A global real-world assessment of the impact on health-related quality of life and work productivity of migraine in patients with insufficient versus good response to triptan medication

DOI: https://doi.org/10.1186/s10194-020-01110-9

Abstract-Summary We assessed the impact of insufficient response to triptans on health-related quality of life (HRQoL) and work productivity in patients currently receiving any pre- scribed triptan formulation as their only acute migraine medication.

Triptan insufficient responders (TIRs) achieved freedom from headache pain within 2  h of acute treatment in ≤3/5 migraine attacks; triptan responders (TRs) achieved pain freedom within 2 h in ≥4/5 attacks.

Multivariable general linear model examined differences between TIRs and TRs

in HRQoL and work productivity.

The study included 1413 triptan-treated patients (TIRs: n = 483, 34.2%; TRs:

n = 930, 65.8%).

TIRs had significantly more disability, with higher Migraine Disability Scores (MIDAS; 13.2 vs. 7.7; p < 0.001), lower Migraine-specific Quality of Life scores, indicating greater impact (Role Function Restrictive: 62.4 vs. 74.5; Role Function Preventive: 70.0 vs. 82.2; Emotional Function: 67.7 vs. 82.1; all p < 0.001), and lower EQ5D utility scores (0.84 vs. 0.91; p = 0.001).

Work productivity and activity were impaired (absenteeism, 8.6% vs. 5.1% for TIRs vs. TRs; presenteeism, 34.3% vs. 21.0%; work impairment, 37.1% vs. 23.3%; overall activity impairment, 39.8% vs. 25.3%; all p < 0.05).

HRQoL and work productivity were significantly impacted in TIRs versus TRs in this real-world analysis of patients with migraine acutely treated with triptans, highlighting the need for more effective treatments for patients with an insufficient triptan response.

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4 Treatment

Extended: These findings highlight the need for more effective acute migraine treatment and a holistic approach to patient management to help alleviate the burden of migraine in patients who respond insufficiently to triptans.

Introduction Triptans are recommended as first-line acute treatment of moderate-to-severe migraine attacks [AHS 2019], but persistence tends to be low [82].

Triptans are not effective in all patients; an estimated 30–40% of people with

migraine do not respond adequately to triptan therapy in controlled trials [83–86].

Patients with migraine report worse subjective wellbeing and reduced HRQoL

during attacks and in pain-free periods compared with matched controls [87].

Suboptimal HRQoL and reduced work productivity are therefore likely to be particularly problematic in patients whose migraine attacks do not respond ade- quately to triptans; however, few studies have examined outcomes in this patient population.

The objectives of the present study were to determine the HRQoL and work productivity impact on patients with migraine who have an insufficient response to triptan therapy compared with those who have a good response, and to identify fac- tors and characteristics associated with insufficient response to triptans.

Methods The candidate categorical covariates included physician specialty; sex; diagnosis of migraine with aura; diagnosis of migraine without aura; days since the patient received a diagnosis of migraine categorized by five levels, four of which were based on quartile distribution of non-missing values and one level for missing val- ues; country; health insurance that includes cover for migraine medication; cardio- vascular risk status (mild versus others); comorbidities (depression, anxiety, stress, sleeping disorder, neck pain); whether the patient ever misused opioid medication; diagnosis of menstrual migraine; diagnosis of menstrual- related migraine; symp- toms currently experienced: pain on one side of the head; symptoms currently expe- rienced: pain on both sides of the head; symptoms currently experienced: nausea; symptoms currently experienced: vomiting; when acute medication is taken relative to the start of the attack (At the first sign of a migraine [before the pain starts], When the pain starts, or After the pain has started and I have an idea of how severe it is); taking over-the-counter (OTC) medication for migraine attacks; and whether the patient ever received preventive medication for their migraine.

Results TIRs experienced more monthly headache days than TRs: physicians reported a mean of 7.0 versus 4.4, respectively, whereas patients reported 7.3 versus 4.3, respectively (both p ≤ 0.001).

When compared with patients not taking OTC medications for their migraine, patients taking OTC medications were more likely to be TIRs (OR 1.465; 95% CI 1.000, 2.147; p = 0.050).

Compared with patients taking their prescribed acute medication at first the sign of a migraine attack (i.e. premonitory phase), patients taking medication after the pain has started were more likely to be TIRs (OR 2.433; 95% CI 1.258, 4.703; p = 0.008).

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Patients taking medication when the pain starts were more likely to be TIRs than those taking their prescribed acute medication at the first sign of a migraine attack (i.e. premonitory phase) (OR = 1.726; 95% CI 1.252, 2.380; p = 0.001).

Discussion The results of this real-world study of consulting patients with migraine currently treated with triptans show that those with an insufficient response to triptan medica- tion have significantly worse HRQoL and higher work productivity burden than those who respond to triptans.

Preventive medication use in the present study was statistically significantly higher among TIRs than TRs, which is not surprising given the greater disease severity and headache day frequency among the TIRs, and is in line with treatment guidelines that recommend preventive medication for patients not responding to, overusing, or experiencing frequent headache days despite, acute treatment [52].

That study included patients receiving any acute medication for their migraine, whereas the present study included those receiving triptan medication only for the acute treatment of their migraine, allowing us to focus on response to triptans in the most appropriate population.

Conclusion Awareness of these factors may enable physicians to specifically ask patients about their migraine medication use and potentially identify those at risk of insufficient response to their triptan.

These findings highlight the need for more effective acute migraine treatment and a holistic approach to patient management to help alleviate the burden of migraine in patients who respond insufficiently to triptans.

Acknowledgement A machine generated summary based on the work of Lombard, Louise; Farrar, Mallory; Ye, Wenyu; Kim, Yongin; Cotton, Sarah; Buchanan, Andrew S.; Jackson, James; Joshi, Shivang. 2020 in The Journal of Headache and Pain.

A Framework for Estimating the Eligible Patient Population for New Migraine Acute Therapies in the United States