Abstract Details

Title Opioid Use, Rebound Headache, and Resource Utilization Among Migraine Patients With Insufficient Response to Triptans Based on Real-World Data

Topic Headache

Presentation(s) S59 - Migraine: Impact, Treatment Patterns and Resource Utilization (2:06 PM-2:17 PM)

Poster/Presentation
Number 007

Background Real-world observational studies have demonstrated low persistence with triptans. Data related to outcomes among patients inadequately managed on triptans are limited.

Objective To assess the proportion of triptan insufficient responders and evaluate outcomes associated with triptan insufficient response in migraine patients.

Design/Methods This analysis utilized US data from the Adelphi Disease-Specific Programme™, a multi-country, cross-sectional study using data from electronic medical records (EMR), and patient and physician surveys collected from August to December 2017. Triptan insufficient responders were defined as patients currently prescribed triptans/had received triptans in the past 6 months and failed to achieve pain freedom at 2 hours post dose, or responded to triptans but discontinued due to lack of efficacy or side effects. Outcomes included opioid use, hospital admissions (inpatient/ emergency room), and healthcare professional (HCP) visits extracted from EMR, and self-reported rebound headache. Logistic and Poisson regression models were used to compare each outcome between triptan insufficient responders and responders, adjusting for demographics, migraine type, frequency, and severity.

Results Triptan insufficient responders (n=331) had a mean±SD age of 43.3±13.2 years, whereas triptan responders (n=535) were younger (40.9±13.6 years). Triptan insufficient responders were 13 times more likely to receive an opioid (adjusted odds ratio [aOR] [95% CI]:12.8 [2.4-68.4], P=0.003) and 3 times more likely to suffer from rebound headaches (aOR: 3.1 [1.6-6.0], P=0.001) and to be admitted to a hospital in the past year (aOR: 2.5 [0.9-6.9], P=0.081) than triptan responders. Triptan insufficient responders had 37% more visits to an HCP in the past year (adjusted incident rate ratio: 1.4 [1.0-1.8], P=0.021).

Conclusions Triptan insufficient response was associated with increased opioid utilization, more frequent rebound headaches, and greater healthcare resource utilization, including hospital admissions and HCP visits, suggesting a need for improved acute treatment of migraine and a role for novel therapeutic options in this population.

Authors/Disclosures
Stephen D. Silberstein, MD, FAAN (Jefferson Headache Center) PRESENTER	Dr. Silberstein has received publishing royalties from a publication relating to health care.
Anand R. Shewale (AbbVie)	Anand R. Shewale has received personal compensation for serving as an employee of AbbVie. Anand R. Shewale has stock in AbbVie.
	No disclosure on file
Richard B. Lipton, MD, FAAN (Albert Einstein College of Medicine)	Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biohaven. Dr. Lipton has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GlaxoSmithKline. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vedanta. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Grifols. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Axon. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Satsuma. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cool Tech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BDSI. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Linpharma. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Axsome. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clexio. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shiratronics. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Lipton has stock in Biohaven. Dr. Lipton has stock in Manistee. Dr. Lipton has stock in Axon. Dr. Lipton has stock in CoolTech. The institution of Dr. Lipton has received research support from Teva. The institution of Dr. Lipton has received research support from Amgen. The institution of Dr. Lipton has received research support from Allergan/Abbvie. The institution of Dr. Lipton has received research support from Gammacore. The institution of Dr. Lipton has received research support from Axsome. The institution of Dr. Lipton has received research support from Charleston Labs. The institution of Dr. Lipton has received research support from Eli Lilly. The institution of Dr. Lipton has received research support from Satsuma. The institution of Dr. Lipton has received research support from NIH . The institution of Dr. Lipton has received research support from Veterans Administration. Dr. Lipton has received publishing royalties from a publication relating to health care.
Sarah Cotton	Sarah Cotton has nothing to disclose.
James Jackson (Adelphi Real World)	James Jackson has nothing to disclose.
Hema Viswanathan	Ms. Viswanathan has received personal compensation for serving as an employee of Allergan plc. Ms. Viswanathan has received personal compensation for serving as an employee of Precision Medicine Group. Ms. Viswanathan has received stock or an ownership interest from Allergan plc. Ms. Viswanathan has received stock or an ownership interest from Precision Medicine Group.

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