Physician and patient preferences for dosing options in migraine prevention

DOI: https://doi.org/10.1186/s10194-019-0998-8

Abstract-Summary This study evaluated the impact of having flexible dosing options on acceptance of and adherence to a new migraine preventive therapy class among adults with migraine.

Both surveys presented the participants with three scenarios: 1) only monthly, 2)

only quarterly, and 3) both dosing options of the new medication are available.

Physicians estimated the proportion of their migraine patients who would receive

the new medication in each scenario.

Patients were asked about their dosing preference when either or both options are

available.

The availability of both dosing options yielded a significant increase in the pro-

portion of patients expected to receive the new medication.

Among those who preferred monthly dosing (n = 147), a greater proportion indi- cated they are more likely to fill the prescription (77% vs 56%, P < 0.05) and remain adherent (80% vs 57%, P < 0.05) when only monthly is available versus when only quarterly is available.

Among those who preferred quarterly dosing (n  =  166), a greater proportion indicated they are likely to fill (63% vs 55%, P < 0.05) and remain adherent (62% vs 54%, P  <  0.05) when only quarterly is available compared with when only monthly is available.

Physicians anticipated that the proportion of patients to receive the new medica-

tion would increase when both dosing options are available.

Patients stated that they are more likely to fill the prescription and adhere to the

new therapy when their preferred dosing regimen is available.

Extended: The availability of both monthly and quarterly dosing options for a

therapy would benefit patients with any migraine severity.

Future studies could investigate the impact on physician and patient preference and acceptance of having the ability to switch between dosing regimens, as well as the impact of other variables known to affect adherence.

Background In a population for whom adherence to preventive migraine medication has been historically low because of suboptimal efficacy and poor tolerability, it is therefore beneficial to investigate the impact of different dosing schedules on adherence when patients are offered an efficacious and well-tolerated therapy.

A separate survey of Greek outpatients seeking neurologic consultation for head- aches found that, when asked to assume that all options had equal efficacy and safety, more migraine patients preferred a migraine preventive therapy with a once- daily oral pill option (51%) over subcutaneous or intravenous administration on a quarterly (15% and 13%, respectively) or monthly (8% and 4%, respectively) basis [212].

4.2 Preventive Treatment

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We evaluated the benefits of having flexible dosing options, monthly and quar- terly, on physicians’ intent to prescribe and patients’ acceptance of and adherence to a new migraine preventive therapy class that is administered by subcutaneous injection.

Methods This observational study used two distinct 20-min anonymized online surveys to minimize the risk of bias, one completed by physicians (including headache special- ists, general neurologists, pain specialists, and primary care physicians) and the other completed by patients diagnosed with migraine.

The physician survey collected information on demographics, primary specialty, specialized training, and clinical setting, as well as on the practice of treating patients with migraine, including patient volume and characteristics, and experience with current migraine treatment.

Physicians were asked about their likelihood of prescribing the new preventive therapy class for their migraine patients using a seven-point Likert scale with 1 being “not at all likely” and 7 being “extremely likely”.

To assess the impact of dosing options on the acceptance of and adherence to the new migraine preventive therapy class, the patients were presented with the same three scenarios as included in the physician survey.

Results Using the same ranking method described for the value of monthly dosing, physi- cians were also asked to select the most important reasons for prescribing the quar- terly dosing option.

To assess the impact of flexible dosing on the number of patients receiving (phy- sicians prescribing and patients accepting) the new medication, physicians were asked to provide their expectations in scenarios in which monthly, quarterly, or both dosing options are available (flexible dosing).

Physicians anticipated a relatively even split of prescribing across the two dosing options (mean monthly, 23.4%; mean quarterly, 26.0%) when both monthly and quarterly dosing are available for patients with CM.

Patients with migraine were asked to choose their favored dosing option in a scenario in which both monthly and quarterly dosing regimens are available for the same medication.

Discussion This observational study involved two 20-min anonymized online surveys, which assessed patients’ and physicians’ attitudes toward monthly and quarterly dosing options for a new preventive migraine therapy.

When asked about the value of quarterly dosing, physicians indicated that this option would improve treatment adherence and would be beneficial for those who want to decrease their monthly injection burden.

Responses from both physicians and patients suggest that a quarterly dosing plan may be appealing to patients who have established a treatment routine, are confident with self-injection, and want the convenience of less-frequent injection days.

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4 Treatment

Monthly dosing may be more appealing than less-frequent quarterly dosing to patients who would like more guidance by a physician in establishing a treatment routine.

These results suggest that offering multiple dosing options for a medication may increase the number of patients receiving preventive migraine treatment and may improve therapy adherence.

Conclusions The availability of both monthly and quarterly dosing options for a therapy would benefit patients with any migraine severity.

Dosing flexibility would allow patients to choose their preferred therapy based on their individual needs, with a commensurate increase in the likelihood of patients receiving and being adherent to the new migraine preventive therapy class.

Acknowledgement A machine generated summary based on the work of Cowan, Robert; Cohen, Joshua M.; Rosenman, Erik; Iyer, Ravi. 2019 in The Journal of Headache and Pain.

Patient Perspectives and Experiences of Preventive Treatments and Self-Injectable Devices for Migraine: A Focus Group Study