Abstract
Background
Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are indicated for migraine prevention in the United States. Limited data comparing real-world treatment patterns for CGRP mAbs are available.
Objective
To compare the treatment patterns among patients with migraine initiating galcanezumab, fremanezumab, and erenumab.
Methods
This retrospective study included adult patients with one or more claims for a self-injectable CGRP mAb (galcanezumab, fremanezumab, or erenumab), with continuous enrollment in medical and pharmacy benefits for 12 months pre-index and 6 and 12 months post-index using MerativeTM MarketScan® Commercial and Medicare databases from May 2017 through March 2021. Propensity-score matching was used to address confounding by observed covariates. Outcomes analyzed included proportion of days covered (PDC), medication-possession ratio (MPR), persistence (≤60-day gap), treatment discontinuation, and switch to a non-index drug. Descriptive X2 and t-test analyses were conducted.
Results
At the 12-month follow-up, matched galcanezumab and fremanezumab cohorts each comprised 2674 patients and the galcanezumab and erenumab cohorts 3503 each. The mean (SD) PDC and MPR were both 0.6 (0.3) across all cohorts. Based on PDC ≥0.80 and MPR ≥0.80, a greater proportion of galcanezumab vs fremanezumab (46.2% vs 43.7%, p=0.053; 46.8% vs 44.3%, p=0.053) and galcanezumab vs erenumab (46.2% vs 44%, p=0.156; 46.7% vs 44.5%, p=0.262), respectively, initiators were adherent. Compared to galcanezumab, fremanezumab (248.0 days vs 236.5 days, p=0.001), and erenumab (247.8 days vs 241.7 days, p=0.061) initiators had lower mean persistence. Galcanezumab initiators were less likely to discontinue treatment than fremanezumab (47.8% vs 51.7%, p=0.005) and erenumab (47.7% vs 50.2%, p=0.040) initiators. Across cohorts, most switchers initiated onabotulinum toxin A as subsequent treatment. Similar results were observed for 6-month follow-up cohorts.
Conclusion
Patients with migraine who initiated treatment with galcanezumab showed higher persistence and lower treatment discontinuation rates than those initiating either fremanezumab or erenumab.
Plain Language Summary
What was known before? Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are medicines developed for migraine prevention. CGRP mAbs bind to the CGRP ligand or receptor and limit pain associated with migraine attacks. Currently, three self-injectable CGRP mAbs are approved for prevention: erenumab, fremanezumab, and galcanezumab. Use of erenumab, fremanezumab, and galcanezumab can slow or stop migraine-related symptoms and reduce migraine-related disability.
What does this study add? This study describes how migraine medications are used in the US by patients with migraine who started using galcanezumab, fremanezumab, or erenumab for migraine treatment. Over a period of 12 months, patients who started treatment for migraine with galcanezumab were more likely to continue their treatment than those who started using either fremanezumab or erenumab. At 12 months, fewer patients who started galcanezumab were likely to discontinue their treatment than patients who started using either fremanezumab or erenumab. Among patients who discontinued and switched, most patients switched to Botox A, a non-CGRP treatment. Among patients who switched to a different CGRP mAb, most patients in the fremanezumab and erenumab groups switched to galcanezumab, while most patients in the galcanezumab group switched to erenumab.
Interpretation: These findings suggest that patients remained on galcanezumab longer and were less likely to discontinue.
Data Sharing
The data that support the study findings were provided by Merative. Restrictions apply to the availability of these data, which were used under license for this study and therefore are not publicly available. Requests may be sent to Merative for more information on data availability and licensing.
Ethics Approval
This study was conducted in accordance with the Declaration of Helsinki of 1975 by the World Medical Association, as revised by the 59th WMA General Assembly 2008 in Seoul. Since the study used only deidentified patient records, neither institutional review board approval nor patient informed consent to conduct this study was required. Informed consent was obtained from all participants.
Acknowledgments
Medical writing support was provided by Priyanka Bannikoppa, PhD and Keerthana Muthiah from Eli Lilly Services India.
Author Contributions
All authors have made significant contributions to the work reported, including study conception, design, execution, acquisition of data, analysis, and interpretation. The authors also contributed towards drafting the manuscript, revising, or critically reviewing the draft, and gave final approval to the version to be published, have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work.
Disclosure
Brenna L Brady is an employee of Merative who received funding from Eli Lilly and Company to conduct this analysis. Yvonne P Robles was an employee of Merative, Ann Arbor, MI, USA for the entire period of this study, and is now an employee of Panalgo (265 Franklin Street, Boston, MA 02110, USA). Oralee J Varnado, Anthony J Zagar, and Margaret Hoyt are full-time employees and shareholders at Eli Lilly and Company.