For the estimated 35 million people in the United States who suffer from migraines, multiple prescription therapies are available that have proved effective in acutely treating migraine pain and its associated symptoms. Among approved prescription medications, the migraine-specific “triptan” drug class represents the largest—and most extensively prescribed—group of therapies. All of the molecules in this class are available as oral tablet formulations, and several are also available in non-oral formulations (e.g., nasal sprays, subcutaneous [SC] injectables), which serve as alternative treatment options for patients with precise clinical needs. Additional approved acute prescription therapies, including ergotamine derivatives and select non-migraine-specific analgesics, represent the remaining therapies that are formally approved for the acute treatment of migraine. Agents from these last two classes are generally reserved for patients who do not respond satisfactorily or are contraindicated to triptans (in the case of non-migraine-specific analgesics) or cannot tolerate triptans.
As a class, the triptans have experienced extensive generics competition; although several branded-only products remain, they too will become subject to generics competition in the coming years. Meanwhile, drug developers continue to develop new non-oral reformulations of existing triptan molecules—as well as explore drug development opportunities outside the triptan space—in the hopes of providing acute migraine symptom relief to those patients underserved by currently available products.
Using patient-level claims data, this report tracks the share of acute, prescription antimigraine drugs through lines of therapy, evaluates treatment flow, and analyzes why certain key acute therapies are chosen over others in light of the multiple acute therapeutics available.
Primary patient-level data: Quantitative findings from our analysis of data covering 40 million lives providing the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet with claims that are less than six months old at the time of publication.
Patients aged 15 or older who are continuously enrolled for the complete 4.5-year study period must meet the following condition: at least two claims with a diagnosis code for migraine (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes (346.00-346.93 [inclusive]) during the study period.
Quantified lines of therapy analysis showing exact share of each acute antimigraine agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.
Newly Diagnosed Patients:
- Patient share by acute antimigraine drug class and key acute products across three lines of therapy within two years of diagnosis.
- Patient flowchart through two years of acute treatment for all first-line products, including progression rates and add/switch behavior.
- Polypharmacy and concomitant prescriptions among key acute therapies by line of therapy.
- Quarterly trending of patient share by line of therapy.
Recently Treated Patients:
- Quarterly snapshot of patient share by acute drug class and key acute products.
- Pathway to key acute therapy flowcharts tracking the preceding acute therapy patterns for all key acute therapies, including add/switch behavior.
- Brand source of business including share for continuing, new (switches/adds), and new (initial therapy) business.
- Polypharmacy and concomitant prescriptions among key acute therapies.
- Acute drug persistence and compliance.
- Quarterly trending of patient share for all key acute therapies.