Persistence, Switching, and Healthcare Use after Initiating Calcitonin Gene-Related Peptide Inhibitors: A Real-world Assessment

Background: Migraine is a prevalent and disabling condition affecting one billion people worldwide. Calcitonin gene-related peptide (CGRP) inhibitors have transformed migraine management. We describe real-world trends in CGRP inhibitor treatment, switching, discontinuation, and migraine-related health care use (including emergency department, ED, and ambulatory care visits). Methods: We used the United States Merative™ MarketScan® Research data to identify adults using CGRP inhibitors between May 2018 and December 2022. We evaluated treatment patterns, including switching between CGRP agents or other prophylactic migraine treatments and therapy discontinuation. Healthcare and migraine-related medication use were compared one year pre- and post-CGRP inhibitor initiation. Results: We studied 148,100 individuals with at least one CGRP inhibitor dispensation. CGRP inhibitor use increased over time, with newer agents being more commonly dispensed in recent years. Within the first year, 10.3% of individuals switched between CGRP inhibitors, and 13.5% discontinued their first CGRP inhibitor. Post-initiation, the proportion of individuals with migraine-related medication use decreased by 4.5% (95% confidence interval, CI: 4.0%-4.9%), and healthcare use declined by 12.8% (95% CI: 12.3%-13.2%). Conclusions: CGRP inhibitors demonstrated increasing use over time, low frequency of switching between CGRP agents (particularly within the first year of initiation) and reduction in other migraine-related medications and physician/ED visits following CGRP initiation. Trial Registration: N/A