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Deighton AM, Harris LA, Johnston K, Hogan S, Quaranta LA, L'Italien G, Coric V. The burden of medication overuse headache and patterns of switching and discontinuation among triptan users: a systematic literature review. BMC Neurol 2021; 21:425. [PMID: 34727873 PMCID: PMC8561931 DOI: 10.1186/s12883-021-02451-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A synthesis of real-world discontinuation and switching patterns among triptan users and rates of acute medication use among patients with medication overuse headache (MOH) is needed to better understand the burden among patients with migraine. The study objectives were to: (1) synthesize rates of switching and discontinuation from triptans; (2) characterize acute medication use among patients with MOH; and (3) describe the associated burden. METHODS A systematic literature review was conducted, under the Preferred Reporting Items for Systematic Review guidelines, using MEDLINE/EMBASE from database inception to July 2019. The search strategy targeted studies of adults with migraine, and included terms related to migraine and its treatment. Continuous variables were summarized using means, standard deviations, and ranges. Dichotomous and categorical variables were summarized using the number and proportion of individuals. RESULTS Twenty studies were included; seven describing patterns of switching and discontinuation among triptan users, and 13 characterizing triptan overuse among patients with MOH. High rates of switching to non-specific acute medications and low two-year retention rates were reported; among US samples switching to opioids at the first refill (18.2%) or after 1-year (15.5%) was frequent. Compared to persistent use of triptans, switchers experienced greater headache related impact and either no improvement or increased headache-related disability. Rates of medication overuse by agent among patients with MOH varied greatly across the included studies, and only one study described factors associated with the risk of MOH (e.g. duration of medication overuse). Medication agent, increased headache frequency (p = .008), and increased disability (p = .045) were associated with unsuccessful withdrawal; patients overusing triptans were more successful at withdrawal than those overusing opioids or combination analgesics (P < .0001). CONCLUSIONS The evidence summarized here highlights that rates of WCS are low and many patients turn to other acute medication at their first refill. Patients may experience no improvement in disability when switching from one triptan agent to another, or experience increasing disability and/or increasing migraine frequency when turning to traditional acute treatment for migraine. Variability in health care settings, patient severity, and study design contributed to heterogeneity across the synthesis.
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Affiliation(s)
- Alison M Deighton
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada.
| | - Linda A Harris
- Biohaven Pharmaceuticals, 215 Church Street, New Haven, CT, USA
| | - Karissa Johnston
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada
| | - Shomari Hogan
- Biohaven Pharmaceuticals, 215 Church Street, New Haven, CT, USA
| | - Lynn A Quaranta
- Biohaven Pharmaceuticals, 215 Church Street, New Haven, CT, USA
| | | | - Vlad Coric
- Biohaven Pharmaceuticals, 215 Church Street, New Haven, CT, USA
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Yang CP, Liang CS, Chang CM, Yang CC, Shih PH, Yau YC, Tang KT, Wang SJ. Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2128544. [PMID: 34633423 PMCID: PMC8506232 DOI: 10.1001/jamanetworkopen.2021.28544] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE New therapeutic classes of migraine-specific treatment have been developed, including 5-hydroxytryptamine1F receptor agonists (lasmiditan) and calcitonin gene-related peptide antagonists (rimegepant and ubrogepant). OBJECTIVE To compare outcomes associated with the use of lasmiditan, rimegepant, and ubrogepant vs triptans for acute management of migraine headaches. DATA SOURCES The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to March 5, 2020. STUDY SELECTION Double-blind randomized clinical trials examining current available migraine-specific acute treatments were included. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was applied to extract the data according to a predetermined list of variables of interest, and all network meta-analyses were conducted using a random-effects model. MAIN OUTCOMES AND MEASURES The primary outcome was the odds ratio (OR) for freedom from pain (hereafter referred to as pain freedom) at 2 hours after the dose, and the secondary outcomes were ORs for pain relief at 2 hours after the dose and any adverse events. RESULTS A total of 64 randomized clinical trials were included (46 442 participants; 74%-87% women; age range, 36-43 years). Most of the included treatments were associated with reduced pain at 2 hours compared with placebo. Most triptans were associated with higher ORs for pain freedom at 2 hours compared with lasmiditan (range: OR, 1.72 [95% CI, 1.06-2.80] to OR, 3.40 [95% CI, 2.12-5.44]), rimegepant (range: OR, 1.58 [95% CI, 1.07-2.33] to OR, 3.13 [95% CI, 2.16-4.52]), and ubrogepant (range: OR, 1.54 [95% CI, 1.00-2.37] to OR, 3.05 [95% CI, 2.02-4.60]). Most triptans were associated with higher ORs for pain relief at 2 hours compared with lasmiditan (range: OR, 1.46 [95% CI, 1.09-1.96] to OR, 3.31 [95% CI, 2.41-4.55]), rimegepant (range: OR, 1.33 [95% CI, 1.01-1.76] to OR, 3.01 [95% CI, 2.33-3.88]), and ubrogepant (range: OR, 1.38 [95% CI, 1.02-1.88] to OR, 3.13 [95% CI, 2.35-4.15]). The comparisons between lasmiditan, rimegepant, and ubrogepant were not statistically significant for both pain freedom and pain relief at 2 hours. Lasmiditan was associated with the highest risk of any adverse events, and certain triptans (rizatriptan, sumatriptan, and zolmitriptan) were also associated with a higher risk of any adverse events than the calcitonin gene-related peptide antagonists. CONCLUSIONS AND RELEVANCE For pain freedom or pain relief at 2 hours after the dose, lasmiditan, rimegepant, and ubrogepant were associated with higher ORs compared with placebo but lower ORs compared with most triptans. However, the lack of cardiovascular risks for these new classes of migraine-specific treatments may offer an alternative to triptans.
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Affiliation(s)
- Chun-Pai Yang
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan
- Department of Nutrition, Hungkuang University, Taichung, Taiwan
| | - Chih-Sung Liang
- Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Mao Chang
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Chia Yang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Po-Hsuan Shih
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Chinese Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yun-Chain Yau
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung, Taipei, Taiwan
| | - Kuo-Tung Tang
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- PhD Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shuu-Jiun Wang
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Khan K, Arain MI, Asghar MA, Rehman AA, Ghoto MA, Dayo A, Imtiaz MS, Rana MH, Asghar MA. Analysis of treatment cost and persistence among migraineurs: A two-year retrospective cohort study in Pakistan. PLoS One 2021; 16:e0248761. [PMID: 33770109 PMCID: PMC7996986 DOI: 10.1371/journal.pone.0248761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/04/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives The persistence pattern of anti-migraine drugs’ use among migraineurs is very low in the United States and different European countries. However, the cost and persistence of antimigraine drugs in Asian countries have not been well-studied. Hence, the present study aimed to evaluate the treatment cost and persistence among migraineurs in Pakistan. Methods Data from prescriptions collected from migraineurs who visited the Outpatient Department (OPD) of different public and private sector tertiary-care hospitals of Karachi, Pakistan were used to conduct this retrospective cohort study from 2017 to 2019. The minimum follow up period for each migraineur was about 12 months for persistence analysis while dropped-out patients data were also included in survival analysis as right censored data. Pairwise comparisons from Cox regression/hazards ratio were used to assess the predictors of persistence with the reference category of non-binary variables i.e. hazard ratio = 1 for low frequency migraineurs and NSAIDs users. Persistence with anti-migraine drugs was estimated using the Kaplan-Meier curve along with the Log Rank test. Results A total of 1597 patients were included in this study, 729 (45.6%) were male and 868 (54.3%) were female. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most prescribed class of drug initially for all classes of migraineurs (26.1%). Of them, 57.3% of migraineurs discontinued their treatment, 28.5% continued while 14.8% were switched to other treatment approaches. Persistence with initial treatment was more profound in female (58.8%) patients compared to males while the median age of continuers was 31 years. The total cost of migraine treatment in the entire study cohort was 297532.5 Pakistani Rupees ($1901.1). By estimating the hazard ratios (HR) using the Cox regression analysis, it can be observed that patients with high frequency (HR, 1.628; 95%CI, 1.221–2.179; p<0.0001) migraine, depression (HR, 1.268; 95%CI, 1.084–1.458; p<0.0001), increasing age (HR, 1.293; 95%CI, 1.092–1.458; p<0.0001), combination analgesics (HR, 1.817; 95%CI, 0.841–2.725; p = 0.0004) and prophylaxis drugs (HR, 1.314; 95%CI, 0.958–1.424; p<0.0001) users were at a higher risk of treatment discontinuation. However, patients with chronic migraine (HR, 0.881; 95%CI, 0.762–0.912; p = 0.0002), epileptic seizure (HR, 0.922; 95%CI, 0.654–1.206; p = 0.0002), other comorbidities (HR, 0.671; 95%CI, 0.352–1.011; p = 0.0003) and users of triptan(s) (HR, 0.701; 95%CI, 0.182–1.414; p = 0.0005) and triptan(s) with NSAIDs (HR, 0.758; 95%CI, 0.501–1.289; p<0.0001) had more chances to continue their initial therapy. Conclusion Similar to western countries, the majority of migraineurs exhibited poor persistence to migraine treatments. Various factors of improved persistence were identified in this study.
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Affiliation(s)
- Kamran Khan
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mudassar Iqbal Arain
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan
| | - Muhammad Arif Asghar
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
- * E-mail:
| | - Ahad Abdul Rehman
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Muhammad Ali Ghoto
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan
| | - Abdullah Dayo
- Department of Pharmaceutics, Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan
| | - Muhammad Suleman Imtiaz
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mohsin Hamied Rana
- Department of Research and Development, Reckitt Benckiser, Karachi, Pakistan
| | - Muhammad Asif Asghar
- Food and Feed Safety Laboratory, Food and Marine Resources Research Centre, PCSIR Laboratories Complex, Shahrah-e-Salimuzzaman Siddiqui, Karachi, Sindh, Pakistan
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Chen CL, Yeh YC, Chen YY. Ergotamine Use and Overuse in Taiwan: A Retrospective Cohort Study. Headache 2017; 58:416-423. [PMID: 29168165 DOI: 10.1111/head.13230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the pattern of ergotamine prescription and overuse in Taiwan. BACKGROUND Ergotamine is a frequently prescribed medication for the treatment of migraine, although excessive use may lead to medication-overuse headache. METHODS We conducted a retrospective cohort study by using the Longitudinal Health Insurance Database 2005 in Taiwan. Patients enrolled in the study were between the ages of 18 and 80 years, received at least two prescriptions of ergotamine, and follow-up for more than 1 year at outpatient clinics during 1999 to 2013. Each ergotamine prescription was converted into a defined daily dose (DDD) and patients were sorted into two groups: occasional users, having fewer than 3 consecutive months of use, and regular users, with 3 consecutive months of use or more. Regular users were further divided into overusers (DDDs ≥ 10 per month) and non-overusers. RESULTS A total of 41,023 migraine patients were enrolled in the study; 5803 patients were classified as regular users, with 859 of those being overusers. Of the ergotamine overusers, around 698/859 (82%) continued to use, and 443/859 (52%) remained overusers of ergotamine in the subsequent year after the index date. The most frequently prescribed prophylactic medications were propranolol and flunarizine, which were prescribed in 30.4% and 20.0% of overuse patients, respectively. CONCLUSIONS Ergotamine overuse remains common in Taiwan, while prophylactic medicine is still underutilized. More education on ergotamine-overuse headache is needed to improve awareness.
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Affiliation(s)
- Chu-Ling Chen
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Chun Yeh
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.,Research Education and Epidemiology Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yen-Yu Chen
- Research Education and Epidemiology Center, Changhua Christian Hospital, Changhua, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Fischer M, Frank F, Wille G, Klien S, Lackner P, Broessner G. Triptans for Acute Migraine Headache: Current Experience With Triptan Use and Prescription Habits in a Tertiary Care Headache Outpatient Clinic: An Observational Study. Headache 2016; 56:952-60. [DOI: 10.1111/head.12820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/11/2016] [Accepted: 02/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Marlene Fischer
- Headache Outpatient Clinic, Department of Neurology; Medical University of Innsbruck; Innsbruck Austria (M. Fischer, F. Frank, G. Wille, S. Klien, P. Lackner, and G. Broessner)
- Department of Anaesthesiology; University Medical Center Hamburg-Eppendorf; Hamburg Germany (M. Fischer)
| | - Florian Frank
- Headache Outpatient Clinic, Department of Neurology; Medical University of Innsbruck; Innsbruck Austria (M. Fischer, F. Frank, G. Wille, S. Klien, P. Lackner, and G. Broessner)
| | - Georg Wille
- Headache Outpatient Clinic, Department of Neurology; Medical University of Innsbruck; Innsbruck Austria (M. Fischer, F. Frank, G. Wille, S. Klien, P. Lackner, and G. Broessner)
| | - Stephanie Klien
- Headache Outpatient Clinic, Department of Neurology; Medical University of Innsbruck; Innsbruck Austria (M. Fischer, F. Frank, G. Wille, S. Klien, P. Lackner, and G. Broessner)
| | - Peter Lackner
- Headache Outpatient Clinic, Department of Neurology; Medical University of Innsbruck; Innsbruck Austria (M. Fischer, F. Frank, G. Wille, S. Klien, P. Lackner, and G. Broessner)
| | - Gregor Broessner
- Headache Outpatient Clinic, Department of Neurology; Medical University of Innsbruck; Innsbruck Austria (M. Fischer, F. Frank, G. Wille, S. Klien, P. Lackner, and G. Broessner)
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