Conflict of Interest: The sponsor and corresponding author directed the research design and reviewed all major research decisions (eg, systematic searching strategy and analyses). The authors had full access to all data and had final responsibility for the decision to submit for publication. A.J.M., M.Y., P.J.G., K.T., and L.M.B. participated in planning the study and writing the manuscript. M.Y. and K.T. collected the data. All authors were involved in interpreting the results, as well as critical review and editing of the manuscript. All authors approved the manuscript before submission. All authors met the International Committee of Medical Journal Editors authorship criteria. Neither honoraria nor payments were made for authorship.
Treatment Persistence and Switching in Triptan Users: A Systematic Literature Review
Article first published online: 10 JUN 2014
© 2014 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 54, Issue 7, pages 1120–1130, July/August 2014
How to Cite
Messali, A. J., Yang, M., Gillard, P., Tsai, K., Tepper, S. J., Bloudek, L. M. and Kori, S. H. (2014), Treatment Persistence and Switching in Triptan Users: A Systematic Literature Review. Headache: The Journal of Head and Face Pain, 54: 1120–1130. doi: 10.1111/head.12404
Financial arrangements of the authors with companies whose products may be related to the present report are listed below, as declared by the authors. A.J.M. is an employee of Allergan, Inc., and a doctoral student at the University of Southern California. M.Y. and P.G. are employees of Allergan, Inc. K.T. is a former employee of OptumRx and former intern at Allergan, Inc. L.M.B. is an employee of Xcenda, L.L.C, and was previously employed by Allergan, Inc. during the development of this manuscript. At the time of manuscript development, S.H.K. was an employee of MAP Pharmaceuticals, a wholly owned subsidiary of Allergan, Inc. S.J.T. reports grant/research support (no personal compensation) from ATI, BristolMyerSquibb, ElectroCore, GSK, Merck, NuPathe, OptiNose, Zogenix; consultancy for Allergan, ATI, Merck, Nautilus, NuPathe, Zogenix; speaker's bureau for Allergan, ATI, Merck, Nautilus, Zogenix; advisory board for Allergan, Amgen, ATI, GSK, Merck, Nautilus, NuPathe, Pfizer, Zogenix; stock options for ATI; and royalties from University of Mississippi Press, Peoples Publishing House of Peking, Springer.
Financial Support: This systematic literature review was sponsored by Allergan, Inc., Irvine, CA, USA. Editorial assistance in formatting the article to journal guidelines was provided to the authors by Anny Wu, PharmD and Kristine Schuler, MS (Complete Healthcare Communications, Chadds Fords, PA, USA) and funded by Allergan Inc.
- Issue published online: 16 JUL 2014
- Article first published online: 10 JUN 2014
- Manuscript Accepted: 26 APR 2014
- Allergan, Inc.
To conduct a systematic review to evaluate persistence to and switching of triptan therapy for the acute treatment of migraine.
Migraine affects over 12% of adults in Western countries and an estimated 36 million people in the United States. Triptans are an abortive treatment option in patients with moderate to severe migraine. Despite the safety and efficacy of triptans reported in clinical trials, observational studies have consistently demonstrated low persistence to therapy and frequent switching among products over time.
The following databases were researched: Medline, CENTRAL, and EMBASE. Detailed inclusion and exclusion criteria were specified a priori before conducting abstract and full-text screening. Included studies were required to: (1) report triptan use for migraine treatment; (2) report measures of persistence and/or switching patterns; (3) study migraineurs aged 18 years or older; and (4) conduct an observational study. Studies were excluded if they (1) incorporated interventional study design; (2) lack information or relevance to outcome of interest; (3) were not original research; (4) did not clearly state the results; and (5) were not written in English. Abstracts and full-text articles were reviewed independently by two investigators.
Out of 595 studies identified, 380 studies were included for abstract screening. A total of 12 articles met the eligibility criteria after full-text screening of 44 studies, including four studies from reference search. The proportion of patients that remained persistent up to six refills of an index triptan ranged from 3.2% to 12.6% and the proportion of patients that never refilled their index triptan ranged from 38% to 65.8%. In addition to those patients who discontinued, several studies reported that 5-9% of newly initiating triptan users switch to a different triptan before refilling their original medication. Finally, several studies reported the 1-year probability of discontinuation among a general group of triptan users (not limited to treatment naïve patients) to be between 30% and 60%.
Triptans can be a valuable option for acute treatment of migraine. However, studies have shown that treatment persistence is low. This, along with frequent switching behaviors, suggests that a significant unmet clinical need remains despite the wide availability of triptans.