Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are approved for migraine prevention. However, real-world studies comparing their treatment patterns in the US are limited.

This retrospective cohort study utilized administrative claims data from the Merative Marketscan® Commercial and Medicare Supplemental Databases. Included patients had ≥1 claim for an approved self-injectable CGRP mAb between May 2018 and September 2021 and had continuous enrollment in medical and pharmacy benefits (12 months pre- and 12 months post-index). Index date was defined as date of first prescription fill for a CGRP mAb (index medication). Adherence and persistence were compared for 6- and 12-months post index. Adherence to index medication was assessed as proportion of days covered (PDC) and medication possession ratio (MPR). Persistence was defined as continuous therapy from index until the end of the 12-month post-index period, allowing for a maximum gap between fills of 60 days.

At 12-months follow-up, 26,176 patients (>85% female) were grouped into galcanezumab (n=9,121), fremanezumab (n=5,003), erenumab (n=12,052) groups based on their index medication. The mean (SD) age was 43.8 (11.3), 44.4 (11.1) and 44.7 (11.2) years, respectively. Mean (SD) PDC and MPR were 0.6 (0.3) for all three groups. More patients in the galcanezumab (45.9%) group achieved PDC ≥ 0.8 followed by fremanezumab (42.8%) and erenumab (41.8%,) groups. Similarly, 46.4%, 43.4%, 42.4% achieved MPR ≥ 0.8 in the respective groups. More patients in the galcanezumab group (52.2%) were persistent through the end of the study period, followed by fremanezumab (47.5%) and erenumab (47.8%) groups. Similar trends were observed for the 6-months follow-up cohort.

Our findings suggest that patients treated with galcanezumab were more adherent and persistent followed by patients treated with fremanezumab and erenumab.