Real-world evidence presented in June at the Canadian Neurological Sciences Federation conference in Montreal, QC revealed several important unmet needs in the management of migraine in Canada.
Limited real-world evidence for migraine in Canada
As the second leading cause of years lived with disability in the world, and the first in people under 50, migraine represents a major burden to healthcare systems.1 Furthermore, migraine poses a significant burden in Canada; however, there is limited evidence available in Canadian populations about the burden of illness of migraine.2
To bridge this gap, a real-world evidence study was initiated to examine the burden of newly diagnosed migraine in Alberta, including epidemiological characteristics, patient and clinical characteristics, treatment patterns, and healthcare resource utilization (HRU).
Why Alberta? The province of Alberta has the largest fully-integrated health system in Canada. The administrative data from Alberta Health and Alberta Health Services covers approximately 4.5 million residents and provides linkable data across all levels of care. A key research advantage for Alberta is the Pharmaceutical Information Network (PIN) database, which includes comprehensive information on all drug dispenses, regardless of whether the payment was covered by a public or private drug plan, or paid directly by the patient. Many other provinces in Canada are only able to access the public drug plan claims data, which can be a limitation for research studies. – Tara Cowling, President and Managing Principal at Medlior Health Outcomes Research
Closing the gap with a retrospective observational study
The study was a retrospective observational study examining a cohort of individuals with ≥1 diagnostic code for migraine or ≥1 prescription(s) dispensed for migraine-specific acute medication captured in the Alberta health system administrative data between April 1, 2012 and March 31, 2018. 3
The study found: 3
- 199,931 incident cases identified during the cohort identification period.
- The mean age of the cohort was 40.0, with the majority (54.3%) of patients under age 40 at index.
- The most common clinical comorbidities were depression (19.7%), cardiovascular disease (18.9%), and anxiety (16.6%).
- The majority of HRU was for reasons other than migraine, which highlights the large burden of illness for patients with migraine.
In terms of pharmacological management of migraine, it was found that: 3
- Fewer than one-in-three of the total tried triptans at least once
- Fewer than one-fifth were prescribed a preventive medication within the follow-up period
High use of opioids
A surprising finding also included high use of opioids: among patients with ≥ 1 dispense for acute medications, the most frequently prescribed class of medications over the study follow-up period was “Other” (i.e., opioids and barbiturates). 3
“While not completely surprising, this demonstrates that we have a long way to go to meet standards of care. This should serve as a timely reminder to the medical community in Canada to improve education of health care professionals in the management of migraine.” Dr. Wasif Hussain, Assistant Clinical Professor; Adult Neurology Residency Program Director, Department of Medicine at the University of Alberta
Overall, the low medication prescription rates of acute and preventive medications and high HRU and opioid use indicates a potential unmet need and high disability in patients with migraine. Additionally, the results of this study highlight the need to further educate Canadian healthcare professionals to recognize and optimize treatment strategies to better manage migraine. 3
This study was performed by Medlior Health Outcomes Research and sponsored by Lundbeck Canada.
