PND85 Prophylactic migraine medication use in primary care setting in Finland

Wahlman Hanna1 , Purmonen Timo1 , Korolainen Minna A.1 , Forsström Jari2 1 Novartis Finland Oy, Espoo, Finland 2 Multirec Oy, Turku, Finland

Backround Discussion and limitations References

• Migraine is a disabling health condition. While it is the most • This study was based on primary health care prescriptions Linde et al. The cost of headache disorder in Europe: common among working-aged people, it presents significant and thus, excludes those patients who have only visited The Eurolight project. Eur J Neurol. 2012 19(5):703-11. indirect costs on society, especially when the attacks are specialized health care units or private health care providers. frequent (1). The results are descriptive and further studies is needed to evaluate potential differences in the patient subgroups. • It is important to define the current treatment when new Disclosures therapies are entering the market. • While these results provide an overview of prophylactic migraine medication use in primary health care, no • Aim of this study was to assess the use of prophylactic conclusion can be made on potential outcomes related • This research was initiated and funded by treatments and assess the number of prophylactic to these treatments. Novartis Finland Oy. treatment lines in a primary care setting in Finland. • Data extraction and data analysis were performed by

Multirec Oy. Material and methods Conclusions: • Poster presented at: International Society for Pharmacoeconomics and Outcomes Research 21st Annual European Congress 10-14 November, 2018, • We conducted a retrospective register-based study on • Variety of different medications are used for migraine Barcelona, Spain. prescription data from primary healthcare electronic medical prophylaxis in primary care in Finland. records (Pegasos). This register covers an overall primary • First-line prophylactic migraine treatments are regularly health care patient population of 2,1 million, which includes used in primary care, but the second-line or third-line almost 40 % of the Finnish population. treatments are initiated infrequently. • For this study, prophylactic treatments were extracted from the data (1.1.2014- 31.1.2018) and only newly initiated prophylactic treatments were taken into account. Table 1. ATC classes for prophylaxis which were taken into Table 2. Numbers of patients using different prophylactic account in the analysis treatments • To be included in the new user cohort, 24 months period

without any medication on migraine was required. Active ATC Class ATC class 1. line 2.line 3.line incredient • When assessing the treatment lines, a new prescription indicated the start of a new treatment. Minimum 13 months C07 Beta Blocker C07AB07 Bisoprolol 512 14 1 C09CA06 Candesartan 422 45 5 follow-up time was required. C09CA ATR Blockers • Prophylactic medication prescriped for migraine was N06AA09 Amitriptyline 370 59 1 NO6AA Non selective MAO-inhibitors defined according to pre-defined ATC-classes. ATC-classes C07AA05 Propranolol 265 4 2 for prophylaxis, which were taken into account in the analysis NO3AX Other Antiepileptics C07AB02 Metoprolol 255 11 2 were: C07, C09CA, N06AA, N03AX, N06CA, N03AG- and all Others* Others* 101 9 3 other with free text prophylaxis “esto” in finnish or ICD NO6CA Antidepressants in combination with psycholeptics N03AX11 Topiramate 79 16 2 10-code for prophylaxis Z29 (table 1). NO3AG Fatty acid derivates N06AA10 Nortriptyline 41 8 2 And all other with free text “prophylaxis ” in finnish of ICD 10-code for prophylaxis Z29. All prescriptions including word Amitriptyline and N06CA01 34 12 3 “migraine” in the clinical indication field as free text of the psycholeptics prescription were considered. Results N03AG01 Valproic acid 16 4 ATC=Anatomical therapeutical chemical. Total: 2095 182 21 More detailed description of ATC codes can be found at www.whocc.no. *Other prescription medicines with less than 10 users • Altogether 2095 patients starting new prophylactic treatment were identified. Figure 1. Proportions of prophylactic treatments prescribed in 1. and 2. line. • Only a small proportion of patients, who received prophylactic 2. line treatment, initiated second-line treatment (n=182; 8,7 %) 1. line or third-line treatment n=21; 1,0 %) (table 2). 2 % 1 % 1 % 2 % • Regardless the treatment line, the most commonly used 4 % 7 % 8 % prophylactic drugs were bisoprolol (22,9 %), candesartan 5 % (20,5 %), amitriptyline (18,7 %), propranolol (11,8 % ), metoprolol 24 % 4 % (11,7 %), topiramate (4,3 %), nortriptyline (2,2%) and amitriptyline and antipsycholeptics (2,1 %). 9 % 12 % • Bisoprolol (n=512; 24,4 %), Candesartan (n=422; 20,1 %) and 25 % amitriptylin (n=370; 17,7 %) were the most commonly used 5 % prophylactic treatments in first-line. • Altogether the most commonly used drug classes are 13 % 6 % betablockers 48 % (C07), ATR-blockers 21 % (C09CA) 20 % and non-selective MAO-inhibitors 21 % (N06AA). 2 %

18 % 32 %

Bisoprolol Candesartan Amitriptyline Propranolol Metoprolol Others Topiramate Nortriptyline Amitriptyline and psycholeptics Valproic acid