Evaluating the impact of Erenumab on acute drug use, health care resource utilization

Erenumab is associated with a significant reduction in acute drug use and health care resource use (HCRU) in migraine sufferers in a real setting, according to results published in The Headache and Pain Journal.

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

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

To assess the actual impact of erenumab in adult migraine sufferers in the United States, researchers conducted a retrospective analysis using data from Optum’s Clinformatics Data Mart (CMD) database.

Anonymized claims data from commercially insured patients and Medicare Advantage members were included in the analysis. All migraine sufferers were at least 18 years of age and had one or more full prescriptions for erenumab between May 2018 and September 2019. “Patients who received other non-erenumab anti-CGRP biologic drugs within 12 months pre-index or 6 months post-the reference period was excluded, ”noted the authors.

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

About 85% of people in the overall cohort were women with a mean age (standard deviation) of 50.7 (13.6) years. The majority (62.5%) also suffered from chronic migraine, while significant comorbidities in the 12-month period preceding the index included anxiety, cardiovascular disease, depression, insomnia, and constipation.

The analyzes revealed:

  • Compared to the 6-month pre-index period, the use of acute drugs was significantly reduced over the 6 months after initiation of erenumab. The average number of complaints fell 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 increased from to>P<.0001>
  • HCRU at 6 months decreased significantly, with the mean number of migraine-specific office visits dropping 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 increasing from to>P<.0001>
  • For the composite result, the mean number of events (outpatient visits, hospital admissions, emergency room 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 presenting one of the 3 events was also observed (52.7% versus 39.5%; P<.0001>

In the onabotA subgroup, 6 months after starting erenumab, acute drug use was significantly reduced, patients had significantly lower odds of receiving different types of acute drugs compared to baseline and HCRU has declined significantly.

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

As the data was gleaned from a US policyholder database, the results may not be generalizable to the global or international population. In addition, a prescription listed in the database does not necessarily guarantee that patients have taken the prescription.

“A significant reduction of 25% on the composite endpoint of outpatient consultations with an acute drug claim specific to migraine [emergency department] or hospital visits show the overall benefit of erenumab in the real world, ”the authors concluded.

Reference

Tepper SJ, Fang J, Vo P et al. Impact of erenumab on acute drug use and health care resource utilization in migraine patients: a United States claims database study. J Headache pain. Published online April 19, 2021. doi: 10.1186 / s10194-021-01238-2


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