erenumab initiation whereas 216 reported the adversarial occasion all through the examine interval. Nevertheless, 22% of those sufferers “had been prescribed remedies in the course of the examine interval apart from erenumab which may be probably related to constipation,” the authors stated.
As a result of tapering and discontinuation of different remedies would sometimes happen after migraineurs achieved a steady response to erenumab, the present examine interval could not have absolutely captured full remedy discontinuation patterns or dose modifications within the common 9-month follow-up.
Over half of sufferers within the examine additionally suffered from behavioral nervous system problems, that are threat elements for persistent migraine.
“Additional analysis is required to achieve a greater understanding of migraine remedy patterns and to ascertain a transparent strategy to modifying present migraine remedy profiles after anti-CGRP pathway therapies are initiated,” the researchers wrote.
Higher instruments to measure and assess constipation in a clinically significant method are additionally warranted.
The potential for lacking or inaccurate information reported in medical charts mark a limitation to the examine, along with a scarcity of standardization in doctor reporting of knowledge throughout facilities. Outcomes is probably not generalizable to all these with migraine and people with episodic migraine.
“Additional long-term analysis throughout varied medical apply settings is required to raised perceive real-world affected person outcomes and remedy patterns with erenumab remedy,” the authors concluded.
Faust E, Pivneva I, Yang Okay, et al. Actual-world remedy profiles, medical outcomes, and healthcare useful resource utilization of sufferers with migraine prescribed erenumab: a multicenter chart-review examine of US headache facilities. Neurol Ther. Printed on-line April 15, 2021. doi:10.1007/s40120-021-00245-4