Why carry out this study? |
Migraine is a common condition affecting approximately 30 million adults and 9 million children and adolescents in the US; symptoms and disability during an attack are managed with acute treatments, including simple analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, butalbital-containing analgesic products, and over-the-counter combinations of analgesics and caffeine, as well as prescription migraine-specific agents which historically have included triptans and ergot derivatives (e.g., dihydroergotamine). |
Triptans are commonly used for acute treatment of migraine attacks. However, some patients may not be adequately managed with triptans because of lack of efficacy; intolerable side effects known as “triptan sensations” (including nausea, fatigue, malaise, rapid heart rate, feelings of tingling, numbness, warmth, and chest/neck pressure or tightness); and safety concerns for those with a history of vascular disease, multiple risk factors for vascular disease (such as hypertension and diabetes), and during pregnancy. |
The US Food and Drug Administration (FDA) has recently approved three new acute treatments for migraine—rimegepant (NURTECTM ODT) and ubrogepant (UBRELVY®), both CGRP receptor antagonists, and lasmiditan (REYVOW®), a 5-HT1F receptor agonist—which the American Headache Society (AHS) has recommended for patients who have contraindications to triptans or who have failed to respond to or tolerate at least two oral triptans. |
Understanding the size of the patient population likely to use new treatments may be of interest to payers and health systems; in this study, we therefore developed a conceptual framework for estimating anticipated use of new acute therapies, based on a targeted literature review (TLR) and insights from clinical experience. |
What was learned from the study? |
A minority of individuals with migraine (15%–25%) may be expected to use new acute therapies, given that only a limited proportion of patients currently use migraine-specific acute therapies. Among such patients, a significant proportion do not have adequate symptom control. |
The framework developed in this study is intended to facilitate estimating the eligible patient population in assessments of costs of new acute therapies. Such assessments should also consider recommendations that patients have access to multiple types of acute therapies, which may yield savings from reduced MOH, progression to chronic migraine, and urgent-care costs. |