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Report: Oral Triptans Are Most Commonly Prescribed Migraine Treatment

Use of rizatriptan products remains unchanged (October 22)

Based on U.S. patient-level claims data, Decision Resources — a research and advisory firm located in Burlington, Mass. — finds that oral triptans are the most commonly prescribed therapies used by newly diagnosed patients across the first three lines of therapy within 2 years of diagnosis.

These findings are consistent with treatment guidelines, which recommend triptans as appropriate early-line pharmacological options for the acute treatment of migraine.

In particular, oral formulations of sumatriptan (Imitrex, GlaxoSmithKline; generics) have the greatest patient share across all three lines of therapy in newly diagnosed patients — capturing over half of the total first-line patient share in this population. This dominance reflects the product’s position as the standard of care for acute migraine and its long presence on the market, bolstered by its generic availability.

Among newly diagnosed patients, oral and orally dispersable table (ODT) formulations of rizatriptan benzoate (Maxalt, Merck) and elitriptan hydrobromide (Relpax, Pfizer) consistently capture the second- and third-most patient shares, respectively, across all three lines.

The report also finds that, among recently treated patients, Maxalt captured the second-highest patient share behind oral sumatriptan in a quarterly analysis beginning in the first quarter of 2012 until the entrance of generic versions of rizatriptan in the first quarter of 2013, the final quarter analyzed. Following its launch, prescriptions of generic rizatriptan have increased dramatically at the expense of branded Maxalt, although the total use of rizatriptan products has remained flat, the report says.

The findings also reveal that, consistent with the intermittent nature of migraines, several months typically elapse before a patient will progress to another line of acute prescription therapy. Moreover, movement to later lines of acute therapy among the approved antimigraine drugs queried typically involves a switch in treatment — these therapies are rarely prescribed as part of a regimen.

“The filling of concomitant prescriptions for approved acute antimigraine agents occurs infrequently in newly diagnosed patients,” said analyst Bethany A. Kiernan, PhD. “That said, our data show that non-oral formulations of acute therapies are more likely to be used as part of a regimen, presumably reflecting their use for particular types of migraines or as rescue treatments when an oral formulation alone fails to provide adequate symptom relief.”

Source: Decision Resources; October 22, 2013.

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