Treatment patterns and characteristics of patients with migraine in Japan: A retrospective analysis of health insurance claims data

Abstract

Objective To describe treatment patterns of migraine patients in the Japan Medical Data Center (JMDC) database. Methods Patients aged ≥18 years with ≥1 inpatient or ≥2 outpatient migraine diagnoses, ≥1 outpatient diagnosis and ≥1 migraine-specific acute treatment (triptan or ergotamine), or ≥2 migraine-specific acute treatments from 1 May 2011 to 30 April 2014 were identified. Patients were required to be enrolled in a health plan for ≥1 year before and after the index date. The first migraine diagnosis or acute treatment defined the index date. Patients were stratified by the migraine treatments observed after the index date (i.e. migraine-specific acute treatment only [AT], prophylactic with or without migraine-specific acute treatment [PT], or no treatment [NT]) and described regarding the first migraine treatment regimen and subsequent treatment patterns during up to 1 year of follow-up. Results A total of 16,443 patients met the eligibility criteria (9873 AT, 3022 PT, and 3548 NT). AT patients had mean (SD) 10.3 (20.5) acute treatment days during 1-year follow-up, and 81.9% received triptans. When assessing the first migraine treatment regimen during follow-up in PT patients, 29.2% received prophylactic treatment only and 51.7% received both acute and prophylactic treatment. Calcium-channel blockers with or without concomitant triptans (34.4%) were the most common first regimen. Approximately 62.2% discontinued initial prophylactic treatment after an average of 61.2 days (SD = 65.3) of persistent treatment. Among discontinuers, 15.2% reinitiated original treatment and 7.0% switched treatment post-discontinuation within a year, while the remaining patients did not receive prophylactic therapy following discontinuation. Conclusions Among Japanese migraine patients, prophylactic use was low and associated with a high rate of discontinuation following a brief treatment period. Many patients reinitiated or switched treatment following discontinuation, while a significant proportion of patients remained discontinued from prophylactic therapy, suggesting a high unmet need.

Social burden of people with the migraine diagnosis in Japan: evidence from a population-based cross-sectional survey

“…Open access medication (non-Rx) (figure 1). However, 56.6% of non-Rx had previously received treatment which indicates a high treatment discontinuation rate which is supported by the previous study by Meyers et al 30 where 62.2% discontinued prophylactic treatment after an average of 61.2 days. Also, 43.4% of non-Rx patients have not previously received prescription medication which reflects an unmet need for treatment.…”

Migraine treatment and healthcare costs: retrospective analysis of the China Health Insurance Research Association (CHIRA) database

“…The treatment patterns for adult migraine patients in this study indicate relatively low levels of headache management in China. Only 26.4% of patients were prescribed acute medication, which contrasts with higher rates (73%) from Japanese insurance claims data [17]; this may reflect cultural differences in prescribing patterns or greater reliance on over-the-counter rather than prescription acute medications in China. In the US, approximately half of patients used prescription acute medication, with or without over-the-counter acute medication [18], and much higher rates were reported among patients consulting specialist neurologists and physicians for their migraine [19].…”

“…Surveys of migraine patients attending hospital neurology departments in mainland China have also found triptan use to be rare [21,22]. In contrast, triptans are among the most commonly prescribed acute medications for migraine in Europe, the US, and Japan [17,19,23,24]. The lower rate of triptan use in China may be explained by barriers to access owing to limited triptan availability in most hospitals and pharmacies.…”

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

“…Further real-world evidence that people with migraine in Japan have unmet treatment needs, albeit with respect to preventive medications, was also seen in a 2019 analysis of the Japan Medical Data Center claims database. This study reported that only 15% of people identified with migraine had received preventive medication as their index migraine treatment regimen and that, among these people, discontinuation of initial preventive treatment was common (67-83%), occurred following only a short period of treatment, and was ongoing, with most (85% of discontinuers) continuing to receive no preventive treatment after discontinuation [26].…”