Table 3.
Reasons for discontinuation of previous migraine prevention therapy in patients with ≥1 prior preventive failure in EVOLVE studies (N = 453)
|
Inadequate efficacy n (%) |
No efficacy n (%) |
Safety/tolerability n (%) |
Overall n (%) |
|
|---|---|---|---|---|
| Antiepileptic | 199 (43.9) | 54 (11.9) | 46 (10.2) | 280 (61.8) |
| Topiramate | 181 (40.0) | 39 (8.6) | 32 (7.1) | 246 (54.3) |
| Valproate | 28 (6.2) | 10 (2.2) | 12 (2.6) | 49 (10.8) |
| Gabapentin | 8 (1.8) | 4 (0.9) | 0 (0.0) | 12 (2.6) |
| Zonisamide | 4 (0.9) | 3 (0.7) | 3 (0.7) | 10 (2.2) |
| Pregabalin | 1 (0.2) | 3 (0.7) | 3 (0.7) | 6 (1.3) |
| Ergenyl® chrono | 2 (0.4) | 1 (0.2) | 2 (0.4) | 5 (1.1) |
| Beta blocker | 95 (21.0) | 32 (7.1) | 19 (4.2) | 145 (32.0) |
| Propranolol | 64 (14.1) | 16 (3.5) | 14 (3.1) | 94 (20.8) |
| Metoprolol | 15 (3.3) | 9 (2.0) | 6 (1.3) | 30 (6.6) |
| Nadolol | 9 (2.0) | 4 (0.9) | 1 (0.2) | 14 (3.1) |
| Antidepressant | 100 (22.1) | 25 (5.5) | 25 (5.5) | 140 (30.9) |
| Amitriptyline | 67 (14.8) | 16 (3.5) | 12 (2.6) | 92 (20.3) |
| Nortriptyline | 16 (3.5) | 4 (0.9) | 1 (0.2) | 21 (4.6) |
| Venlafaxine | 7 (1.5) | 2 (0.4) | 6 (1.3) | 15 (3.3) |
| Duloxetine | 2 (0.4) | 3 (0.7) | 2 (0.4) | 6 (1.3) |
| Escitalopram | 2 (0.4) | 1 (0.2) | 3 (0.7) | 6 (1.3) |
| Calcium channel blocker | 26 (5.7) | 13 (2.9) | 10 (2.2) | 48 (10.6) |
| Flunarizine | 19 (4.2) | 9 (2.0) | 8 (1.8) | 35 (7.7) |
| Verapamil | 3 (0.7) | 3 (0.7) | 1 (0.2) | 7 (1.5) |
| Botulinum toxin type A | 16 (3.5) | 16 (3.5) | 0 | 31 (6.8) |
| Angiotensin II antagonists | 10 (2.2) | 6 (1.3) | 2 (0.4) | 18 (4.0) |
| Supplements | 16 (3.5) | 1 (0.2) | 0 (0.0) | 17 (3.8) |
| Magnesium | 9 (2.0) | 1 (0.2) | 0 (0.0) | 10 (2.2) |
| Riboflavin | 5 (1.1) | 0 (0.0) | 0 (0.0) | 5 (1.1) |
| Antihistamines | 9 (2.0) | 0 (0.0) | 3 (0.7) | 12 (2.6) |
| Pizotifen | 9 (2.0) | 0 (0.0) | 3 (0.7) | 12 (2.6) |
| Muscle relaxant | 6 (1.3) | 2 (0.4) | 0 (0.0) | 8 (1.8) |
| Tizanidine | 5 (1.1) | 1 (0.2) | 0 (0.0) | 6 (1.3) |
| NSAIDs | 3 (0.7) | 3 (0.7) | 1 (0.2) | 7 (1.5) |
| Antipsychotic | 2 (0.4) | 0 (0.0) | 0 (0.0) | 2 (0.4) |
| ACE inhibitors | 1 (0.2) | 0 (0.0) | 0 (0.0) | 1 (0.2) |
| Ergot alkaloids | 0 (0.0) | 1 (0.2) | 0 (0.0) | 1 (0.2) |
| Triptan | 1 (0.2) | 0 (0.0) | 0 (0.0) | 1 (0.2) |
ACE, angiotensin‐converting enzyme; NSAID, non‐steroidal anti‐inflammatory drugs.
A full list of drugs with reasons for failure is presented in Appendix S1. Individual medications included here are those that were failed by >1% of patients for efficacy and/or safety/tolerability reasons. Medications identified in the treatment guidelines as having been investigated for preventive use 5, 15 were used to restrict the list of preventives reported by the investigative sites.