(355) Real-world switch rates of injectable migraine preventive therapies in patients with chronic migraine

Background: : OnabotulunimtoxinA (onabotA) and calcitonin gene-related peptide (CGRP) mAbs are injectable therapies approved for the prevention of chronic migraine in the United States (US). Frequent treatment switching may indicate suboptimal response to therapy, access issues, or other unmet needs.

Objective: : A retrospective healthcare claims analysis using US claims data was conducted to understand real-world treatment switch rates among chronic migraine patients who initiated onabotA or a CGRP mAb.

Methods: : Adult patients with chronic migraine who initiated onabotA or a CGRP mAb between Oct 1, 2021 and Jun 30, 2023 were identified in the Merative MarketScan database. The first recorded treatment claim served as the index date. Patients were excluded if there were any claims for onabotA or CGRP agents during the 12 months preceding the index date, or if there were any diagnosis codes indicating the usage of onabotA for non-migraine indications. The primary endpoint was treatment switching, defined by the occurrence of ≥1 claim for a different branded migraine preventive treatment (onabotA, CGRP mAb, or atogepant) in the 12 months following the index date. Multivariable logistic regression was used adjust for differences in baseline demographics, comorbidities, migraine treatment history, and provider specialty when comparing odds of switching between onabotA and CGRP mAbs.

Results: : A total of 1869 patients met the study inclusion criteria, of which 723 initiated onabotA and 1146 initiated a CGRP mAb (303 erenumab, 308 fremanezumab, 517 galcanezumab, 18 eptinezumab) as their index therapy. After 12 months of follow-up, 11.1% of onabotA users and 22.5% of CGRP mAb users (27.7% erenumab, 20.8% fremanezumab, 20.7% galcanezumab, and 16.7% eptinezumab) initiated a different branded migraine preventive treatment. After adjusting for differences in baseline characteristics, those on a CGRP mAb had 122% higher odds of switching therapy at 12 months than those on onabotA (OR 2.22, 95%CI 1.68, 2.97, p< 0.001).

Conclusions: : Chronic migraine patients on a CGRP mAb were significantly more likely to switch to a different branded migraine preventive treatment within 12 months of treatment initiation compared to those on onabotA.

Sponsorship:: AbbVie