Real-World Study Reveals Rimegepant Usage Trends for Acute and Preventive Migraine Treatment

Jessica Ailani, MD

Credit: MedStar Health

A recent study provided real-world data on medication trends and characteristics of new users of rimegepant for migraines.¹

“This study is the first to evaluate characteristics and tablet utilization patterns among rimegepant users in a commercially insured population with migraine,” wrote investigators, led by Jessica Ailani, MD, from the department of neurology at Medstar Georgetown University Hospital, in Washington, DC.

Rimegepant is the only oral calcitonin gene-related peptide antagonist approved in the US for acute and preventive treatment of migraine.² Investigators sought to assess trends of utilization and pre-treatment characteristics of new users of rimegepant.¹

The team conducted a retrospective cohort study of 14,037 participants (aged ≥ 18 years) who recently started taking rimegepant through the healthcare services of MarketScan® and Optum®. The data was of new users of rimegepant from March 1, 2020, through the end of data availability (January 31, 20223 for MarketScan, and June 30, 2022, for Optum).

Investigators identified a patient’s first prescription pill for rimegepant during the study period though pharmacy dispensing claims, and this was considered a patient’s index date. They included participants if they had a rimegepant fill within 120 days after their index date and had ≥ 365 of continuous enrollment in medical and pharmacy benefits pre-index. Participants also had to have a migraine diagnosis according to the ICD-10-CM codes before or at the index date and could not have evidence of other gepant use before their index date.

The team collected data on baseline characteristics, including age, sex, insurance type, and geographic region, and medication use history at baseline and during the 365-day pre-baseline period. The team also assessed for triptan contraindications, warnings, and cardiovascular risk factors, such as hypertension, hyperlipidemia, obesity, tobacco use, and diabetes. Additionally, they assessed for other comorbidities linked to migraines, including anxiety, sleep disturbances, and other chronic pain.

Investigators characterized 4 rimegepant tablet utilization measures: quantity of tablets dispensed on index date, quantity of tablets dispensed during follow-up, total quantity dispensed during study period, total tablet utilization per 30 days, and total period of rimegepant use.

Participants were placed into the acute (79.8%) or prevention (13.4%) cohorts. Those in the acute cohort received an index quantity of 8 tablets; the prevention cohort received an index quantity of 15 or 16 tablets.

Acute and prevention users did not differ significantly in baseline characteristics. Among new rimegepant users, 88.4% were female, 99% had commercial insurance, and the mean age was 43.3 ± 11.4 years. In total, 28.4% of all rimegepant users had triptan contraindications or warnings, and the most common reasons were arrhythmias (10.2%), other cardiac conditions (6.1%), and ischemic cerebrovascular diseases (5.4%). Other common comorbidities included chronic pain (43.7%), anxiety (42.5%), depression (32.8%), and sleep disturbances (29.9%).

The year before going on rimegepant, the prescription trends for acute medications was: triptans (59.3%), NSAIDs (35.1%), general antiemetics (33.1%), opioids (30.6%), migraine-specific antiemetics (19%), butalbital (13.5%), and acetaminophen (13.2%). In total, 11.2% used non-oral acute treatments.

The study showed it was common for patients to overuse acute medication before starting rimegepant, with this applying to 25.1% of rimegepant users.

Ailani and colleagues discovered the acute use of rimegepant tablets was 4.9 ± 2.1 tablets per 30 days and the preventive use was 13.1 ± 7.7 tablets per 30 days. Acute medication users had an average period of rimegepant use of 325 ± 186 days. Most (82.7%) participants on acute rimegepant continued filling 8 tablets; 1.5% filled 16 tablets after the index fill and 14.8% filled multiple quantities throughout the follow-up. A mean of 54.6 ± 45.8 tablets were dispensed.

Among new users on acute medication, the team observed a high prevalence of triptan contraindications, warnings, and high cardiovascular risk. In total, 46.2% of the participants met ≥ 1 of these criteria.

As for preventive medications, the most common one was Anti-CGRP mAbs (30.6%), followed by anticonvulsants (29.1%), beta-blockers (21.8%), tricyclic (17.3%) and other anti-depressants (17.5%), and onabotulinumtoxinA (15.7%). More than half (61.4%) used a conventional oral prevention agent the 365 days before starting rimagepant. On average, 7.6 ± 39.6 tablets were dispensed with average use of 8.9 ± 2.7 tablets per 30 days

“Tablet utilization for rimegepant for acute and preventative use was approximately 5 tablets per 30 days and 13 tablets per 30 days, respectively, using varied approaches to measure use periods,” investigators wrote. “Real-world data with treatment indication, tablet utilization, and migraine frequency are needed to further understand rimegepant utilization.”

References

^{Ailani J, Lewis M, Dai F, et al. Evaluation of rimegepant utilization patterns and patient characteristics among new users: a United States administrative claims-based study. Curr Med Res Opin. Published online September 28, 2024. doi:10.1080/03007995.2024.2410930}

^{Campbell, P. Rimegepant Eliminates Migraine Pain, Reduce Symptoms in Clinical Trial. HCPLive. July 10, 2019. https://www.hcplive.com/view/rimegepant-eliminates-migraine-pain-reduce-symptoms-in-clinical-trial. Accessed October 4, 2024.}