Presentation (CTI)

OBJECTIVES: To evaluate racial disparities in uptake of calcitonin gene-related peptide (CGRP) therapies (Erenumab, Fremanezumab, Galcanezumab, Eptinezumab, Atogepant, or Rimegepant) for migraine prevention among adults in the United States.
METHODS: This retrospective cohort study was conducted using the Komodo Research Dataset and Komodo Race and Ethnicity. Index date was patient's first migraine diagnosis. Adults ≥18 years with ≥2 migraine diagnoses (01/01/2022-10/31/2024), ≥12 months of continuous pre- and post-index enrollment, and no prior migraine diagnosis/pregnancy/cluster headache/CGRP therapy exposure/clinical trial participation were included. Race/ethnicity was categorized as White (reference), Black or African American, Hispanic or Latino, Asian or Pacific Islander, and Other. Outcomes included CGRP initiation and time to initiation. Kaplan-Meier curves were used to estimate cumulative incidence of CGRP initiation by race/ethnicity; pairwise log-rank tests compared groups vs White. AI-assisted analytics were validated by a secondary reviewer.
RESULTS: Total of 298,041 individuals met study criteria. The cohort was predominantly female (76.6%), mean age 45.9 years, and included 63.8% White, 12.1% Black, 15.7% Hispanic, 4.0% Asian, and 4.4% Other patients. Overall, 43,685 (14.7%) initiated a CGRP therapy, with 12.3% Asian, 12.7% Black, 13.8% Hispanic, 15.2% White, and 16.9% Other initiating therapy. Median (Q1-Q3) time to initiation were: Asian 206 days (41-521), Black 216 (49-518), Hispanic 199 (48-484), White 207 (49-490), and Other 198 (43-491). Twelve-month cumulative incidence ranged from 8.0% (Asian and Black) versus 10.0% in White patients; at 24 months, from 10.8% (Asian) and 11.2% (Black) to 14.9% (Other) versus 13.5% (White) (p<0.001 for all groups compared to White).
CONCLUSIONS: CGRP initiation remained low across all groups. Although median time to initiation was similar, cumulative incidence patterns suggest differential adoption over time.