Overuse of triptans for migraine relief common
Approximately 16% of patients with migraine who were prescribed triptans overused the medication, according to data presented at PainWeek 2018.
“Current evidence-based guidelines for treatment of migraine recommend individualized pharmacological management of acute attacks in addition to preventive intervention as warranted,” Shonda Foster, MS, PharmD, from Eli Lilly and Company, and colleagues wrote in the abstract. “Overuse of medications intended for acute or symptomatic treatment of migraine may be associated with medication overuse headache and/or progression from episodic to chronic migraine.”
Foster and colleagues analyzed data from the Truven Marketscan Commercial and Medicare-Supplemental administrative claims database to determine trends in acute medication use and frequency of overuse among patients with migraine. The researchers included 216,674 patients aged 18 years or older (mean age, 44.3 years; 85.9% women) with at least one migraine diagnosis during 2016 and an additional diagnosis anytime before Jan. 1, 2016. Patients with HIV, cancer, cluster headache or epilepsy were not included in the analysis.
Using triptan for more than 120 days of therapy per year, opioids for more than 96 days per year and barbiturates for more than 60 days per year were considered acute medication overuse. The researchers did not report on the overuse of NSAIDs/acetaminophen because claims data could not evaluate over-the-counter use.
A total of 101,111 participants were on preventive therapy and 115,536 were not.
Data indicated that 83.5% of patients had at least one claim for acute medication during 2016, of whom 49.7% had a claim for triptans, 46.9% had a claim for opioids, 44.3% had a claim for NSAIDs/acetaminophen and 14.2% had a claim for barbiturates.
In 2016, the average acute medication days of therapy was 116 days for patients with a claim for at least one acute medication. The average days of therapy for patients with at least 1 day of therapy was 99 days for triptans, 67 days for opioids, 60 days for NSAIDs/acetaminophen and 58 days for barbiturates. The mean number of prescriptions for 2016 was 4.75 for triptans, 5.11 for opioids, 2.98 for NSAIDs/acetaminophen and 3.99 for barbiturates among patients with at least one prescription of each respective class.
Overuse of triptan therapy was observed in 15.7% of all participants. Opioids were overused by 9.7% of participants and barbiturates were overused by 3.8%. About 32% of patients with at least 1 day of therapy for triptans overused the medication, as did 20.7% of those with at least 1 day of therapy for opioids and 27% of those with at least 1 day of therapy for barbiturates.
“Effective treatment options that can help to reduce acute medication use are needed in the management of patients with migraine,” Foster and colleagues concluded. “Understanding current utilization and overuse of acute medications among patients with migraine will better inform potential interventions to improve patient care and outcomes.” – by Alaina Tedesco
Foster S, et al. Acute medication use and overuse in patients with migraine. Presented at: PAINWeek 2018; Sept. 4-9, 2018; Las Vegas.
Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.