Prescription of Monoclonal Antibodies Against Calcitonin Gene‐Related Peptide for the Prophylaxis of Migraine in Austria: A Retrospective, Longitudinal Analysis of Nationwide Insurance Data

Background Insurance data allow insights into dispensations of medications. This retrospective study over 49 months examined dispensations of monoclonal antibodies against calcitonin gene‐related peptide (CGRP‐mAbs). Methods Using nationwide insurance data, we examined dispensations of erenumab, fremanezumab, or galcanezumab from September 1, 2018 to September 30, 2022. We examined the duration of treatment and breaks (Kaplan–Meier curves, medians, quartiles), persistence (proportion of days covered), and switches, acute medications, and other preventatives. Results Of 8.8 million persons, 8934 were at least once dispensed a CGRP‐mAb (83.5% women, median age 45 years). Median individual follow‐up time was 710 days, median duration of treatment with any CGRP‐mAb was 297 days, 42.9% had CGRP‐mAbs for at least 1 year. Median duration of treatment with the first‐ever CGRP‐mAb was 327 days; 63.4% experienced a therapy break. Within 1 year after stopping, 53.5% resumed the same CGRP‐mAb, 16.9% another CGRP‐mAb, 29.6% did not resume any CGRP‐mAb; 13.7% started a second CGRP‐mAb and 1.7% a third. 22% definitively stopped therapy within their follow‐up. Dispensation of triptans decreased during and after therapy with CGRP‐mAbs; dispensation of other acute prescription medications was low without change. 11.4% had other preventatives before and 2.4% during CGRP‐mAb therapy. The proportion of days covered was 96%. Conclusions In this nationwide study persistence with CGRP‐mAbs was excellent; dispensations of triptans and other preventatives decreased during CGRP‐mAb therapy. Therapy breaks were common, but the majority resumed CGRP‐mAbs, which indicates the need for long‐term prophylaxis.