Predictors of Adherence to Triptans: Factors of Sustained vs Lapsed Users

Authors

  • Roger K. Cady MD,

    1. From Clinvest, Springfield, MO, USA (R.K. Cady, D.L. Reeves); Kaiser Permanente, Woodland Hills, CA, USA (M. Maizels); National Cognitive Recovery Foundation, Murrieta, CA, USA (D.M. Levinson); Merck Research Laboratories, West Point, PA, USA (J.K. Evans).
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  • Morris Maizels MD,

    1. From Clinvest, Springfield, MO, USA (R.K. Cady, D.L. Reeves); Kaiser Permanente, Woodland Hills, CA, USA (M. Maizels); National Cognitive Recovery Foundation, Murrieta, CA, USA (D.M. Levinson); Merck Research Laboratories, West Point, PA, USA (J.K. Evans).
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  • Dennis L. Reeves PhD,

    1. From Clinvest, Springfield, MO, USA (R.K. Cady, D.L. Reeves); Kaiser Permanente, Woodland Hills, CA, USA (M. Maizels); National Cognitive Recovery Foundation, Murrieta, CA, USA (D.M. Levinson); Merck Research Laboratories, West Point, PA, USA (J.K. Evans).
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  • Daniel M. Levinson PhD,

    1. From Clinvest, Springfield, MO, USA (R.K. Cady, D.L. Reeves); Kaiser Permanente, Woodland Hills, CA, USA (M. Maizels); National Cognitive Recovery Foundation, Murrieta, CA, USA (D.M. Levinson); Merck Research Laboratories, West Point, PA, USA (J.K. Evans).
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  • Judith K. Evans MD

    1. From Clinvest, Springfield, MO, USA (R.K. Cady, D.L. Reeves); Kaiser Permanente, Woodland Hills, CA, USA (M. Maizels); National Cognitive Recovery Foundation, Murrieta, CA, USA (D.M. Levinson); Merck Research Laboratories, West Point, PA, USA (J.K. Evans).
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  • Financial support: Merck & Co., Inc. provided financial support to the conduct of the study.

  • Conflict of Interest: J.K. Evans was an employee of Merck & Co., at the time this article was written and may potentially own stock and/or hold stock options in the company. R.K. Cady serves as a consultant for GlaxoSmithKline and Merck and Co., Inc., is on the advisory boards of GlaxoSmithKline and Merck and Co., Inc., and has received research grants from GlaxoSmithKline, Merck and Co., Inc., and Pfizer. M. Maizels has served as a paid lecturer and scientific advisor and has received research support from Merck and Co., Inc. D.L. Reeves and D.M. Levinson have no interests to disclose.

R.K. Cady, Headache Care Center, 3805 S. Kansas Expressway, Springfield, MO 65807, USA.

Abstract

Objective.— The present study was conducted to identify factors that predict adherence to triptans by migraine patients.

Background.— Triptans have demonstrated efficacy for acute migraine yet many migraine sufferers discontinue their use.

Design and Methods.— A survey study was conducted using 785 subjects (390 health maintenance organizations [HMO] and 395 non-HMO). Of those, 586 were sustained users of triptans (defined by at least 1 refill within the past year), and 199 were classified as lapsed users (ie, individuals who had 0 refills in the past year). Groups were compared on a variety of measures including a comprehensive Migraine Survey that included items related to efficacy and adverse events associated with the patient's current medication, as well as the Headache Impact Test (HIT)-6 and Migraine Disability Assessment Score (MIDAS) questionnaires. Data were analyzed with multivariate analysis of variance and stepwise multiple regression.

Results.— Sustained users of triptans were significantly more satisfied with their medication, confident in the medication's ability to control headache, and reported control of migraine with fewer doses of medication. Sustained users also switched triptans products significantly less often than lapsed users, and reported greater benefit from triptan intervention in restoring normal daily functions, including improved cognitive ability, compared with lapsed users' ratings of their nontriptan medication. More lapsed users than sustained users reported adverse events associated with past triptan use. Results from multiple and logistic regression analyses correctly classified 95% of sustained users and identified the most significant predictors for sustained use as: satisfaction and belief in medication, reliability of response, effectiveness in rapidly restoring normal levels of productivity, and fewer doses of medication for resolving an attack. The HIT-6 and MIDAS distinguished between sustained and lapsed triptan users on days unable to do household work and missed family and social events.

Conclusions.— Predictors of adherence to triptans included satisfaction and confidence in triptans' ability to stop the migraine and associated symptoms and to return the individual to normal functioning. The findings suggest that lapsed users may not be receiving optimal treatment, and that if their past response to triptans was a consequence of inadequate education, they may benefit from additional education on proper use of triptans.

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