Abstract Details

Title GLP-1 Receptor Agonists and Chronic Migraine: A Real-world Cohort Study of Healthcare Utilization and Preventive Escalation

Topic Headache

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 15-017

Objective

To compare healthcare utilization, triptan use, and preventive-treatment escalation following initiation of a glucagon-like peptide-1 receptor agonist (GLP-1RA) compared with topiramate in adults with chronic migraine (CM).

Background

GLP-1RAs, widely used for metabolic disorders, exert anti-inflammatory and neurovascular effects that may influence migraine pathophysiology. Despite growing interest, no randomized controlled trials have assessed their preventive efficacy in migraine. To address this gap, we examined whether real-world data could reveal clinical benefits of GLP-1RA initiation compared with a standard first-line migraine preventive.

Design/Methods

We performed a real-world, active-comparator cohort study using TriNetX. Adults with CM initiating a GLP-1RA (liraglutide, semaglutide, dulaglutide, exenatide, lixisenatide, or albiglutide) within 12 months of diagnosis were compared with topiramate initiators, excluding prior use of the opposite class. Cohorts were 1:1 propensity-score-matched for demographics, BMI, comorbidities, and prior preventive use (β-blockers, TCAs, SNRIs, valproate, CGRP mAbs/gepants, Botox). Outcomes over 12 months included ED visits, hospitalizations, nerve-block procedures, triptan prescriptions, and new preventive initiation. Patients with prior use of each preventive were excluded from its respective outcome analysis. Risk ratios (RR) with 95% CIs were estimated.

Results

After 1:1 matching, 10,997 patients per cohort (mean age 48 years; 87.8% female) were analyzed. Baseline characteristics were balanced (SMD <0.1). Compared with topiramate, GLP-1RA initiators showed lower RRs for ED visits (0.90, 0.86-0.94), hospitalizations (0.86, 0.81-0.91), nerve blocks (0.87, 0.78–0.97), and triptan use (0.87, 0.84–0.91). They also showed reduced RR for initiation of TCAs (0.65, 0.55–0.77), valproate (0.52, 0.40–0.68), gepants (0.77, 0.69–0.85), CGRP mAbs (0.58, 0.52–0.65), and SNRI (0.80, 0.64–0.995). There were no significant differences in beta-blocker initiation.

Conclusions

In CM, GLP-1RA initiation compared with topiramate was associated with lower acute-care utilization and less escalation to additional preventives, despite similar baseline profiles. These findings suggest a potential role of GLP-1RAs in migraine management and warrant prospective evaluation.

Authors/Disclosures
Vitoria Acar, MD PRESENTER	Dr. Acar has received research support from Pfizer Brazil. Dr. Acar has a non-compensated relationship as a Volunteer/ advocacy with ABRACES that is relevant to AAN interests or activities.
Mateus D. Franco, MD	An immediate family member of Mr. Franco has received research support from Pfizer Brazil . Mr. Franco has received personal compensation in the range of $500-$4,999 for serving as a Second Lieutenant with Brazilian Army . Mr. Franco has a non-compensated relationship as a Member with Abraces - Brazilian Association for Cluster Headache and Migraine. that is relevant to AAN interests or activities.
Victor Wang, MD (Thomas Jefferson University Hospital)	Dr. Wang has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Dr. Wang has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie.
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center)	An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cephalalgia. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. The institution of Dr. Yuan has received research support from Pfizer. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Invited speaker with Chinese Stroke Association.

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