NATIONAL HARBOR, MD. –
“There’s very little consistency in study design, making it difficult to make real-world comparisons,” said Carly Rodriguez, PharmD, FAMP, pharmacy director at Moda Health. Dr. Rodriguez presented data on the efficacy and pharmacoeconomic factors of migraine therapy at the annual meeting of the Academy of Managed Care Pharmacy.
The paucity of translatable evidence makes comparing and evaluating newer migraine therapies – such as botulinum toxins and calcitonin gene-related peptide (CGRP) inhibitors – particularly difficult.
These two injectable drug classes are not first-line treatments for migraine; they are currently reserved for patients who are refractory to at least one prophylactic treatment, but they offer important alternatives and additions to therapy.
“OnabotulinumtoxinA makes a good case because it costs less than a single ER visit, but there’s not enough supporting data,” Dr. Rodriguez said. According to a report from the Institute for Clinical and Economic Review (ICER) that evaluated the clinical efficacy and economic impact associated with onabotulinumtoxinA, administering the drug saved $157/headache day averted for 20 baseline headaches per month and $223/headache day avoided for 15 baseline headaches per month.
OnabotulinumtoxinA administration showed a moderate yet significant health benefit in preventing chronic migraines by reducing the number of headache days patients experienced by more than 50%. No benefit for episodic migraines was observed.
Several single- and multicenter studies found that onabotulinumtoxinA produced positive outcomes such as a decreased number of visits to urgent care centers, a lower average number of migraines patients experienced, and improved quality of life.
An ICER report investigating CGRP inhibitors found that the cost of anti-CGRP therapy may not produce viable clinical benefits.
Both botulinum toxins and CGRP inhibitors require prior authorization, and their injectable dosage forms restrict the settings in which they are administered and dispensed. Because botulinum toxins must be administered by a health care professional, the vast majority of these drugs are restricted to medical settings, with brand-to-generic substitution often varying among health plans. For this reason, botulinum toxins rarely appear on formularies. Several health plans consider botulinum toxins interchangeable and may give prescribers options to select the botulinum toxin product of their choice.
According to Dr. Rodriguez, there is some variability as to whether CGRP therapies are available in community pharmacy settings or are restricted to specialty pharmacies. Additionally, some plans consider all CGRP inhibitors to be interchangeable, while others take a more conservative approach.
Overall, generic drugs continue to dominate migraine drug therapy, with triptans leading the way. Generics that are heavily prescribed include beta-blockers, antidepressants, and antiepileptics.
More than 37 million people living in the United States suffer from migraines – approximately 8% of the overall population. Women are four times as likely to have migraines than men.