A retrospective cohort study comparing treatment persistence between rimegepant and lasmiditan for the acute treatment of migraine in the US

BackgroundThis study compared treatment persistence of individuals newly initiating treatment with rimegepant or lasmiditan for the acute treatment of migraine.MethodsA retrospective cohort analysis was conducted on individuals from MarketScan (commercial and managed Medicare) newly initiating treatment with rimegepant or lasmiditan between March 2020 and December 2022. Treatment persistence was defined as the proportion of individuals with ≥1 medication refill within 12 months of the index prescription. Subgroups included individuals with chronic migraine, index lasmiditan dose (50 and 100 mg) and individuals with a history of two or more uses of controlled substances (prior repeated use of controlled substances [PRUCS] defined here as opioids, butalbital, nausea medications with central nervous system action). Treatment persistence was compared between inverse probability of treatment weighting (IPTW)-adjusted cohorts using odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe primary analysis included 16,603 rimegepant and 716 lasmiditan users. A significantly higher proportion of individuals in the rimegepant cohort were treatment persistent compared with the lasmiditan cohort (OR 3.79 [95% CI 3.23-4.41]). This finding remained consistent across lasmiditan dosages (50 mg: 5.05 [3.87-6.60]; 100 mg: 3.33 [2.78-4.00]), chronic migraine diagnosis (3.89 [3.21-4.71]), or PRUCS (ORs ranged from 2.78 to 4.63; all statistically significant).ConclusionRimegepant users demonstrated higher treatment persistence over 12 months compared to lasmiditan users, which could reflect better real-world treatment satisfaction.