Abstract Details

Title Acute Anti-Migraine Prescription Varies According to Baseline Cardiovascular Risk and Clinical Characteristics: A Real-World Evidence Study

Topic Headache

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-017

Objective To characterize baseline demographic and clinical characteristics among migraine patients using cardiovascular disease risk score (DRS) and to test the hypothesis that migraine patients with fewer cardiovascular risk factors are more likely to receive triptan prescriptions in real-world settings.

Background Triptans can induce vasoconstriction and potentially increase the risk of serious ischemic events. The approved triptan labels indicate that triptans are contraindicated among patients with ischemic cardiovascular conditions. As a result, triptan-exposed migraine patients treated according to standard-of-care in real-world settings may have a lower baseline CVD risk compared with triptan-unexposed migraineurs.

Design/Methods The present retrospective cohort study characterizes baseline traits among three acute anti-migraine patient cohorts (triptan, opiates, prescription NSAIDs), untreated migraine, and a general patient cohort matched on age, gender, index date and insurance type. A logistic regression model was developed and validated among untreated migraine patients, which predicted 1-year myocardial infarction (MI) risk among these patients. Subsequently, a DRS was generated using the validated prediction model. The analysis was conducted using a U.S.-based claims insurance database.

Results The study identified 455,776 triptan, 52,793 opiates, and 325,419 prescription NSAIDs for migraine-treated patients, 1,240,116 untreated migraine patients, and 4,960,339 matched general patients. Triptan-prescribed migraine patients were younger (37.62 ±12.31 years of age) and had fewer cardiovascular risk factors (e.g. hypertension, diabetes and hyperlipidemia), baseline hospitalizations, and concomitant medication uses compared to other study cohorts. Furthermore, the distribution of DRS showed that a greater proportion of opiates patients (2.7%) and NSAIDs (3.4%) compared to triptan patients (0.9%) were at the highest risk category for 1-year MI (>10%).

Conclusions Migraine patients with more CV risk factors and a higher 1-year MI risk were disproportionately prescribed opiates and NSAIDs compared to triptans. Future research should explore the unmet needs for migraine patients with conditions for which triptan therapy is contraindicated.

Authors/Disclosures
Hu Li PRESENTER	No disclosure on file
Maurice Vincent, MD, PhD	Prof. Vincent has received personal compensation for serving as an employee of Eli Lilly and Company. Prof. Vincent has stock in Eli Lilly and Company.
	No disclosure on file
	No disclosure on file
Sheena K. Aurora, MD (Department of Neurology and Neurological Sciences)	Dr. Aurora has received personal compensation for serving as an employee of Alzheimer's Association.

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