(73) Persistence with Eptinezumab and Other Preventive Treatments for Chronic Migraine in the United States: Results of a Retrospective, Observational, Cohort Study

Background: : In 2018, a new class of anti–calcitonin gene-related peptide (aCGRP) preventive treatments was introduced. Given the entry of these newer agents, it is important to understand persistence among these therapies alongside onabotulinumtoxinA, which is commonly used for migraine prevention.

Objective: : This cohort study evaluated persistence in adults with chronic migraine (CM) prescribed preventive aCGRP therapies or onabotulinumtoxinA.

Methods: : This claims-based, observational cohort study used data from the Aetna commercially insured (CI) and Medicare Advantage (MA) database collected between February 2020–July 2024. This study included adults ≥18 years with a CM diagnosis within the 24-month observation period, defined as ≥12 months of pre- and post-index continuous coverage, who had a claim for an FDA-approved migraine-specific preventive treatment (gepants [atogepant or rimegepant (preventive dosing)], subcutaneous [SC] aCGRP monoclonal antibodies [mAbs], eptinezumab, or onabotulinumtoxinA). Index was the initiation date of the most recent qualifying treatment episode. The following outcomes were evaluated separately for the CI and MA subgroups over the 12 months post-index: persistence (based on days on therapy), proportion of days covered (PDC), and medication possession ratio (MPR). Weighted sensitivity analyses were also conducted on these outcomes.

Results: : This study included 76 and 164 participants on eptinezumab; 642 and 797 on gepants; 2073 and 2194 on SC aCGRP mAbs; and 1671 and 2638 on onabotulinumtoxinA in the CI and MA subgroups, respectively. Twelve-month unweighted persistence with eptinezumab (52.6% and 31.7%) was comparable to that with onabotulinumtoxinA (48.4% and 39.6%) and higher than with gepants (21.7% and 16.8%) and SC aCGRP mAbs (40.8% and 29.6%). Twelve-month unweighted PDC and MPR results paralleled 12-month persistence findings based on days on therapy. Participants were significantly more likely to discontinue SC aCGRP mAbs and gepants than eptinezumab (all P≤0.003) in both populations. Unweighted results were validated by the weighted sensitivity analysis.

Conclusions: : As an important component of migraine care, it is critical to assess real-world treatment persistence. This analysis focused on preventive aCGRP therapies and onabotulinumtoxinA. Eptinezumab was similar to onabotulinumtoxinA and higher than gepants and SC aCGRP mAbs across multiple persistence and compliance measures, indicating favorable prospects for long-term, real-world adherence.

Sponsorship:: H. Lundbeck A/S (Copenhagen, Denmark)