(370) Triptans, opioids, and rescue medications use among patients with migraines Prescribed CGRP for Migraine Prophylaxis

Background: : Migraines are a prevalent and debilitating neurological condition, affecting 40 million adults in the United States. Multiple studies have shown the detrimental impact of migraines, such as loss of time in work and life domains and overall decline in quality of life. Patients can be prescribed prophylaxis (e.g., beta blockers, anticonvulsants, antidepressants), and rescue medications (e.g., triptans, opioids [which are not recommended for use to treat migraines]) to treat and/or relieve migraines. Approximately 38% of migraine patients would benefit from prophylaxis. Calcitonin gene-related peptide receptor antagonists (CGRP) are the newest class of drugs approved for migraine prophylaxis. Patients taking CGRPs report reduced migraine frequency and severity, which should result in lower utilization of rescue migraine medications.

Objective: : Examine the use of triptans, rescues medications and opioids for patients with migraines prescribed CGRPs and patients who are not prescribed CGRPs.

Methods: : This retrospective, cross-sectional study examined health and pharmacy claims using data from Komodo Health from 2018-2023. Patients were between 18-60 years old, have commercial, Medicaid, or Medicare coverage with a migraine diagnosis. Inclusion criteria include being prescribed a migraine drug during the index period, and with 12 months of continuous health coverage before and after the migraine prescription index date. Opioid use was operationalized as morphine milligram equivalent (MME). Pearson’s chi-square was used to compare pre and post period within each group.

Results: : 94,990 patients were included in this study. Among those on CGRP medications (n=18,835), triptan use decreased in post period (58.7% vs 53.7%; p< 0.001) while increased among patients on non-CGRP medications (n=76,155; 37.4% vs 49.3%, p< 0.001). For both cohorts, the use of opioids increased post index period (CGRP: 18.7% vs 19.3%, p=0.2) (non-CGRP: 14.8% vs 16.4%, p< 0.001). Rescue medications increased in the post period among those on non-CGRP medications (64.5% vs 68.6%, p< 0.001) but decreased in the post period among those on CGRP medications (69.1% vs 69.0%, p=0.8).

Conclusions: : In the cohort prescribed CGRPs, there was a statistically significant correlation with lower triptan use. While an increase in opioid use was observed in the post period, the increase was not statistically significant. Comparatively, the non CGRP cohort had statistically significant increases in the use of triptans and opioids. Further research can elucidate how CGRPs may reduce the need for migraine rescue medications.

Sponsorship:: Evernorth Research Institute