Persistence of pharmacological migraine prevention based on statutory health insurance claims data from Germany: a retrospective cohort study

Introduction In the global population aged 20–99 years, migraine shows the second greatest loss of disability-adjusted life years (DALYs). In Germany, migraine affects around 15% of all women and 6% of all men. Migraine preventive therapy aims to reduce the frequency, severity and duration of attacks. We evaluated the persistence of conventional drug therapies for migraine prevention under real-world conditions focusing on defined oral drugs and Clostridium botulinum neurotoxin type A (BoNTA) in patients who were subsequently prescribed aCGRP monoclonal antibodies. Methods Claims data from German statutory health insurance were used to analyze prescription patterns. Prevalent migraine patients were defined as individuals over 18 years of age at the beginning of the observation period with at least one ICD-10 G43 diagnosis. Persistence of oral prophylactic therapies and BoNTA was determined retrospectively in migraine patients with a first prescription of an aCGRP-mAb between October 1 and December 31, 2021 and uninterrupted retrospective data over the preceding five years. Persistence was defined as 180 days of uninterrupted preventive therapy with the same as the first prescription. Prescription duration was based on the therapeutic range per prescribed package according to the prescribing information. Kaplan–Meier survival analyses were conducted to evaluate the time until treatment discontinuation. Results For the analysis of conventional therapies, a cohort of 137 patients was identified. The 137 patients (119 females and 18 males) received an average of 2.6 conventional preventive therapies during the five-year observation period before the first monoclonal antibody prescription. For most of the preventive drugs less than five patients fulfilled the persistence criteria on 180 days. On average, patients began therapy with a monoclonal antibody more than one year after the last previous conventional therapy was dispensed. Discussion The persistence of oral preventive migraine treatments not specifically developed for migraine prevention was low, suggesting either temporary relief from migraine or treatment discontinuation for reasons that could not be identified from the data used in this study. Further systematic investigations comparing the persistence of conventional preventive therapies and aCGRP-mAbs in routine clinical practice in Germany are warranted.