More triptan use linked to more acute treatment, hospital visits, health care costs

Key takeaways:

• A retrospective claims analysis included more than 184,000 individuals with migraine who used at least one triptan.
• Migraine-related acute treatment was higher for those who used two or more triptans.

SAN DIEGO — Patients who used two or more triptans for migraine faced more acute treatment, more emergency-related hospital visits and higher medical costs compared with those who used one, data show.

“Triptans are the most commonly prescribed acute treatment for migraine attacks,” Amit Bodhani, a researcher at AbbVie, and colleagues wrote in an abstract that was presented at the American Headache Society Annual Scientific Meeting. “However, not all patients have an adequate response to their initial triptan.”

Bodhani and colleagues aimed to assess the burden of triptan cycling by evaluating medication use, medication overuse headache (MOH) diagnoses and migraine-specific health care resource utilization (HCRU) and associated costs in those treated with a single triptan compared to those treated with two or more triptans.

Their retrospective claims analysis employed both the MarketScan Commercial and Medicare databases from January 2015 through February 2023 to yield 184,717 new triptan users: 91,406 individuals who used one triptan (mean age 42 years; 82.2% female) and 22,909 individuals who required two or more triptans (mean age 38 years; 85.9% female) during a 24-month follow-up period.

Within the cohort that used one triptan, 32.1% had one refill, 18.1% had two refills and 49.8% had at least three refills of their index triptan.

The researchers used descriptive statistics to categorize baseline participant demographics and clinical characteristics, while chi-square teste were employed for comparisons of post-index medication use. Regression models were included to measure MOH and adjusted migraine-specific HCRU and costs over the 24-month follow-up.

According to results, migraine-related acute treatment use excluding triptans (48.8% vs. 29.6%) and preventive treatment use (83.1% vs. 68.9%) were higher in the cohort that used two or more triptans compared to the cohort that used one triptan.

Diagnosed MOH occurred in 3.5% of the two+ triptan cohort and 1.1% of the cohort using one (OR = 2.98; 95% CI, 2.71-3.28). Migraine-related ED, diagnostic imaging and outpatient visits were 1.4, 1.3 and 1.4 times higher in the 2+ triptans cohort compared with the cohort using one triptan, respectively.

Data further showed that adjusted migraine-related medical costs were $2,235 higher (mean ratio (MR) = 1.88; 95% CI, 1.79-1.98) and prescription costs were $1,939 higher (MR = 2.31; 95% CI, 2.23-2.41) in the 2+ triptans cohort compared with the cohort using one triptan.

“The cost and benefits of switching to a different class of medications should be explored,” Bodhani and colleagues wrote.