Long-term persistence to onabotulinumtoxinA to prevent chronic migraine: results from 11 years of patient data from a tertiary headache center

• Published in: Pain medicine (Malden, Mass.) Vol. 25; no. 8; pp. 487 - 492
• Main Authors: Moskatel, Leon S, Graber-Naidich, Anna, He, Zihuai, Zhang, Niushen
• Format: Journal Article
• Language: English
• Published: England 01.08.2024
• Subjects: Adult; Botulinum Toxins, Type A - therapeutic use; Chronic Disease; Cohort Studies; Female; Humans; Male; Middle Aged; Migraine Disorders - drug therapy; Migraine Disorders - prevention & control; Neuromuscular Agents - therapeutic use; Retrospective Studies; Tertiary Care Centers; real-world evidence; access to care; chronic migraine; onabotulinumtoxinA
• ISSN: 1526-2375; 1526-4637; 1526-4637
• DOI: 10.1093/pm/pnae020

To determine if patients with chronic migraine continue onabotulinumtoxinA (onabotA) long-term. We performed a retrospective cohort analysis using aggregated, de-identified patient data from the Stanford Headache Center. We included patients in California who received at least one prescription for onabotA during the years of 2011-2021. The primary outcome was the number of onabotA treatments each patient received. Secondary outcomes included sex, age, race, ethnicity, body mass index (BMI), distance to the treatment facility, and zip code income quartile. A total of 1551 patients received a mean of 7.60 ± 7.26 treatments and a median of 5 treatments, with 16.2% of patients receiving only one treatment and 10.6% receiving at least 19. Time-to-event survival analysis suggested 26.0% of patients would complete at least 29 treatments if able. Younger age and female sex were associated with statistically significant differences between quartile groups of number of onabotA treatments (P = .007, P = .015). BMI, distance to treatment facility, and zip code income quartile were not statistically significantly different between quartile groups (P > .500 for all). Prescriptions of both triptans and non-onabotA preventive medications showed a statistically significant increase with each higher quartile of number of onabotA treatments (P < .001; P < .001). We show long-term persistence to onabotA is high and that distance to treatment facility and income are not factors in continuation. Our work also demonstrates that as patients continue onabotA over time, there may be an increased need for adjunctive or alternative treatments.