Abstract Details

Title CGRP Antagonist (Gepant) vs Triptan use Profiles in Individuals with Migraine: A Multicenter Electronic Medical Record Analysis of Patient Characteristics and Emergency Department Services Utilization

Topic Headache

Presentation(s) P6 - Poster Session 6 (5:30 PM-6:30 PM)

Poster/Presentation
Number 2-010

Background To date, no direct head-to-head effectiveness comparison between gepants and triptans is available. Real-world data on the utilization of ED services and injectable medications commonly used for migraine may be surrogate markers for assessing overall effectiveness.

Objective

To characterize emergency department (ED) service utilization between calcitonin gene-related peptide (CGRP) antagonists (gepants) and triptans.

Design/Methods

Using the TriNetX® database, we compared adults (age≥18) with migraine (ICD-10 G43) between December 23, 2019 and October 11, 2022, who were prescribed gepants (rimegepant and ubrogepant) but not triptans (gepant group) against those prescribed triptans but not gepants (triptan group). Propensity score-matched cohorts were used to balance demographics, medical comorbidities, and concurrent CGRP monoclonal antibodies (mAbs). The outcome analyses included ED services and parental migraine treatments.

Results

We identified 15672 (age 46.2±14.6; female 84.84%) in the gepant group and 725645 (age 40.7±14.1, female 83.47%) in the triptan group. Before propensity matching, comparison between the gepant and triptan groups, respectively, revealed significantly lower percentages were black (n=1788, 11.41% vs. n=91414, 12.80%, p<0.0001) and Hispanic/Latino (n=632, 4.03% vs. n=39002, 5.46%, p<0.0001). Medical comorbidity burden was higher in the gepant group for chronic migraine, mood disorders, ischemic heart diseases, hypertension, hyperlipidemia, diabetes mellitus, and BMI≥30. Medication utilization was also higher in the gepant group for opioids, dihydroergotamine, Botox, and CGRP mAbs. After propensity matching, the gepant group had a lower utilization of ED service (risk ratio [RR] 0.546, 95%CI 0.522-0.552, p<0.0001) and parenteral migraine treatments (RR 0.506, 95%CI 0.471-0.542, p<0.0001) than the triptan group.

Conclusions Gepants carry lower prescription rates across black and Hispanic/Latino populations while having higher rates amongst older individuals, those with increased medical comorbidities, and concurrent medications. Gepant use appears to be associated with lower ED service utilization than triptan use. This study is limited by the dependence on medical records data and the aggregate nature of the dataset.

Authors/Disclosures
Victor Wang, MD (Thomas Jefferson University Hospital) PRESENTER	Dr. Wang has nothing to disclose.
Steven Bieser	Mr. Bieser has nothing to disclose.
	No disclosure on file
Michael Li	No disclosure on file
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center)	An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH.