BACKGROUND: Chronic migraine (CM) is a common neurologic disorder that imposes substantial
burden on payers, patients, and society. Low rates of persistence to oral migraine
preventive medications have been previously documented; however, less is known about
persistence and costs associated with innovative nonoral migraine preventive medications.
OBJECTIVE: To evaluate real-world persistence and costs among adults with CM treated
with onabotulinumtoxinA (onabotA) or calcitonin gene-related peptide monoclonal antibodies
(CGRP mAbs). METHODS: This was a retrospective, longitudinal, observational study
analyzing the IBM MarketScan Commercial and Medicare databases. The study sample included
adults with CM initiating treatment with either onabotA or a CGRP mAb on or after
January 1, 2018. Persistence and costs over 12 months after treatment initiation were
evaluated using chi-square and Student's t-tests. Persistence to onabotA was compared
with CGRP mAbs as a weighted average of the class and by individual CGRP mAbs. Mean
pharmacy (acute and preventive), medical (inpatient, emergency department, and outpatient),
and total costs are reported. Multivariate regression analyses were conducted to generate
adjusted estimates of persistence and costs after controlling for potential confounders
(age, sex, region, insurance type, number of baseline comorbidities, Charlson Comorbidity
Index, and number of previously used oral migraine preventive medications). RESULTS:
Of 66,303 individuals with onabotA or CGRP mAb claims, 2,697 with CM met the inclusion/exclusion
criteria. In the total population, individuals were primarily female (85.5%), lived
in the South (48.5%), and had a mean (SD) age of 44 (12) years, which was consistent
across the onabotA and CGRP mAb cohorts. Common comorbid conditions included anxiety
(23.9%), depression (18.2%), hypertension (16.5%), and sleep disorders (16.9%). After
adjusting for potential confounding variables, persistence to onabotA during the 12-month
follow-up period was 40.7% vs 27.8% for CGRP mAbs (odds ratio [OR] = 0.683; 95% CI
= 0.604-0.768; P < 0.0001). Persistence to erenumab, fremanezumab, and galcanezumab
was 25.5% (OR = 0.627; 95% CI = 0.541-0.722; P < 0.0001), 30.3% (OR = 0.746; 95% CI
= 0.598-0.912; P = 0.0033), and 33.7% (OR = 0.828; 95% CI = 0.667-1.006; P = 0.058).
All-cause ($18,292 vs $18,275; P = 0.9739) and migraine-related ($8,990 vs $9,341;
P = 0.1374) costs were comparable between the onabotA and CGRP mAb groups. CONCLUSIONS:
Among adults with CM receiving onabotA and CGRP mAbs, individuals initiating onabotA
treatment had higher persistence compared with those receiving CGRP mAbs. Total all-cause
and migraine-related costs over 12 months were comparable between those receiving
onabotA and CGRP mAbs. DISCLOSURES: This study was sponsored by Allergan (prior to
its acquisition by AbbVie), they contributed to the design and interpretation of data
and the writing, reviewing, and approval of final version. Writing and editorial assistance
was provided to the authors by Dennis Stancavish, MS, of Peloton Advantage, LLC, an
OPEN Health company, Parsippany, NJ, and was funded by AbbVie. The opinions expressed
in this article are those of the authors. The authors received no honorarium/fee or
other form of financial support related to the development of this article. Dr Schwedt
serves on the Board of Directors for the American Headache Society and the American
Migraine Foundation. Within the prior 12 months he has received research support from
Amgen, Henry Jackson Foundation, Mayo Clinic, National Institutes of Health, Patient-Centered
Outcomes Research Institute, SPARK Neuro, and US Department of Defense. Within the
past 12 months, he has received personal compensation for serving as a consultant
or advisory board member for AbbVie, Allergan, Axsome, BioDelivery Science, Biohaven,
Collegium, Eli Lilly, Ipsen, Linpharma, Lundbeck, and Satsuma. He holds stock options
in Aural Analytics and Nocira. He has received royalties from UpToDate. Dr Lee and
Ms Shah are employees of AbbVie and may hold AbbVie stock. Dr Gillard was an employee
of AbbVie and may hold AbbVie stock. Dr Knievel has served as a consultant for AbbVie,
Amgen, Eli Lilly, and Biohaven; conducted research for AbbVie, Amgen, and Eli Lilly;
and is on speaker programs for AbbVie and Amgen. Dr McVige has served as a speaker
and/or received research support from Allergan (now AbbVie Inc.), Alder, Amgen/Novartis,
Avanir, Biohaven, Eli Lilly, Lundbeck, and Teva. Ms Wang and Ms Wu are employees of
Genesis Research, which provides consulting services to AbbVie. Dr Blumenfeld, within
the past 12 months, has served on advisory boards for Allergan, AbbVie, Aeon, Alder,
Amgen, Axsome, BDSI, Biohaven, Impel, Lundbeck, Lilly, Novartis, Revance, Teva, Theranica,
and Zosano; as a speaker for Allergan, AbbVie, Amgen, BDSI, Biohaven, Lundbeck, Lilly,
and Teva; as a consultant for Allergan, AbbVie, Alder, Amgen, Biohaven, Lilly, Lundbeck,
Novartis, Teva, and Theranica; and as a contributing author for Allergan, AbbVie,
Amgen, Biohaven, Novartis, Lilly, and Teva. He has received grant support from AbbVie
and Amgen. AbbVie is committed to responsible data sharing regarding the clinical
trials we sponsor. This includes access to anonymized, individual, and trial-level
data (analysis data sets), as well as other information (eg, protocols, clinical study
reports, or analysis plans), as long as the trials are not part of an ongoing or planned
regulatory submission. This includes requests for clinical trial data for unlicensed
products and indications. These clinical trial data can be requested by any qualified
researchers who engage in rigorous, independent scientific research, and will be provided
following review and approval of a research proposal and Statistical Analysis Plan
and execution of a Data Sharing Agreement. Data requests can be submitted at any time
after approval in the United States and Europe and after acceptance of this manuscript
for publication. The data will be accessible for 12 months, with possible extensions
considered. For more information on the process, or to submit a request, visit the
following link: https://www.abbvieclinicaltrials.com/hcp/data-sharing/.