Changes in use of acute and preventive medications for migraine after erenumab initiation over 12 months: A United States retrospective cohort study

Abstract Objective To assess changes in real‐world use of acute and preventive medications for migraine over a 12‐month follow‐up period in the United States following initiation of the anti‐calcitonin gene‐related peptide (CGRP) pathway monoclonal antibody (mAb) erenumab. Background Early assessments of real‐world use of acute and preventive medications for migraine after initiation of erenumab have been limited to 6 months of follow‐up. Methods This retrospective cohort study used data from the IQVIA open‐source longitudinal prescription (LRx) and medical (Dx) claims databases. Adult patients with an initial claim (index date) for erenumab between May 2018 and April 2020 were identified. Results Among 201,176 patients who met inclusion criteria, the mean (standard deviation SD) age was 47.5 (13.8) years and 85.6% ( n = 172,153) were female. Most patients used one or more acute (88.4%; n = 177,795) and one or more traditional preventive (86.1%; n = 173,225) medications during the 12‐month pre‐index period. Adherence to erenumab (proportion of days covered PDC ≥0.80) was 40.2% ( n = 80,927) with an overall mean (SD) PDC of 0.60 (0.34). Among all patients, 70.0% ( n = 140,809) discontinued erenumab. After accounting for 24.7% ( n = 49,720) of patients who restarted erenumab, discontinuation without reinitiation was observed in 45.3% ( n = 91,089) of total patients. Switching to a different anti‐CGRP pathway mAb was observed in 13.1% ( n = 26,446) of total patients. Among 177,795 patients with pre‐index use of one or more acute migraine medication class, 86.5% ( n = 153,788) had post‐index use of the same class, and 56.7% (87,134/153,788) of them discontinued one or more class of acute medication in the 12‐month follow‐up period. Similarly, among 173,225 patients with pre‐index use of one or more traditional migraine preventive medication class, 67.7% ( n = 117,274) had post‐index use of the same class, and 46.7% (54,790/117,274) of them discontinued one or more class of traditional preventive medication in the 12‐month follow‐up period. Conclusions In this long‐term study, we observed the discontinuation of both acute and preventive medications for migraine post‐erenumab initiation.