Opioid Use, Rebound Headache, and Resource Utilization Among Migraine Patients With Insufficient Response to Triptans Based on Real-World Data (S59.007)

Objective: To assess the proportion of triptan insufficient responders and evaluate outcomes associated with triptan insufficient response in migraine patients. Background: Real-world observational studies have demonstrated low persistence with triptans. Data related to outcomes among patients inadequately managed on triptans are limited. Design/Methods: This analysis utilized US data from the Adelphi Disease-Specific Programme™, a multi-country, cross-sectional study using data from electronic medical records (EMR), and patient and physician surveys collected from August to December 2017. Triptan insufficient responders were defined as patients currently prescribed triptans/had received triptans in the past 6 months and failed to achieve pain freedom at 2 hours post dose, or responded to triptans but discontinued due to lack of efficacy or side effects. Outcomes included opioid use, hospital admissions (inpatient/emergency room), and healthcare professional (HCP) visits extracted from EMR, and self-reported rebound headache. Logistic and Poisson regression models were used to compare each outcome between triptan insufficient responders and responders, adjusting for demographics, migraine type, frequency, and severity. Results: Triptan insufficient responders (n=331) had a mean±SD age of 43.3±13.2 years, whereas triptan responders (n=535) were younger (40.9±13.6 years). Triptan insufficient responders were 13 times more likely to receive an opioid (adjusted odds ratio [aOR] [95% CI]:12.8 [2.4–68.4], P=0.003) and 3 times more likely to suffer from rebound headaches (aOR: 3.1 [1.6–6.0], P=0.001) and to be admitted to a hospital in the past year (aOR: 2.5 [0.9–6.9], P=0.081) than triptan responders. Triptan insufficient responders had 37% more visits to an HCP in the past year (adjusted incident rate ratio: 1.4 [1.0–1.8], P=0.021). Conclusions: Triptan insufficient response was associated with increased opioid utilization, more frequent rebound headaches, and greater healthcare resource utilization, including hospital admissions and HCP visits, suggesting a need for improved acute treatment of migraine and a role for novel therapeutic options in this population. Disclosure: Dr. Silberstein has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Alder Biopharmaceuticals, Allergan, Amgen, Avanir, eNeura, ElectroCore Medical, Labrys Biologics, Medscape, Medtronic, Neuralieve, NINDS, Pfizer, and Teva. Dr. Silberstein has received compensation for serving on the Board of Directors of eNeura and Biohaven. Dr. Silberstein has received royalty, license fees, or contractual rights payments from Biohaven. Dr. Silberstein holds stock and/or stock options in Biohaven which sponsored research in which Dr. Silberstein was involved as an investigator. Dr. Silberstein holds stock and/or stock options in Biohaven. Dr. Silberstein has received research support from Allergan, Amgen, Cumberland Pharmaceuticals, ElectroCore Medical, Labrys Biologics, Eli Lilly, Merz, and Troy Healthcare.. Dr. Shewale has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities as a full-time employee of Allergan plc. Dr. Shewale holds stock and/or stock options in Allergan plc which sponsored research in which Dr. Shewale was involved as an investigator. Dr. Baradaran has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan. Dr. Lipton has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with American Academy of Neurology, Alder Biopharmaceuticals, Allergan, American Headache Society, Amgen, Autonomic Technologies, Avanir Pharmaceuticals, Biohaven, Biovision, Boston Scientific, Dr. Reddy’s, Electrocore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, and Vedanta. Dr. Lipton holds stock and/or stock options in Biohaven. Dr. Cotton has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Eli Lilly and Company. Dr. Cotton has received research support from Eli Lilly and Company. Dr. Jackson has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Adelphi Real World. Dr. Viswanathan has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan, Inc. Dr. Viswanathan holds stock and/or stock options in Allergan, Inc., which sponsored research in which Dr. Viswanathan was involved as an investigator. Dr. Viswanathan holds stock and/or stock options in Allergan, Inc.