A global real-world assessment of the impact on health-related quality of life and work productivity of migraine in patients with insufficient versus good response to triptan medication

Abstract

Background Migraine is a chronic, disabling neurological disease characterized by moderate-to-severe headache pain with other symptoms, including nausea, vomiting, and photophobia. Triptans, while generally effective, are insufficiently efficacious in 30–40% of patients and poorly tolerated by or contraindicated in others. We assessed the impact of insufficient response to triptans on health-related quality of life (HRQoL) and work productivity in patients currently receiving any prescribed triptan formulation as their only acute migraine medication. Methods Data were from the 2017 Adelphi Migraine Disease Specific Programme, a cross-sectional survey of primary care physicians, neurologists, and headache specialists and their consulting patients with migraine in the USA, France, Germany, Italy, Spain, and UK. Triptan insufficient responders (TIRs) achieved freedom from headache pain within 2 h of acute treatment in ≤3/5 migraine attacks; triptan responders (TRs) achieved pain freedom within 2 h in ≥4/5 attacks. Multivariable general linear model examined differences between TIRs and TRs in HRQoL and work productivity. Logistic regression identified factors associated with insufficient response to triptans. Results The study included 1413 triptan-treated patients (TIRs: n = 483, 34.2%; TRs: n = 930, 65.8%). TIRs were more likely to be female (76% vs. 70% for TIRs vs TRs, respectively; p = 0.011), older (mean age 42.6 vs. 40.5 years; p = 0.003), and had more headache days/month (7.0 vs. 4.4; p < 0.001). TIRs had significantly more disability, with higher Migraine Disability Scores (MIDAS; 13.2 vs. 7.7; p < 0.001), lower Migraine-specific Quality of Life scores, indicating greater impact (Role Function Restrictive: 62.4 vs. 74.5; Role Function Preventive: 70.0 vs. 82.2; Emotional Function: 67.7 vs. 82.1; all p < 0.001), and lower EQ5D utility scores (0.84 vs. 0.91; p = 0.001). Work productivity and activity were impaired (absenteeism, 8.6% vs. 5.1% for TIRs vs. TRs; presenteeism, 34.3% vs. 21.0%; work impairment, 37.1% vs. 23.3%; overall activity impairment, 39.8% vs. 25.3%; all p < 0.05). Conclusion HRQoL and work productivity were significantly impacted in TIRs versus TRs in this real-world analysis of patients with migraine acutely treated with triptans, highlighting the need for more effective treatments for patients with an insufficient triptan response. Further research is needed to establish causal relationships between insufficient response and these outcomes.

Factors associated with insufficient response to acute treatment of migraine in Japan: analysis of real-world data from the Adelphi Migraine Disease Specific Programme

“…However, insufficient responders to acute treatment were more likely than sufficient responders to exhibit greater migraine severity, as indicated by the higher proportions of insufficient responders with a clinical diagnosis of chronic migraine or medication-overuse or tension-type headache and the greater requirements of insufficient responders for extra doses of prescribed acute medication to relieve pain symptoms or symptoms of a migraine attack. Headache-related disability was also significantly greater and HRQoL significantly lower in Japanese insufficient responders to acute treatment than in sufficient responders, and similar findings have been reported in the overall 2017 analysis of Adelphi Migraine DSP data from USA, France, Germany, Italy, Spain, and the UK [20] and in the 2014 US Adelphi Migraine DSP [19].…”

Evaluation of Patients with Insufficient Efficacy and/or Tolerability to Triptans for the Acute Treatment of Migraine: A Systematic Literature Review

“…Increased physician awareness may help better identify patients at risk of insufficient response to triptans [55]. In addition to factors identified here, overuse of over-the-counter (OTC) medication and timing of triptan administration were factors identified in a global real-world study using data obtained from physicians and patients.…”

“…Patient-Reported Outcomes (PROs) are mostly used in clinical research rather than in clinical practice. However, some PRO tools such as Migraine-Specific Quality of Life Questionnaire (MSQ) and Migraine Disability Assessment (MIDAS), although not specific to acute treatment, might give an idea of impact of attacks [55]. Further, it might be helpful to have some potential specific PRO tools such as Migraine Treatment Optimization Questionnaire (MTOQ) for the acute treatment which may aid physicians in identifying when to consider reassessment of migraine treatment options [55].…”

“…Insufficient response to triptans has been shown to result in considerable humanistic burden [ 55 – 57 ]. While effective for many, the unmet need remains high in patients using triptans, resulting in the need for newer drug classes [ 58 , 59 ].…”

Impact of Individual Headache Types on the Work and Work Efficiency of Headache Sufferers

“…It was shown that productivity loss is less when early migraine treatment is applied, and when pain is not moderate to severe, either with triptan or non-triptan treatment [11,13]. Migraine patients treated with triptans showed that those with an insufficient response to triptan medication have significantly worse health-related quality of life and are less productive than those who respond to triptans [17]. Furthermore, pharmacoeconomic research demonstrated that early interventions with triptans have more benefits than delayed interventions do [13,14].…”