Abstract and Introduction
Abstract
Objective: To assess preferences among adults with migraine for differentiating attributes of injected or infused preventive treatment options and evaluate their importance in determining a treatment choice.
Background: Adults with migraine and health-care providers consider many factors when making treatment decisions. Injected or infused preventive migraine treatment options differ in several attributes, including mode of administration and dosing frequency, which may be preferentially selected or avoided by patients. Understanding a patient's preference is important for clinicians as they advise on various treatment options.
Methods: A total of 604 US adults diagnosed with migraine participated in an online survey that captured information on demographics, migraine history, and treatment preferences. A discrete choice experiment (DCE) was used to evaluate participants' preferences for specific attributes of injected/infused preventive migraine therapies. The DCE data were utilized to estimate attribute importance (expressed as a percentage) and identify subgroups that had different distributions of preferences.
Results: In the overall migraine population, mode of administration (28.8%), durability of effectiveness (27.0%), and speed of onset (25.5%) had the highest relative importance, whereas administration setting (9.9%) and dosing frequency (8.8%) had the lowest. Four distinct subgroups were identified: Group 1 (n = 128) preferred self-injection administration and durability of effectiveness; Group 2 (n = 189) expressed aversion to cranial injections; Group 3 (n = 158) prioritized rapid speed of onset; and Group 4 (n = 129) favored health-care provider administration and durability of effectiveness.
Conclusions: Speed of onset, durability of effectiveness, and mode of administration are key moderators of treatment preference among US adults with migraine. Certain segments of the migraine population prioritize specific treatment attributes over others, with intravenous infusion not considered a barrier in three of four identified segments. Clinicians can best help their patients find the right medication if they understand which medication attributes are most and least important to them.
Introduction
Given the array of available migraine therapies, patients and clinicians now have an opportunity to select among several options and choose regimens best suited to individual patient needs. There are a wide range of features, or "attributes," to consider when deciding between treatments for migraine, such as efficacy, dosing, and mode of administration. These defining attributes may independently or conjointly sway the preference for an overall product; thus, to understand why some products are accepted or rejected, it is important to know how adults with migraine feel about each attribute.
Among patients seeking preventive migraine treatment, as many as 72% report efficacy as the most important factor in preventive treatment choice compared to other attributes, such as adverse events, dosing frequency, and speed of onset (i.e., time to full effectiveness).[1] While it is taken for granted that a clinician will prescribe an effective therapy for a patient, there are other aspects of the selected regimen (e.g., odds of adverse events, frequency of administration, differences in how quickly a medication becomes therapeutically effective) that must be considered regarding the potential benefits and negative effects to the patient. In other words, there is little point in a clinician prescribing a high-efficacy therapy if it will not be accepted by the patient based on other therapeutic dimensions.
One method for determining how patients value and compare the various attributes of a given therapy is via a discrete choice experiment (DCE). A DCE is a quantitative method that can be used in health care or other settings to determine preferences of respondents without asking them to directly state their preferred options. Prior DCE investigations, in which adults with migraine completed online preference-elicitation thresholding exercises, found that individuals generally want to achieve more migraine-free days (i.e., efficacy) but they are differentially willing to accept other aspects of therapy (e.g., odds of adverse events, cost, side effects like weight gain) to achieve a reduction in monthly migraine days.[2] Additionally, participants preferred the speed with which therapeutic onset begins, with reduction of migraine on day one as important as a clinically relevant reduction in migraine days over the first month of treatment.[3] These studies demonstrate that many factors interact to determine how patients assign value to their migraine therapies. However, few studies have focused specifically on attributes that define non-oral preventive medications.
In this study, we evaluated the attributes that are most important when considering a non-oral preventive migraine medication. Given that preventive therapies vary broadly in their administration, including oral, intramuscular (onabotulinumtoxinA[4]), subcutaneous injections (monoclonal antibodies targeting the calcitonin gene–related peptide [CGRP] pathway; fremanezumab,[5] galcanezumab,[6] and erenumab),[7] and intravenous routes (eptinezumab),[8] we isolated our study to only include injected and infused therapies. In this primary analysis, a DCE was used to examine the relative importance of five distinct attributes that characterize injected or infused therapies: mode of administration, durability of effectiveness, speed of onset, administration setting, and dosing frequency. In addition, latent class analyses (LCA) were used to examine potential heterogeneity of preferences among the migraine population. We hypothesized that several subgroups would be identified, each with a unique combination of patient preferences for different treatment attributes. Together, the results aim to inform on the overall preferences for infused and injected preventive therapies among adults with migraine and highlight subgroups of the overall population that value certain treatment attributes more than others. Clinicians should consider these preferences when recommending migraine treatments.
Headache. 2023;63(4):484-493. © 2023 Blackwell Publishing