Real-life use of onabotulinumtoxinA reduces healthcare resource utilization in individuals with chronic migraine: the REPOSE study

Abstract

Background Chronic migraine (CM) is associated with substantial economic burden. Real-world data suggests that onabotulinumtoxinA treatment for CM reduces healthcare resource utilisation (HRU) and related costs. Methods REPOSE was a 2-year prospective, multicentre, non-interventional, observational study to describe the real-world use of onabotulinumtoxinA in adult patients with CM. This analysis examined the impact of onabotulinumtoxinA on HRU. Patients received onabotulinumtoxinA treatment approximately every 12 weeks according to their physicians’ discretion, guided by the summary of product characteristics (SPC) and PREEMPT injection paradigm. HRU outcome measures were collected at baseline and all administration visits and included headache-related hospitalizations and healthcare professional (HCP) visits. Health economic data, including family doctor and specialist visits, inpatient treatment for headache, acupuncture, technical diagnostics, use of nonpharmacologic remedies, and work productivity were also collected for patients enrolled at German study centres. Results Overall, 641 patients were enrolled at 78 study centres across 7 countries (Germany, UK, Italy, Spain, Norway, Sweden, and Russia), 633 received ≥1 onabotulinumtoxinA dose, and 128 completed the 2-year study. Patients were, on average, aged 45 years, 85% were female, and 60% (n = 377) were from Germany. At the end of the 2-year observation period, significantly fewer patients reported headache-related hospitalizations (p < 0.02) and HCP visits (p < 0.001) within the past 3 months than in the 3 months before baseline. In the German population, reductions were observed across all health services at all follow-up visits compared with baseline. The percentage of patients who saw a family doctor decreased from 41.7% at baseline to 13.5% at administration visit 8 and visits to a medical specialist decreased from 61.7% to 5.2% of patients. Inpatient acute treatment and technical diagnostics declined from 6.4% and 19.7% of patients at baseline to 0.0% and 1.0% at administration 8, respectively. The use of nonpharmacologic remedies and medication for the acute treatment of migraine also decreased with continued onabotulinumtoxinA treatment. Work incapacity, disability, absenteeism, and impaired performance at school/work improved with onabotulinumtoxinA treatment for CM over the 2-year observation period. Conclusions Real-world evidence from REPOSE demonstrates that onabotulinumtoxinA treatment is associated with decreased HRU and supports the long-term benefits associated with the use of onabotulinumtoxinA for CM in clinical practice. Trial registration NCT01686581. Name of registry: ClinicalTrials.gov. URL of registry: Date of retrospective registration: September 18, 2012. Date of enrolment of first patient: July 23, 2012.

Long‐term adherence, safety, and efficacy of repeated onabotulinumtoxinA over five years in chronic migraine prophylaxis

“…11,12 Furthermore, BoNTA demonstrated its efficacy in about 70% of treated patients after three courses of BoNTA on all clinical and quality of life measures and a favorable benefit-risk ratio in subsequent PREEMPT pooled subgroup analysis of CM patients with or without MOH. [13][14][15] Real-world data have also been consistent with the positive benefit-risk profile of BoNTA ascertained in all PREEMPT-based publications, in addition to demonstrating improvements on patientreported outcomes (PROs), 16 even in the context of direct head-tohead comparison with topiramate. 17 Finally, real-world long-term experience with BoNTA in CM patients for up to four years of treatment supports its sustained efficacy and adequate safety and tolerability over time.…”

“…In addition, there is evidence to support the beneficial effect of BoNTA injections at different sites, not just the forehead, in reducing the frequency and severity of comorbid psychiatric disorders, including depression and anxiety 47,48 . Finally, the real‐life efficacy/safety evidence that has been collected on BoNTA since the date it was first marketed for the treatment of CM is significantly richer, compared with MAbs against CGRP or CGRP receptor 16,49 …”

“…47,48 Finally, the real-life efficacy/safety evidence that has been collected on BoNTA since the date it was first marketed for the treatment of CM is significantly richer, compared with MAbs against CGRP or CGRP receptor. 16,49 To conclude, we have provided real-life data on the excellent…”

OnabotulinumtoxinA in chronic migraine: is the response dose dependent?

“…In a Canadian population based study, 77% of migraineurs reported restriction in their functional ability, 50% had to discontinue the normal activities, 30% had to cancel family or social activities, and 19% reported missing work time during their last migraine attack [ 38 ]. OnabotulinumtoxinA is a cost-effective treatment for chronic migraine and is associated with decreased healthcare utilization [ 39 , 40 ]. Severe headache days have more impact on the function and productivity of patients and hence impose higher financial burden on the patients and employers.…”

Chronic Migraine: A Narrative Review on the Use of Botulinum Toxin with Clinical Indications and Future Directions

“…Moreover, there was a reduction in percentage of 77% and 78% of patients absent from school or work as well as an increased performance at school or work over the 2-year period. Therefore, no patients reported headacherelated disability at visit 8 [96].…”