Assessing Erenumab’s Impact on Acute Medication Use, Health Care Resource Utilization

Erenumab is associated with significantly reduced acute medication use and health care resource utilization (HCRU) among migraineurs in a real-world setting, according to findings published in The Journal of Headache and Pain.

Results of the US claims database study indicate erenumab, a fully human monoclonal antibody, significantly reduces the burden of the disease. The treatment was first approved in 2018 and is administered monthly via self-injection of a 70- or 140-mg dose. It works to block the calcitonin gene-related peptide (CGRP) receptor, which is believed to play a crucial role in the pathophysiology of migraine.

An estimated 19% of individuals aged 18 to 54 in the United States suffer from debilitating migraines, placing a substantial economic burden on patients, health systems, and employers.

To evaluate the real-world impact of erenumab among adult migraineurs in the United States, researchers conducted a retrospective analysis using data from Optum’s Clinformatics Data Mart (CMD) database.

De-identified claims data from commercially insured patients and Medicare Advantage members were included in the analysis. All migraineurs were at least 18 years old and had 1 or more prescription filled for erenumab between May 2018 and September 2019. “Patients who received other non-erenumab anti-CGRP biologics during the 12-month pre-index or 6-month post-index period were excluded,” authors noted.

An additional subgroup analysis analyzed a cohort of patients who received onabotulinumtoxinA (onabotA) during the 12 months before index date. A total of 3171 patients were included in the overall study cohort, of which 720 were eligible for the onabotA subgroup analysis.

Approximately 85% of those in the overall cohort were female with a mean (SD) age of 50.7 (13.6) years. The majority (62.5%) also had chronic migraine, while prominent comorbidities during the 12-month pre-index period included anxiety, cardiovascular disease, depression, insomnia, and constipation.

Analyses revealed:

• Compared with the 6 months pre-index period, use of acute medication decreased significantly in the 6-months post-initiation of erenumab. The mean number of claims declined from 3.29 (4.40) to 2.52 (3.78) (rate ratio [RR] 0.77; 95% CI, 0.74–0.80; P < .0001), and the proportion of patients using acute medications reduced from 70.9% to 61.1% (P < .0001)
• 6-month HCRU decreased significantly, with the mean number of migraine-specific office visits decreasing from 2.56 (2.68) to 1.97 (2.24) (RR 0.77; 95% CI, 0.74–0.80; P < .0001), and the proportion of patients with migraine-specific office visits decreasing from 86.2% to 77.6% (P < .0001)
• For the composite outcome, the mean number of events (outpatient visits, hospital admissions, emergency department visits) decreased from 1.03 to 0.77 (RR 0.75; 95% CI, 0.71–0.79; P < .0001)
• A decrease in the proportion of patients with any of the 3 events was also observed (52.7% vs. 39.5%; P < .0001)

In the onabotA subgroup, 6 months after the initiation of erenumab, the use of acute medication significantly decreased, patients had significantly lower odds of receiving different types of acute medication vs baseline, and HCRU decreased significantly.

“The personal, economic, and societal burden of migraine can be eased by improving acute care therapy and earlier treatment commencement of effective preventive therapy,” researchers wrote.

As the data was gleaned from a US database of insured individuals, findings may not be generalizable to the overall or international populations. In addition, a prescription listed in the database does not necessarily guarantee patients took the prescription.

“A significant reduction of 25% on the composite endpoint of the outpatient visits with an acute medication claim and migraine-specific [emergency department] or inpatient visits shows the overall benefit of erenumab in the real-world,” authors concluded.

Reference

Tepper SJ, Fang J, Vo P, et al. Impact of erenumab on acute medication usage and health care resource utilization among migraine patients: a US claims database study. J Headache Pain. Published online April 19, 2021. doi:10.1186/s10194-021-01238-2