Real-World Experience with Anti-CGRP Pathway Monoclonal Antibodies in a Large United States Healthcare Plan: Results of the Migraine Signature Study

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Calcitonin gene-related peptide (CGRP) pathway-targeted monoclonal antibodies (mAbs) are first-line treatment options for migraine prevention. Data on persistence and patient-reported outcomes including satisfaction are limited. This real-world study aimed to report the experience of patients prescribed ≥ 1 self-injectable anti-CGRP mAb in a large United States healthcare network. The Migraine Signature Study, an observational study, conducted at Sutter Health, utilized electronic health records (EHRs) to identify adult patients with migraine who were prescribed ≥ 1 self-injectable anti-CGRP mAb. These patients were invited to participate in a survey (October–December 2020) on sociodemographics, migraine attack characteristics, treatment patterns, and patient-reported outcomes, including the Migraine Disability Assessment Scale (MIDAS) and 4-item Migraine Interictal Burden Scale (MIBS-4). EHRs were used to assess persistence/discontinuation. Of 4683 eligible patients with migraine, 484 (10.3%) completed the survey. More than half (51%) were 30–54 years old, female (89.1%), and non-Hispanic white (79.1%). Most (53.5%) reported 1–10 headache days in the previous month; 58.2% had moderate or severe migraine-related disability. A total of 430 respondents reported having used ≥ 1 anti-CGRP mAbs, comprising 547 reports of anti-CGRP-mAb experience, 319 (58.3%) current use, and 228 (41.7%) past use. Among participants with prescription-dispensing data (n = 338), ongoing refills were documented for ≥ 2 months in 90.2%, ≥ 6 months in 73.7%, and ≥ 12 months in 54.7%. Greater reduction in number of headache/migraine attacks (62.1% vs. 17.5%), improved ability to function (62.1% vs. 18.0%), and better quality of life (62.4% vs. 17.5%) was reported for current use versus past. Among patients who dispensed ≥ 1 anti-CGRP mAb for migraine, rates of sustained treatment over the course of a year were higher than expected; ~ 75% continued their index mAb at 6 months and > 50% at 12 months. Patients using anti-CGRP mAbs at the time of the survey reported higher satisfaction than patients who had discontinued anti-CGRP mAb. In clinical trials, calcitonin gene-related peptide (CGRP) pathway-targeted monoclonal antibodies (mAbs) have been shown to be effective in preventing migraine and have few side effects. Therefore, they are recommended as a first-line treatment option for migraine prevention. Data on persistence and patient-reported outcomes in real-world clinical practice are limited. In this study, we included patients with migraine who received treatment in a large United States healthcare network. We conducted a web-based survey of patients, identified from electronic health records, who were prescribed ≥ 1 of the 3 injectable anti-CGRP-targeted mAbs. Combining the survey data with prescription dispensing data, we assessed persistence, patient satisfaction with perceived effectiveness, tolerability and access, additional treatment use, migraine-related disability, quality of life, and other outcomes. Approximately three-quarters of patients who started an anti-CGRP- mAb continued to use that medication at 6 months and half of them continued at 1 year. Satisfaction levels were higher for current use of anti-CGRP mAb medications on treatment effectiveness, tolerability and side effects, improved ability to function, and quality of life compared to past use of mAbs. Among patients who discontinued an anti-CGRP mAb, approximately half reported a lack of effectiveness as the main reason for discontinuation, followed by side effects.

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