Migraine, estimated to affect 36 million people in the United States, is a disabling disease characterized by unilateral or bilateral headache pain that may be accompanied by aura and the associated symptoms of nausea and/or vomiting, photophobia, and phonophobia. Treatment of the disease is divided into two strategies: acute and prophylactic therapy. The primary goal of acute treatment is to provide both immediate and sustained relief of migraine-associated pain; patients who experience more frequent attacks or who do not respond to acute treatment are candidates for migraine prophylaxis, entailing daily therapy of some duration to reduce migraine frequency and severity. The goal of prophylactic treatment is to pre-emptively decrease the frequency, severity, and duration of future migraine attacks, reducing disability and potentially increasing the responsiveness of migraine attacks to acute treatment. The prophylactic migraine market is largely comprised of generic options, including antiepileptic drugs, antidepressants, and beta blockers; these three classes of agents form the cornerstone of current prophylactic treatment. The prophylactic use of neuromuscular blocking agents has increased following the 2010 FDA approval of Allergan’s Botox (onabotulinumtoxinA) for chronic migraine prevention—the only therapy approved for this population of migraine patients, and among the few branded therapies used to treat the disease. In general, available prophylactic treatments offer suboptimal efficacy and many prophylactic drugs are associated with side effects that reduce compliance with long-term use and result in discontinuation; thus, unmet need in the migraine prophylaxis market is high.
Using national patient-level claims data, the Treatment Algorithms in Migraine Prophylaxis report explores the use of key therapies and drug classes among prophylactically naive and recently treated migraine prophylaxis patient populations. Among prophylactically naive patients, the report provides a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant prophylactic treatment. Among recently treated patients, the report quantifies a drug’s overall drug share, use in combination with other prophylactic therapies, and source of business compared with its competitors, detailing which prophylactic drugs precede others through an analysis of add-versus-switch patterns. Two additional claims database queries explore persistency and compliance by therapy.