Utilization patterns, cardiovascular risk, and concomitant serotoninergic medications among triptan users between 2008 and 2018: A gender analysis in one Italian region, Tuscany

Abstract

Objective To describe the pattern of triptan use by gender in Tuscany, Italy, focusing on special user populations in which evidence on triptan safety is still not conclusive. Background Growing evidence supports the role of gender differences in migraine pathophysiology and treatment. However, gender impact on triptan real‐word utilization has been poorly investigated. Methods A retrospective, descriptive, cohort study was performed using the population‐based Administrative Healthcare Database of Tuscany region (Italy). Subjects registered in the database on the January 1 of each year between 2008 and 2018 were identified. New users (NU) of triptans (ATC:N02CC*) were patients with one or more triptan dispensation during the year of interest and none in the past. Age, cardiovascular comorbidities representing an absolute or a possible contraindication to triptan utilization, concomitant serotonergic medications, and pattern of triptan use during 1‐year follow‐up were described by gender. Results A total of 86,109 patients who received one or more triptan dispensing were identified. Of 64,672 NU (men = 17,039; women = 47,633), 10.2% (6823/64,672) were aged >65 years, who were mostly women (n = 4613). Among NU, men and women with absolute cardiovascular contraindications were 4.3% (740/17,039) and 2.1% (1022/47,633), respectively, while those concomitantly taking serotonergic medications were 17.2% (267/1549) and 21.9% (949/4330), respectively (949/4330). Regular users (two or more dispensing with ≥3 months between first and last observed dispensing) accounted for 26.4% of women (12,597/47,633) and 19.11% of men (3250/17,039); frequent users (≥15 dosage units/month during ≥3 consecutive months) were overall 0.1% (94/64,672) and 62.0% (58/94) of them concomitantly received serotonergic medications. Conclusion Considering gender differences in triptan use highlighted here, large scale observational studies are warranted to better define what populations are safe to use triptans and whether it is appropriate to tighten or relax certain recommendations on triptan use. In the meantime, any suspected adverse drug reaction observed in the special user populations highlighted in this study should be promptly reported.

Patterns of anti‐CGRP mAbs use and variation of triptan consumption following treatment initiation: A descriptive drug utilization study in the Tuscany region, Italy

“…Such data have been extensively used for drug utilization research studies. 28,31,32 The results presented in this paper come from preplanned analyses of the study dataset. The latter was not previously used for the execution of any other studies.…”

“…In particular, previous triptan users with ≥15 dosage units dispensed per month for ≥3 consecutive months were identified and labeled frequent users. 31 Patients non-persistent to the initial anti-CGRP mAb were identified and labeled "discontinuers." In particular, discontinuers were defined as patients who, at the end of the duration of an anti-CGRP mAb dispensing did not receive another dispensing of the same anti-CGRP mAb before the end of an a priori defined grace period, as detailed below.…”

Virtual issue: Recent advances in the headache–cerebrovascular disease relationship

“…This virtual issue highlights recent reviews and original research published in Headache on the topic of CV disease and headache. With the exception of a 2020 narrative review of the relationship of migraine and ischemic stroke, 1 the papers were published in 2021, 3–5 2022, 6–11 and early 2023 12–16 . The first section focuses on populations of individuals with migraine (stratified by headache frequency) 3 and with aura or aura‐like events, 4,5,9,12 detailing investigations of clinical characteristics and etiologies that may predispose to stroke.…”

“…With the exception of a 2020 narrative review of the relationship of migraine and ischemic stroke, 1 the papers were published in 2021, [3][4][5] 2022, [6][7][8][9][10][11] and early 2023. [12][13][14][15][16] The first section focuses on populations of individuals with migraine (stratified by headache frequency) 3 and with aura or aura-like events, 4,5,9,12 detailing investigations of clinical characteristics and etiologies that may predispose to stroke. The second section includes papers examining the relationship of headache and CV events, including migraine as an ischemic stroke risk factor 1,6,16 and headache following aneurysmal subarachnoid hemorrhage 10,11 or cervicocerebral dissection.…”

“…The second section includes papers examining the relationship of headache and CV events, including migraine as an ischemic stroke risk factor 1,6,16 and headache following aneurysmal subarachnoid hemorrhage 10,11 or cervicocerebral dissection. 14 Papers in the third section focus on cardiovascular risk in persons on migraine therapeutics, specifically triptans 7,8,13 for acute treatment and erenumab, 15 a fully human monoclonal antibody to the calcitonin gene-related peptide receptor, for migraine prevention.…”