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Botulinum Toxin Type A and Acute Drug Costs in Migraine with Triptan Overuse

Published online by Cambridge University Press:  02 December 2014

Suzanne N. Christie ,
Rose Giammarco ,
Marek Gawel ,
Gordon Mackie ,
Jonathan Gladstone  and
Werner J. Becker
Suzanne N. Christie
Affiliation:
Department of Neurology, University of Ottawa, Ottawa
Rose Giammarco
Affiliation:
Department of Neurology, McMaster University, Hamilton
Marek Gawel
Affiliation:
Department of Neurology, University of Toronto, Toronto
Gordon Mackie
Affiliation:
Department of Neurology, Richmond Hospital, Richmond, British Columbia
Jonathan Gladstone
Affiliation:
Gladstone Headache Clinic, Toronto, Ontario
Werner J. Becker*
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
*
Division of Neurology, Foothills Hospital, 1403 29th St NW, Calgary, Alberta, T2N 2T9, Canada.
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Abstract

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Background:

Patients with chronic migraine and medication overuse are significant consumers of health care resources.

Objective:

To determine whether botulinum toxin type A prophylaxis reduces the cost of acute migraine medications in patients with chronic migraine and triptan overuse.

Methods:

In this multicenter, open-label study, patients with chronic migraine (≥15 headache days/month) who were triptan overusers (triptan intake ≥10 days/month for ≥3 months) received botulinum toxin type A (95-130 U) at baseline and month three. Headache (HA) frequency and medication use were assessed with patient diaries, and headache-related disability by means of the MIDAS and Headache Impact Test-6 questionnaires.

Results:

Of 53 patients enrolled (mean age ± standard deviation, 46.5 years ± 8.4; 47 [88.7%] females), 48 (90.6%) completed the study at month six. Based on headache diaries, significant (P≤0.0002) decreases from baseline were observed for days per month with headache/migraine, days with any acute headache medication use, days with triptan use, and triptan doses taken per month. A significant (P<0.0001) increase from baseline in headache-free days per month was also observed. Prescription medication costs for acute headache medications decreased significantly, including significant reductions in triptan costs (mean reduction of -C$106.32 ± 122.87/month during botulinum toxin type A prophylaxis; P<0.0001). At baseline, 78% of patients had severe disability (MIDAS score) and 86.8% had severe impact due to headache (HIT-6 scores); at month six, this decreased to 60% and 68%, respectively.

Conclusions:

Botulinum toxin type A prophylactic therapy markedly decreased costs related to acute headache medication use in patients with chronic migraine and triptan overuse.

Résumé:

RÉSUMÉ:Contexte:

Les patients qui souffrent de migraine chronique et qui surutilisent leur médication sont des consommateurs importants de soins de santé.

Objectif:

Le but de l’étude était de déterminer si la prophylaxie par la toxine botulique de type A (BoNTA) diminue le coüt de la médication utilisée pour traiter la migraine aigue chez les patients qui souffrent de migraine chronique et qui surutilisent les triptans.

Méthodes:

Au cours de cette étude ouverte, multi¬centres, les patients atteints de migraine chronique (> 15 jours de céphalée par mois) qui surutilisaient des triptans (prise de triptans > 10 jours par mois pendant > 3 mois) ont recu de la toxine botulique de type A (95-130 U) au début de l’étude et 3 mois plus tard. La frequence des céphalées et l’utilisation de la médication ont été évaluées au moyen de carnets de migraine et l’invalidité due à la céphalée au moyen des tests de migraine MIDAS et HIT-6.

Résultats:

Quarante-huit (90,6%) des 53 patients admis dans l’étude ont complété cette étude de 6 mois (àge moyen 46,5 ± 8,4 ans ; 47 femmes, soit 88,7%). Selon les carnets de migraine remplis par les patients, une diminution significative (p < 0,0002) du nombre de jours par mois où la céphalée/la migraine était présente, où une médication contre la céphalée aigue a été utilisée et où un triptan a été utilisé, ainsi qu’une diminution des doses de triptan ont été observées par rapport au début de l’étude. Une augmentation significative (p < 0,0001) du nombre de jours par mois sans céphalée a également été observée. Les coüts des médicaments sous prescription pour les médicaments contre la céphalée aigue ont diminué significativement, dont une diminution significative des coüts reliés à l’utilisation des triptans (diminution moyenne de -106,32 ± 122,87 $CA/mois pendant la prophylaxie par BoNTA ; p < 0,0001). Au début de l’étude, l’invalidité était sévère chez 78% des patients (score MIDAS) et 86,8% avaient un impact sévère dü à la céphalée (score HIT-6) ; après 6 mois, les pourcentages avaient diminué à 60% et 68% respectivement.

Conclusions:

La prophylaxie par la toxine botulique de type A diminue de facon appréciable les coüts associés à l’utilisation de la médication contre la céphalée aigue chez les patients atteints de migraine chronique qui surutilisent les triptans.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 5 , September 2010 , pp. 588 - 594
Copyright
Copyright © The Canadian Journal of Neurological 2010

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