Italian Real-World Data Shows Increasing Use of OnabotulinumtoxinA and Anti-CGRP mAbs for Chronic Migraine
Background
Chronic migraine is a debilitating neurovascular disorder often complicated by medication-overuse headache (MOH), imposing significant healthcare and societal costs. Traditional acute therapies frequently fall short, necessitating effective preventive treatments. OnabotulinumtoxinA (BoNT/A) and monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway represent advanced options for patients refractory to conventional approaches. Understanding real-world utilization patterns and therapeutic appropriateness of these innovative therapies is crucial for optimizing patient care and resource allocation in migraine management.
Study Design
This pharmacoepidemiology retrospective study analyzed anonymized data from an Italian regional drug reimbursement and prescription database. Researchers evaluated real-world prescription patterns of onabotulinumtoxinA and anti-CGRP/R mAbs (including eptinezumab) for chronic migraine. The study compared current data from 2023-2024 with previously observed patterns from 2020-2022 to assess trends and the impact of regional organizational measures, particularly before the integration of pharmacists into migraine management protocols. The primary endpoint was the number of prescriptions and observed trends in therapeutic appropriateness.
Results
The study recorded a total of 9,012 prescriptions for innovative preventive migraine therapies in 2023 and 9,705 prescriptions in 2024, demonstrating a clear increasing trend in their utilization. This rise was particularly noted for eptinezumab and onabotulinumtoxinA. The observed increase was associated with regional organizational measures designed to improve patient access to care, enhance adherence to clinical guidelines, and foster integrated management across various healthcare levels. Despite these positive trends in access and utilization, the study concluded that:
Therapeutic appropriateness for chronic migraine management is still far from reaching the gold standard, indicating a significant gap between current practice and optimal clinical outcomes. This suggests that while access to these advanced treatments is improving, their deployment may not always align perfectly with established guidelines, highlighting areas for further optimization in patient selection and treatment protocols.
Key Findings
- Total prescriptions for innovative migraine therapies reached 9,012 in 2023 and 9,705 in 2024.
- A gradual increase in the use of eptinezumab and onabotulinumtoxinA was observed.
- Increased utilization was linked to regional organizational measures improving access and guideline adherence.
- Therapeutic appropriateness for chronic migraine management is still far from the gold standard.
- An increasing role for pharmacists could improve clinical outcomes in migraine management.
Why It Matters
This real-world data highlights a growing acceptance and utilization of advanced chronic migraine therapies like onabotulinumtoxinA and anti-CGRP mAbs in Italy, suggesting improved access for patients. For peptide users and clinicians, the increasing use of eptinezumab specifically indicates its emerging role in the therapeutic landscape. However, the finding that therapeutic appropriateness remains suboptimal underscores a critical need for enhanced education and protocol adherence. Integrating pharmacists into migraine management could significantly improve clinical outcomes by ensuring patients receive the most appropriate treatment based on guidelines, potentially impacting how these peptides are prescribed and monitored in real-world settings. This suggests a shift towards more multidisciplinary care models.
chronic migraine
onabotulinumtoxina
anti-cgrp
eptinezumab
real-world-data
pharmacoepidemiology