1
|
Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep 2022; 71:1-95. [PMID: 36327391 PMCID: PMC9639433 DOI: 10.15585/mmwr.rr7103a1] [Citation(s) in RCA: 426] [Impact Index Per Article: 213.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1-49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1-3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient's circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.
Collapse
|
2
|
Johnston K, Harris L, Powell L, Popoff E, Coric V, L'Italien G, Schreiber CP. Monthly migraine days, tablet utilization, and quality of life associated with Rimegepant - post hoc results from an open label safety study (BHV3000-201). J Headache Pain 2022; 23:10. [PMID: 35038983 PMCID: PMC8903552 DOI: 10.1186/s10194-021-01378-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to describe patterns in monthly migraine days (MMD) and tablet utilization, and to estimate health-related quality of life (HRQoL) measures in patients treated as needed (PRN) with rimegepant 75 mg over 52-weeks. Methods Eligible subjects were adults with ≥1 year history of migraine and ≥ 6 MMD at baseline, who used rimegepant 75 mg up to once daily PRN (at their discretion) for up to 52-weeks in an open-label safety study (BHV3000–201; NCT03266588). Mean MMD were calculated at each 4-week period, along with mean monthly tablets taken. Migraine-specific quality of life (MSQv2) data were mapped to EQ-5D utilities and used to characterize HRQoL over time. A published network meta-analysis was used to characterize pain hours as well as time periods spent migraine free. Results One thousand forty four subjects were included in this post-hoc analysis. Overall mean MMD were 10.9 at baseline and decreased to 8.9 by week 52. Tablet use remained stable over the follow-up period. A total of 0.08 incremental QALYs were associated with rimegepant use. Conclusion For subjects with 6 or more MMD, acute treatment of migraine attacks with rimegepant 75 mg on a PRN basis over one-year of follow-up was found to be associated with reduced MMD frequency without an increase in monthly tablet utilization, and improved HRQoL. There was no evidence of medication-related increases in MMDs when rimegepant 75 mg was used as needed for the acute treatment of migraine over 52-weeks. Trial registration ClinicalTrials.gov identifier NCT03266588. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01378-5.
Collapse
Affiliation(s)
- Karissa Johnston
- Broadstreet Health Economics & Outcomes Research, Vancouver, BC, Canada.
| | | | - Lauren Powell
- Broadstreet Health Economics & Outcomes Research, Vancouver, BC, Canada
| | - Evan Popoff
- Broadstreet Health Economics & Outcomes Research, Vancouver, BC, Canada
| | | | | | | |
Collapse
|
3
|
Ruggeri M, Drago C, Rosiello F, Orlando V, Santori C. Economic Evaluation of Treatments for Migraine: An Assessment of the Generalizability Following a Systematic Review. PHARMACOECONOMICS 2020; 38:473-484. [PMID: 32107743 DOI: 10.1007/s40273-019-00879-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND All health economics reviews on chronic and episodic migraine published to date underline the heterogeneity of results. Currently, the need for the generalizability of economic evaluations across different jurisdictions is considered a key issue to avoid unnecessary overlaps and to minimize the time to reimbursement decisions. OBJECTIVE The aim of this study was to review the economic evaluations on the prophylaxis and treatments for migraine published in the previous 10 years (since 2009) and to perform a critical assessment of their generalizability. METHODS We searched PubMed, EMBASE, and EconLit databases. Articles underwent a three-stage selection process. To assess the level of generalizability, we used the checklist implemented by Augustovski et al. Studies were classified as: (1) generalizable; (2) transferable; and (3) context specific. RESULTS In total, 227 articles were identified after running the search string and 11 studies were included in our review. Overall, none of the studies was judged as generalizable and three were judged transferable according to the established criteria. CONCLUSIONS Our review suggests that no evidence on the economic value of either acute or prophylactic treatments against migraine is generalizable to different jurisdictions. However, the majority of studies reporting results about prophylactic treatments were found to be transferable.
Collapse
Affiliation(s)
- Matteo Ruggeri
- National Center for HTA, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Rome, Italy.
- St. Camillus International University of Health Sciences, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | | |
Collapse
|
4
|
Cameron C, Kelly S, Hsieh SC, Murphy M, Chen L, Kotb A, Peterson J, Coyle D, Skidmore B, Gomes T, Clifford T, Wells G. Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis. Headache 2015; 55 Suppl 4:221-35. [PMID: 26178694 DOI: 10.1111/head.12601] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although triptans are widely used in the acute management of migraine, there is uncertainty around the comparative efficacy of triptans among each other and vs non-triptan migraine treatments. We conducted systematic reviews and network meta-analyses to compare the relative efficacy of triptans (alone or in combination with other drugs) for acute treatment of migraines compared with other triptan agents, non-steroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid (ASA), acetaminophen, ergots, opioids, or anti-emetics. METHODS The Cochrane Library, MEDLINE, and EMBASE were searched for randomized controlled trials that compared triptans (alone or in combination with other drugs) with placebo-controlled or active migraine treatments. Study selection, data extraction, and quality assessment were completed independently by multiple reviewers. Outcome data were combined and analyzed using a Bayesian network meta-analysis. For each outcome, odds ratios, relative risks, and absolute probability of response were calculated. RESULTS A total of 133 randomized controlled trials met the inclusion criteria. Standard dose triptans relieved headaches within 2 hours in 42 to 76% of patients, and 2-hour sustained freedom from pain was achieved for 18 to 50% of patients. Standard dose triptans provided sustained headache relief at 24 hours in 29 to 50% of patients, and sustained freedom from pain in 18 to 33% of patients. Use of rescue medications ranged from 20 to 34%. For 2-hour headache relief, standard dose triptan achieved better outcomes (42 to 76% response) than ergots (38%); equal or better outcomes than NSAIDs, ASA, and acetaminophen (46 to 52%); and equal or slightly worse outcomes than combination therapy (62 to 80%). Among individual triptans, sumatriptan subcutaneous injection, rizatriptan ODT, zolmitriptan ODT, and eletriptan tablets were associated with the most favorable outcomes. INTERPRETATION/CONCLUSIONS Triptans are effective for migraine relief. Standard dose triptans are associated with better outcomes than ergots, and most triptans are associated with equal or better outcomes compared with NSAIDs, ASA, and acetaminophen. Use of triptans in combination with ASA or acetaminophen, or using alternative modes of administration such as injectables, may be associated with slightly better outcomes than standard dose triptan tablets.
Collapse
Affiliation(s)
- Chris Cameron
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.,University of Ottawa Heart Institute, Ottawa, Canada
| | - Shannon Kelly
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Meghan Murphy
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Li Chen
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Ahmed Kotb
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Joan Peterson
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | | | - Tara Gomes
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Tammy Clifford
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.,CADTH, Ottawa, Canada
| | - George Wells
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.,University of Ottawa Heart Institute, Ottawa, Canada
| |
Collapse
|
5
|
Coyle D, Lee KM, Mamdani M, Sabarre KA, Tingley K. Reimbursement-Based Economics - What Is It and How Can We Use It to Inform Drug Policy Reform? Headache 2015; 55 Suppl 4:236-47. [DOI: 10.1111/head.12585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Doug Coyle
- School of Epidemiology, Public Health and Preventive Medicine; Faculty of Medicine; University of Ottawa; Ottawa ON Canada
| | - Karen M. Lee
- School of Epidemiology, Public Health and Preventive Medicine; Faculty of Medicine; University of Ottawa; Ottawa ON Canada
- Canadian Agency for Drugs and Technologies in Health; Ottawa ON Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Institute of Health Policy, Management and Evaluation and Leslie Dan Faculty of Pharmacy; University of Toronto; Toronto ON Canada
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
| | | | - Kylie Tingley
- School of Epidemiology, Public Health and Preventive Medicine; Faculty of Medicine; University of Ottawa; Ottawa ON Canada
- Canadian Agency for Drugs and Technologies in Health; Ottawa ON Canada
| |
Collapse
|
6
|
Woldeamanuel YW, Rapoport AM, Cowan RP. What is the evidence for the use of corticosteroids in migraine? Curr Pain Headache Rep 2015; 18:464. [PMID: 25373608 DOI: 10.1007/s11916-014-0464-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Corticosteroids are widely prescribed for the management of migraine attacks. The earliest clinical studies examining the efficacy of corticosteroid monotherapy for managing migraine attacks date back to 1952. Since then, 26 heterogeneous clinical studies and four meta-analyses have been conducted to assess the efficacy of corticosteroids in either aborting acute migraine attacks, prolonged migraine attacks or recurrent headaches. Most of these (86 %) studies employed different comparator arms with corticosteroids monotherapy administration while some studies (14 %) evaluated adjunctive corticosteroid therapy. The majority of these clinical studies revealed the superior efficacy of corticosteroids as mono- or adjunctive-therapy both for recurrent and acute migraine attacks, while the remaining showed non-inferior efficacy. Different forms of oral and parenteral corticosteroids in either single-dose or short-tapering schedules are prescribed; there are clinical studies supporting the efficacy of both methods. Corticosteroids can be administered safely up to six times annually. Corticosteroids are also useful in managing patients who frequent emergency departments with "medication-seeking behavior." Migraine patients with refractory headaches, history of recurrent headaches, severe baseline disability, and status migrainosus were found to have the most beneficial response from corticosteroid therapy.
Collapse
Affiliation(s)
- Y W Woldeamanuel
- Stanford Headache Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Room H3160, 300 Pasteur Drive, Stanford, CA, 94305-5235, USA,
| | | | | |
Collapse
|
7
|
Bhambri R, Mardekian J, Liu LZ, Schweizer E, Ramos E. A review of the pharmacoeconomics of eletriptan for the acute treatment of migraine. Int J Gen Med 2015; 8:27-36. [PMID: 25624770 PMCID: PMC4296958 DOI: 10.2147/ijgm.s73673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Migraine is a commonly occurring, chronic disorder that can cause significant disability. Eletriptan, a selective serotonin 5-hydroxytryptamine 1 receptor subtype B/D (5-HT1B/1D) agonist, is a clinically effective treatment for moderate to severe migraine. The objective of this literature review was to summarize the available data on the pharmacoeconomics of eletriptan relative to other triptans. Articles meeting the following three criteria were included in the review: 1) contained pharmacoeconomic data on a marketed dose of eletriptan; 2) included data on at least one other comparator triptan; and 3) was in English. A MEDLINE® search yielded a total of eight studies (from the European Union [n=5] and from the USA [n=3]) across multiple regions. Seven of the studies examined the pharmacoeconomics of eletriptan relative to other triptans, and a further study examined the health care costs of eletriptan 40 mg versus sumatriptan 100 mg. Eletriptan 40 mg was among a group of triptans, including rizatriptan 10 mg and almotriptan 12.5 mg, demonstrating the greatest cost-effectiveness. This result held across different definitions of efficacy (2 hours pain-free, sustained pain-free, and sustained pain-free with no adverse events) and also held when cost-effectiveness models accounted for second doses and use of rescue medication, management of adverse events, and productivity loss, in addition to drug acquisition costs. Only limited head-to-head comparator data were available. The majority of pharmacoeconomic studies utilized the same set of efficacy and/or tolerability data, and indirect costs were rarely included despite the fact that the majority of per capita migraine costs are attributable to indirect costs. In summary, although the market is now dominated by generics, eletriptan 40 mg is among the most clinically and cost-effective oral triptans available for the management of acute migraine. Increased effectiveness/efficacy of eletriptan may necessitate a lesser need for other migraine treatments and/or switching to other triptans.
Collapse
Affiliation(s)
| | | | - Larry Z Liu
- Pfizer, Inc., New York, NY, USA ; Weill Medical College of Cornell University, New York, NY, USA
| | | | | |
Collapse
|