Treatment Patterns for Newly Diagnosed Chronic Migraine Patients in a Large US Health Insurer’s Population (P4.127)

Objective: To describe treatment patterns including the use of opioids before and after initial chronic migraine (CM) diagnosis. Background: Prescribing patterns associated with an initial CM diagnosis are not well understood. Design/Methods: This retrospective study analyzed administrative claims data from a large US health insurer for patients with an initial (index) diagnosis of CM (ICD-9/10: 346.7x/G43.7xx) between January 2011, and April 2015, and ≥12 months continuous coverage pre- and post-index. Patients also had ≥1 additional CM diagnosis ≥30 days post-index date. Treatment patterns for acute and preventive migraine medications were assessed using descriptive statistics. Results: The 9,901 patients with CM were 43.3 years old, on average; 85% were female. The percentage of patients treated with preventive medications, either alone (11% to 14%) or with acute medications (52% to 70%), increased from the pre-index to post-index period. The percentage of patients treated only with acute migraine medications (pre-index, 23%; post-index, 11%) or with no migraine medications (14% vs. 5%) decreased from pre-index to post-index period. Of 2,282 patients (23% of sample) who used only acute medication pre-index, 63% added a preventive medication in the post-index period. Triptans (58%) were the most commonly used acute medication and anticonvulsants (53%) were the most commonly used preventive medication in the post-index period. Around 10% of patients used guideline-supported migraine-specific opioids in each period; 57% used any type of opioid in each period. Conclusions: Medication management following an initial CM diagnosis most often consisted of a combination of preventive and acute treatments, with anticonvulsants and triptans as the most commonly used preventive and acute treatments, respectively. More than half of the patients had used opioids before and after their initial CM diagnosis, suggesting that greater migraine awareness and a more targeted therapeutic approach are warranted in this population. Study Supported by: Allergan plc Disclosure: Dr. Shewale has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with 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. Shewale holds stock and/or stock options in Allergan plc. Dr. Halpern has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Optum. Dr. Wade has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with WORC provided consulting to Allergan. Dr. Koep has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Optum. Dr. Viswanathan has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan plc. Dr. Viswanathan holds stock and/or stock options in Yes, Allergan plc, which sponsored research in which Dr. Viswanathan was involved as an investigator. Dr. Viswanathan holds stock and/or stock options in Yes, Allergan plc.