Do patients differ in their preferences for treatment attributes of the injectable migraine preventives currently on the market in Canada?

Traditional therapies for migraine prevention (eg, antidepressants, beta-blockers, anticonvulsants, neurotoxins) are associated with various limitations, such as adverse events and lack of efficacy, that often lead to treatment discontinuation.¹

Newer-generation monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway are specifically developed to target migraine pathophysiology; such treatments are efficacious and well-tolerated in randomized, placebo-controlled clinical trials.^1,2

However, while anti-CGRP medications may address patients’ concerns regarding efficacy and safety³, it is unknown whether these benefits may be offset by differences in other treatment attributes.

In order to address this question, a non-interventional cross-sectional study of self-reported preferences for preventive migraine treatment was carried out.

Informing healthcare providers on how to best assist patients in selecting a preventive migraine therapy that fits their needs is important to improve treatment persistence and symptom management

 

A Canadian patient preference study in migraine prevention

Eligible patients included Canadian adults (≥18 years) who self-reported a physician diagnosis of migraine, ≥5 monthly migraine days, and use of ≥2 prescription migraine treatments. A discrete choice experiment (DCE) online survey was used to assess treatment preferences by having respondents select, in a series of choice tasks, between two profiles that varied in five attributes:

1. Speed of onset
2. Durability of prevention
3. Mode of administration
4. Administration setting
5. Dosing frequency

Preference weights for each DCE attribute level were estimated using hierarchical Bayesian estimation. A total of 200 Canadian respondents participated in this study.

Not surprisingly, mean preference weights showed that all respondents preferred treatments with the best efficacy/durability profiles and those that could be taken less frequently.

Treatments with the best efficacy/durability profiles were preferred by all respondents, as well as those that could be taken less frequently, which was not surprising. Additionally, respondents exhibited similar preference for an IV infusion administered by an HCP or subcutaneous self-injection.

However, respondents exhibited similar preference for an IV infusion administered by an HCP or subcutaneous self-injection (0.58 and 0.47, respectively). Respondents preferred either of these two modes of administration over cranial injections, which were the least preferred mode of administration (-1.04).

Overall, respondents appeared indifferent to whether they received their treatment in-home (0.20) vs in an HCP setting (-0.20). Indeed, setting and administration frequency were relatively less important vs all other attributes. Nevertheless, respondents did agree that having an HCP administer their medication would be advantageous (e.g., provide increased confidence in treatment administration/efficacy and improved adherence).

Individualized treatment for migraine prevention is crucial given the diverse array of preventive therapies on market and the impact of treatment satisfaction on health outcomes.

The importance of considering patient treatment preferences

In this sample of Canadian adults with migraine, it was shown that mode of administration, durability, and speed of onset are important factors when selecting a migraine therapy, and that certain segments of the population may differ in their treatment priorities. Together, these results highlight the need for healthcare providers to consider patients’ preferences when prescribing a preventive migraine therapy.