TY - JOUR
T1 - Migraine Patients With Cardiovascular Disease and Contraindications
T2 - An Analysis of Real-World Claims Data
AU - Dodick, David W.
AU - Shewale, Anand S.
AU - Lipton, Richard B.
AU - Baum, Seth J.
AU - Marcus, Steven C.
AU - Silberstein, Stephen D.
AU - Pavlovic, Jelena M.
AU - Bennett, Nathan L.
AU - Young, William B.
AU - Viswanathan, Hema N.
AU - Doshi, Jalpa A.
AU - Weintraub, Howard
N1 - Funding Information:
Writing and editorial assistance was provided to the authors by Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, and was funded by AbbVie.
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was sponsored by Allergan (prior to its acquisition by AbbVie).
Funding Information:
Jelena Pavlovic, MD, PhD , is a consultant and/or advisory panel member, receives honoraria from AbbVie, Alder Biopharmaceuticals, Amgen, Biohaven, and Promius. She is funded by NIH/NIA K23 AG049466-01A1.
Funding Information:
Richard B. Lipton, MD , serves on the editorial boards of Neurology and Cephalalgia and as senior advisor to Headache. He has received research support from the NIH, the Migraine Research Foundation, and the National Headache Foundation. He has reviewed for the NIA and NINDS; serves as consultant, advisory board member, or has received honoraria from or research support from AbbVie, AEON, Amgen, Axsome, Biohaven, Dr. Reddy’s, electroCore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Impel, Merck, Novartis, Satsuma, Teva, Vector, and Vedanta. He receives royalties from Wolff’s Headache, 8th Edition (Oxford University Press, 2009) and Informa. He holds stock options in Biohaven and eNeura Therapeutics.
Publisher Copyright:
© The Author(s) 2020.
PY - 2020
Y1 - 2020
N2 - Introduction: Triptans, the most commonly prescribed acute treatments for migraine attacks are, per FDA labeling, contraindicated in cardiovascular (CV) disease patients and have warnings and precautions for those with CV risk factors. Methods: Headache specialists, cardiologists, and health economics and outcomes researchers convened to identify diagnostic codes for: (1) CV diseases contraindicating triptans based on FDA labeling; (2) conditions comprising “other significant underlying CV disease”; and (3) CV risk factors included as warnings and precautions for triptans. A retrospective, cross-sectional analysis of commercially insured adult US migraine patients in the 2017 Optum® Clinformatics® Data Mart (CDM) and the 2017 IBM® Watson Health MarketScan® Commercial Claims database was used to estimate the proportion of migraine patients with CV contraindications and warnings and precautions to triptans. Results: Of the 56,662 migraine patients analyzed from Optum CDM, 13.5% had ≥1 CV disease as specified in triptan labeling and an additional 8.5% had ≥1 “other CV disease” judged by the panel to constitute a “significant underlying CV disease” (total: 22.0% migraine patients). Of 176 724 migraine patients analyzed from MarketScan, 12.2% had ≥1 CV disease as specified in the labeling and an additional 8.0% had ≥1 “other significant underlying CV disease” (total: 20.2% of migraine patients). An additional 25.4% and 25.1% of migraine patients had ≥2 CV risk factors in Optum CDM and MarketScan. In total, 47.4% and 45.3% of migraine patients in both databases had a CV disease specified as a contraindication, an “other CV disease” endorsed as significant, or ≥2 CV risk factors identified as warnings and precautions to triptans. Conclusions: Analyses of more than 230,000 people with migraine showed that ≥20% of commercially insured US migraine patients have a CV condition that specifically contraindicates triptan treatment, and an additional 25% have ≥2 CV risk factors identified as warnings and precautions to triptans.
AB - Introduction: Triptans, the most commonly prescribed acute treatments for migraine attacks are, per FDA labeling, contraindicated in cardiovascular (CV) disease patients and have warnings and precautions for those with CV risk factors. Methods: Headache specialists, cardiologists, and health economics and outcomes researchers convened to identify diagnostic codes for: (1) CV diseases contraindicating triptans based on FDA labeling; (2) conditions comprising “other significant underlying CV disease”; and (3) CV risk factors included as warnings and precautions for triptans. A retrospective, cross-sectional analysis of commercially insured adult US migraine patients in the 2017 Optum® Clinformatics® Data Mart (CDM) and the 2017 IBM® Watson Health MarketScan® Commercial Claims database was used to estimate the proportion of migraine patients with CV contraindications and warnings and precautions to triptans. Results: Of the 56,662 migraine patients analyzed from Optum CDM, 13.5% had ≥1 CV disease as specified in triptan labeling and an additional 8.5% had ≥1 “other CV disease” judged by the panel to constitute a “significant underlying CV disease” (total: 22.0% migraine patients). Of 176 724 migraine patients analyzed from MarketScan, 12.2% had ≥1 CV disease as specified in the labeling and an additional 8.0% had ≥1 “other significant underlying CV disease” (total: 20.2% of migraine patients). An additional 25.4% and 25.1% of migraine patients had ≥2 CV risk factors in Optum CDM and MarketScan. In total, 47.4% and 45.3% of migraine patients in both databases had a CV disease specified as a contraindication, an “other CV disease” endorsed as significant, or ≥2 CV risk factors identified as warnings and precautions to triptans. Conclusions: Analyses of more than 230,000 people with migraine showed that ≥20% of commercially insured US migraine patients have a CV condition that specifically contraindicates triptan treatment, and an additional 25% have ≥2 CV risk factors identified as warnings and precautions to triptans.
KW - acute treatment
KW - cardiovascular disease
KW - migraine
KW - risk factors
KW - triptan
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U2 - 10.1177/2150132720963680
DO - 10.1177/2150132720963680
M3 - Article
C2 - 33095099
AN - SCOPUS:85093948262
SN - 2150-1319
VL - 11
JO - Journal of primary care & community health
JF - Journal of primary care & community health
ER -
