Unmet Needs in Japanese Patients Who Report Insufficient Efficacy with Triptans for Acute Treatment of Migraine: Retrospective Analysis of Real-World Data

DOI: https://doi.org/10.1007/s40122-020-00223-y

Abstract-Summary Triptans are widely used as acute medication for a migraine attack but are ineffec- tive, poorly tolerated, or contraindicated in some patients.

HRQoL and work productivity are therefore likely to pose particular problems for patients whose migraine attacks do not respond sufficiently to triptan acute treatment.

This real-world study aimed to determine whether migraine-related HRQoL, dis- ability, and work productivity differed between triptan insufficient responders (TIRs) and sufficient responders (TSRs) receiving this acute treatment for migraine in Japan.

Patients had to be receiving a triptan as their sole acute prescribed medication for

migraine.

TIRs were defined as patients who achieved headache pain freedom within 2 h of

taking triptan acute treatment in no more than three of five migraine attacks.

Of 200 patients receiving a triptan as their sole prescribed acute treatment for

migraine, 88 (44.0%) were classed as TIRs.

Migraine attacks had a negative impact on the HRQoL, disability, and work pro- ductivity of people with migraine in Japan reporting insufficient efficacy with acute triptan treatment, highlighting the need for more effective acute treatment options.

Extended: TIRs were defined as patients who, after taking a triptan as an acute treatment, achieved headache pain freedom within 2 h in no more than three of five

4.1 Acute Treatment

661

migraine attacks, whereas TSRs were defined as those who, after taking a triptan as an acute treatment, achieved headache pain freedom within 2 h in at least four of five migraine attacks [100, 101].

Digital Features This article is published with digital features, including a summary slide, to facili- tate understanding of the article.

To view digital features for this article go to https://doi.org/10.6084/

m9.figshare.13251809.

Introduction A recent systematic review highlighted high levels of unmet needs, relating to a lack of awareness and under- diagnosis of migraine, and a need for better management and therapies for treatment, among patients with the disease in East Asia, including Japan [102].

In Japan, an increasing amount of real-world data suggests that migraine (both episodic and chronic) poses a notable disease burden and highlights high levels of unmet need with prescribed acute and preventive medication among people with migraine [103, 104].

The main aim of this retrospective analysis of 2017 Japan Adelphi Migraine Disease Specific Programme (DSP) cross-sectional survey data was to determine whether migraine-related HRQoL, disability, and work productivity differed between people reporting insufficient efficacy (termed here triptan insufficient responders [TIRs]) or sufficient efficacy (triptan sufficient responders [TSRs]) with prior triptan acute therapy for migraine in Japan.

Methods This was a retrospective analysis of real-world, point-in-time, cross-sectional sur- vey data on migraine treatment practice, patient demographics, clinical features, outcomes, migraine-related HRQoL, disability, and work productivity collected from physicians and their consulting patients with migraine as part of the Japan Adelphi Migraine DSP over the period October 2017–March 2018.

Physicians completed a patient record form (PRF) for nine consecutive adult patients (aged ≥ 18 years) with migraine, collecting information on the patient’s demographics and clinical characteristics, including headache diagnoses (e.g., med- ication overuse, tension-type, chronic, episodic), average migraine severity over the past 3 months, average monthly attack frequency over the past 3 months, symptoms, and prescribed medication; concomitant diagnoses; and treatment history.

Results No significant differences in diagnosed concomitant conditions, including the num- ber of conditions or the incidence of cardiovascular conditions, were reported by physicians between TIRs and TSRs.

Physicians reported that, over the 3 months prior to participation in the study, TIRs experienced significantly more monthly headache days (mean 5.7 vs. 4.5, respectively; p = 0.023) and monthly migraine headache days (4.8 vs. 3.7, respec- tively; p = 0.013) than TSRs.

662

4 Treatment

Patient-reported data indicated that timing of triptan administration differed sig- nificantly (p = 0.033) between TIRs and TSRs, with TIRs more likely than TSRs to take triptan acute medication when/after the pain starts (55.2 vs. 49.1%/13.8 vs. 5.4%) than at the first sign of pain (31.0 vs. 45.5%).

Discussion TIRs were significantly more likely to use OTC and preventive treatments than TSRs, findings also reported in the global analysis of 2017 Adelphi Migraine DSP data [100].

In the current analysis, although a high proportion of patients reported that they were satisfied with their prescribed triptan acute medication, TIRs were more likely than TSRs to express lower levels of satisfaction, or even dissatisfaction, a finding also reported in the global analysis of 2017 Adelphi Migraine DSP data [100].

Early administration of triptan medication (taking acute prescribed medication when/after pain started rather than at first sign of a migraine attack), use of OTC medication, migraine severity during the past 3 months, and EQ-5D utility scores were also identified as factors associated with response to triptan acute medication in the global analysis of 2017 Adelphi Migraine DSP data, which included a larger patient population [100].

Acknowledgement A machine generated summary based on the work of Hirata, Koichi; Ueda, Kaname; Komori, Mika; Ye, Wenyu; Kim, Yongin; Cotton, Sarah; Jackson, James; Treuer, Tamas. 2020 in Pain and Therapy.

A real-world study on unmet medical needs in triptan-treated migraine: prevalence, preventive therapies and triptan use modification from a large Italian population along two years