OBJECTIVES

Preventive therapy is prescribed to decrease the frequency and severity of migraine attacks, but treatment persistence is currently low. The aim of this analysis is to delve into the discontinuation patterns among migraine patients subject to multiple preventive treatment lines.

METHODS

: The BIG-PAC® database was used to retrieve one-year follow-up data of 7,866 adult migraine patients who had started oral preventive medication between 01/01/2016 and 30/06/2018. Since traditional survival analyses provide a truncated view of patient’s persistence over time while considering persistence a dichotomous variable, a Multi-state Model (MSM) was applied instead. A Multi-state Cox model of proportional hazards was designed including first, second and third or fourth treatment lines as well as discontinuation as four possible states. At each state, patients could continue, discontinue or switch treatments. Switching between treatment lines (<60 days since last prescription) were not considered discontinuation events. Included covariates were gender, age, Charlson Comorbidity Index and time since diagnosis.

RESULTS

: 2,390 (30.4%) patients persisted with the treatment by maintaining it or switching medications. First-line median time was 162 (95%CI: 158-166) days. Compared to those who had only been prescribed a single drug, patients in the second or the third and fourth lines had a lower risk of discontinuation (HR: 0.24; 95%CI: 0.124-0.482; P<0.001; HR: 0.21; 95%CI: 0.030-1.433; P=0.11, respectively). Additionally, increasing age was significantly associated with the risk of discontinuing the treatment (5-year HR: 5.06 and 5.1; P<0.001 for the first and second lines, respectively).

CONCLUSIONS

: MSM better describes complex real-world clinical scenarios whereby discontinuation rates may vary according to the treatment line. Since patients tend to discontinue the first line more often, providing alternative measures in a timely manner, like closer patient follow-up, dosage adjustment or an alternative therapeutic option during that time period, could help to improve persistence.