Objectives: Migraine is a disabling disease impacting quality of life, productivity, and health care costs. Triptans are recommended as initial therapy for moderate/severe acute treatment of migraine. Limited real-world data assessing triptan utilization patterns among new initiators is available prior to approval of calcitonin-gene-related peptide inhibitors (CGRPs). The objectives are to describe new triptan initiators’ utilization, treatment switch and discontinuation, patterns in commercially insured members using claims data.

Methods: Integrated medical and pharmacy claims for 15 million commercially insured members =/>18 years were queried for triptan claims from Jan 2017 to Jun 2019. Members were required to have continuous enrollment 12 months before and 24 months after their first (index) triptan claim; an ICD-10-CM code on a medical claim for migraine (G43.xxx), and no triptan claim in the previous 12 months. The index triptan, the number of claims for the index and all triptans, and the total number of different triptans in the post period were identified. The proportion and time to switching were also determined.

Results: 25,483 members met criteria; mean age 41 years and 85% female. Sumatriptan (n=14,211; 55.8%) and rizatriptan (n=7,034; 27.6%) were the most common index triptans. In the 12- and 24-months post-index: mean (sd) total index triptan fills were 2.5 (2.5) and 3.7 (4.5); however, 50.6% and 41.8% did not refill index triptan prescription; and only 9.7 % and 14.3% tried more than one triptan, with mean (sd) days to switch of 262 (210).

Conclusions: Half of commercial members new to triptan therapy did not refill their index triptan prescription; and only 1 in 10 used two or more triptan agents within 12 months. Similar patterns were observed at 24 months. These low triptan refill and switch rates can inform stakeholders on formulary placement and management decisions for the new CGRP acute migraine class.