Identifying the factors underlying discontinuation of triptans

Rebecca E. Wells, Shira Y. Markowitz, Eric P. Baron, Joseph G. Hentz, Kavita Kalidas, Paul G. Mathew, Rashmi B Halker Singh, David William Dodick, Todd J Schwedt

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective To identify factors associated with triptan discontinuation among migraine patients. Background It is unclear why many migraine patients who are prescribed triptans discontinue this treatment. This study investigated correlates of triptan discontinuation with a focus on potentially modifiable factors to improve compliance. Methods This multicenter cross-sectional survey (n = 276) was performed at US tertiary care headache clinics. Headache fellows who were members of the American Headache Society Headache Fellows Research Consortium recruited episodic and chronic migraine patients who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years). Univariate analyses were first completed to compare current triptan users to past users for: migraine characteristics, other migraine treatments, triptan education, triptan efficacy, triptan side effects, type of prescribing provider, Migraine Disability Assessment (MIDAS) scores and Beck Depression Inventory (BDI) scores. Then, a multivariable logistic regression model was selected from all possible combinations of predictor variables to determine the factors that best correlated with triptan discontinuation. Results Compared with those still using triptans (n = 207), those who had discontinued use (n = 69) had higher rates of medication overuse (30 vs 18%, P =.04) and were more likely to have ever used opioids for migraine treatment (57 vs 38%, P =.006) as well as higher MIDAS (mean 63 vs 37, P =.001) and BDI scores (mean 10.4 vs 7.4, P =.009). Compared with discontinued users, current triptan users were more likely to have had their triptan prescribed by a specialist (neurologist, headache specialist, or pain specialist) (74 vs 54%, P =.002) and were more likely to report headache resolution (53 vs 14%, P <.001) or a reduction in pain intensity (71 vs 28%, P <.001) most of the time from their triptan. On a 1-5 scale (1 = disagree, 5 = agree), triptan users felt they had more: control over their migraine attacks (2.9 vs 2.1), confidence in their prescribing provider (4.5 vs 4.0), and were more educated about triptan use (4.2 vs 3.7) compared with triptan discontinuers (P <.001 for all comparisons). Although both current and prior users reported similar rates of side effects (48 vs 43%, P =.44), of those who discontinued use, the main reasons were for lack of effect (44%) and side effects (29%). Our multivariable modeling revealed that the strongest correlate of triptan discontinuation was lack of efficacy (odds ratio = 17, 95% confidence interval [8.8, 33.0]). Other factors associated with discontinuation included MIDAS > 24 (2.6, [1.5, 4.6]), BDI >4 (2.5, [1.4, 4.5]), and a history of ever using opioids for migraine therapy (2.2, [1.3, 3.8]). Having a triptan prescribed by a specialist and using at least 1 other abortive medication with the triptan were associated with a decreased likelihood of triptan discontinuation (0.41, [0.2-0.7] and 0.44 [0.3, 0.8], respectively). Conclusions As expected, discontinuation was most correlated with lack of efficacy, but other important factors associated with those who had discontinued use included greater migraine-related disability, depression, and the use of opioids for migraine attacks. Compared with patients who had discontinued triptans, current triptan users felt more: educated about their triptan, control over their migraine attacks, and confidence in their prescribing provider. Current triptan users had their triptan prescribed by a specialist and used other abortive medications with their triptan more often compared with patients who had discontinued triptans. Given the cross-sectional nature of this study, we cannot determine if these factors contributed to triptan discontinuation or reflect the impact of such discontinuation. Interventions that address modifiable risk factors for triptan discontinuation may decrease the likelihood of triptan discontinuation and thus improve overall migraine control. Because lack of efficacy was most strongly associated with triptan discontinuation, future research should determine why triptans are effective for some patients but not others.

Original languageEnglish (US)
Pages (from-to)278-289
Number of pages12
JournalHeadache
Volume54
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Tryptamines
Migraine Disorders
Headache
Depression
Opioid Analgesics

Keywords

  • adherence
  • discontinuation
  • migraine
  • treatment
  • triptan

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Wells, R. E., Markowitz, S. Y., Baron, E. P., Hentz, J. G., Kalidas, K., Mathew, P. G., ... Schwedt, T. J. (2014). Identifying the factors underlying discontinuation of triptans. Headache, 54(2), 278-289. https://doi.org/10.1111/head.12198

Identifying the factors underlying discontinuation of triptans. / Wells, Rebecca E.; Markowitz, Shira Y.; Baron, Eric P.; Hentz, Joseph G.; Kalidas, Kavita; Mathew, Paul G.; Halker Singh, Rashmi B; Dodick, David William; Schwedt, Todd J.

In: Headache, Vol. 54, No. 2, 02.2014, p. 278-289.

Research output: Contribution to journalArticle

Wells, RE, Markowitz, SY, Baron, EP, Hentz, JG, Kalidas, K, Mathew, PG, Halker Singh, RB, Dodick, DW & Schwedt, TJ 2014, 'Identifying the factors underlying discontinuation of triptans', Headache, vol. 54, no. 2, pp. 278-289. https://doi.org/10.1111/head.12198
Wells RE, Markowitz SY, Baron EP, Hentz JG, Kalidas K, Mathew PG et al. Identifying the factors underlying discontinuation of triptans. Headache. 2014 Feb;54(2):278-289. https://doi.org/10.1111/head.12198
Wells, Rebecca E. ; Markowitz, Shira Y. ; Baron, Eric P. ; Hentz, Joseph G. ; Kalidas, Kavita ; Mathew, Paul G. ; Halker Singh, Rashmi B ; Dodick, David William ; Schwedt, Todd J. / Identifying the factors underlying discontinuation of triptans. In: Headache. 2014 ; Vol. 54, No. 2. pp. 278-289.
@article{b646ce7735ac4685b11e1024e2aee91e,
title = "Identifying the factors underlying discontinuation of triptans",
abstract = "Objective To identify factors associated with triptan discontinuation among migraine patients. Background It is unclear why many migraine patients who are prescribed triptans discontinue this treatment. This study investigated correlates of triptan discontinuation with a focus on potentially modifiable factors to improve compliance. Methods This multicenter cross-sectional survey (n = 276) was performed at US tertiary care headache clinics. Headache fellows who were members of the American Headache Society Headache Fellows Research Consortium recruited episodic and chronic migraine patients who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years). Univariate analyses were first completed to compare current triptan users to past users for: migraine characteristics, other migraine treatments, triptan education, triptan efficacy, triptan side effects, type of prescribing provider, Migraine Disability Assessment (MIDAS) scores and Beck Depression Inventory (BDI) scores. Then, a multivariable logistic regression model was selected from all possible combinations of predictor variables to determine the factors that best correlated with triptan discontinuation. Results Compared with those still using triptans (n = 207), those who had discontinued use (n = 69) had higher rates of medication overuse (30 vs 18{\%}, P =.04) and were more likely to have ever used opioids for migraine treatment (57 vs 38{\%}, P =.006) as well as higher MIDAS (mean 63 vs 37, P =.001) and BDI scores (mean 10.4 vs 7.4, P =.009). Compared with discontinued users, current triptan users were more likely to have had their triptan prescribed by a specialist (neurologist, headache specialist, or pain specialist) (74 vs 54{\%}, P =.002) and were more likely to report headache resolution (53 vs 14{\%}, P <.001) or a reduction in pain intensity (71 vs 28{\%}, P <.001) most of the time from their triptan. On a 1-5 scale (1 = disagree, 5 = agree), triptan users felt they had more: control over their migraine attacks (2.9 vs 2.1), confidence in their prescribing provider (4.5 vs 4.0), and were more educated about triptan use (4.2 vs 3.7) compared with triptan discontinuers (P <.001 for all comparisons). Although both current and prior users reported similar rates of side effects (48 vs 43{\%}, P =.44), of those who discontinued use, the main reasons were for lack of effect (44{\%}) and side effects (29{\%}). Our multivariable modeling revealed that the strongest correlate of triptan discontinuation was lack of efficacy (odds ratio = 17, 95{\%} confidence interval [8.8, 33.0]). Other factors associated with discontinuation included MIDAS > 24 (2.6, [1.5, 4.6]), BDI >4 (2.5, [1.4, 4.5]), and a history of ever using opioids for migraine therapy (2.2, [1.3, 3.8]). Having a triptan prescribed by a specialist and using at least 1 other abortive medication with the triptan were associated with a decreased likelihood of triptan discontinuation (0.41, [0.2-0.7] and 0.44 [0.3, 0.8], respectively). Conclusions As expected, discontinuation was most correlated with lack of efficacy, but other important factors associated with those who had discontinued use included greater migraine-related disability, depression, and the use of opioids for migraine attacks. Compared with patients who had discontinued triptans, current triptan users felt more: educated about their triptan, control over their migraine attacks, and confidence in their prescribing provider. Current triptan users had their triptan prescribed by a specialist and used other abortive medications with their triptan more often compared with patients who had discontinued triptans. Given the cross-sectional nature of this study, we cannot determine if these factors contributed to triptan discontinuation or reflect the impact of such discontinuation. Interventions that address modifiable risk factors for triptan discontinuation may decrease the likelihood of triptan discontinuation and thus improve overall migraine control. Because lack of efficacy was most strongly associated with triptan discontinuation, future research should determine why triptans are effective for some patients but not others.",
keywords = "adherence, discontinuation, migraine, treatment, triptan",
author = "Wells, {Rebecca E.} and Markowitz, {Shira Y.} and Baron, {Eric P.} and Hentz, {Joseph G.} and Kavita Kalidas and Mathew, {Paul G.} and {Halker Singh}, {Rashmi B} and Dodick, {David William} and Schwedt, {Todd J}",
year = "2014",
month = "2",
doi = "10.1111/head.12198",
language = "English (US)",
volume = "54",
pages = "278--289",
journal = "Headache",
issn = "0017-8748",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Identifying the factors underlying discontinuation of triptans

AU - Wells, Rebecca E.

AU - Markowitz, Shira Y.

AU - Baron, Eric P.

AU - Hentz, Joseph G.

AU - Kalidas, Kavita

AU - Mathew, Paul G.

AU - Halker Singh, Rashmi B

AU - Dodick, David William

AU - Schwedt, Todd J

PY - 2014/2

Y1 - 2014/2

N2 - Objective To identify factors associated with triptan discontinuation among migraine patients. Background It is unclear why many migraine patients who are prescribed triptans discontinue this treatment. This study investigated correlates of triptan discontinuation with a focus on potentially modifiable factors to improve compliance. Methods This multicenter cross-sectional survey (n = 276) was performed at US tertiary care headache clinics. Headache fellows who were members of the American Headache Society Headache Fellows Research Consortium recruited episodic and chronic migraine patients who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years). Univariate analyses were first completed to compare current triptan users to past users for: migraine characteristics, other migraine treatments, triptan education, triptan efficacy, triptan side effects, type of prescribing provider, Migraine Disability Assessment (MIDAS) scores and Beck Depression Inventory (BDI) scores. Then, a multivariable logistic regression model was selected from all possible combinations of predictor variables to determine the factors that best correlated with triptan discontinuation. Results Compared with those still using triptans (n = 207), those who had discontinued use (n = 69) had higher rates of medication overuse (30 vs 18%, P =.04) and were more likely to have ever used opioids for migraine treatment (57 vs 38%, P =.006) as well as higher MIDAS (mean 63 vs 37, P =.001) and BDI scores (mean 10.4 vs 7.4, P =.009). Compared with discontinued users, current triptan users were more likely to have had their triptan prescribed by a specialist (neurologist, headache specialist, or pain specialist) (74 vs 54%, P =.002) and were more likely to report headache resolution (53 vs 14%, P <.001) or a reduction in pain intensity (71 vs 28%, P <.001) most of the time from their triptan. On a 1-5 scale (1 = disagree, 5 = agree), triptan users felt they had more: control over their migraine attacks (2.9 vs 2.1), confidence in their prescribing provider (4.5 vs 4.0), and were more educated about triptan use (4.2 vs 3.7) compared with triptan discontinuers (P <.001 for all comparisons). Although both current and prior users reported similar rates of side effects (48 vs 43%, P =.44), of those who discontinued use, the main reasons were for lack of effect (44%) and side effects (29%). Our multivariable modeling revealed that the strongest correlate of triptan discontinuation was lack of efficacy (odds ratio = 17, 95% confidence interval [8.8, 33.0]). Other factors associated with discontinuation included MIDAS > 24 (2.6, [1.5, 4.6]), BDI >4 (2.5, [1.4, 4.5]), and a history of ever using opioids for migraine therapy (2.2, [1.3, 3.8]). Having a triptan prescribed by a specialist and using at least 1 other abortive medication with the triptan were associated with a decreased likelihood of triptan discontinuation (0.41, [0.2-0.7] and 0.44 [0.3, 0.8], respectively). Conclusions As expected, discontinuation was most correlated with lack of efficacy, but other important factors associated with those who had discontinued use included greater migraine-related disability, depression, and the use of opioids for migraine attacks. Compared with patients who had discontinued triptans, current triptan users felt more: educated about their triptan, control over their migraine attacks, and confidence in their prescribing provider. Current triptan users had their triptan prescribed by a specialist and used other abortive medications with their triptan more often compared with patients who had discontinued triptans. Given the cross-sectional nature of this study, we cannot determine if these factors contributed to triptan discontinuation or reflect the impact of such discontinuation. Interventions that address modifiable risk factors for triptan discontinuation may decrease the likelihood of triptan discontinuation and thus improve overall migraine control. Because lack of efficacy was most strongly associated with triptan discontinuation, future research should determine why triptans are effective for some patients but not others.

AB - Objective To identify factors associated with triptan discontinuation among migraine patients. Background It is unclear why many migraine patients who are prescribed triptans discontinue this treatment. This study investigated correlates of triptan discontinuation with a focus on potentially modifiable factors to improve compliance. Methods This multicenter cross-sectional survey (n = 276) was performed at US tertiary care headache clinics. Headache fellows who were members of the American Headache Society Headache Fellows Research Consortium recruited episodic and chronic migraine patients who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years). Univariate analyses were first completed to compare current triptan users to past users for: migraine characteristics, other migraine treatments, triptan education, triptan efficacy, triptan side effects, type of prescribing provider, Migraine Disability Assessment (MIDAS) scores and Beck Depression Inventory (BDI) scores. Then, a multivariable logistic regression model was selected from all possible combinations of predictor variables to determine the factors that best correlated with triptan discontinuation. Results Compared with those still using triptans (n = 207), those who had discontinued use (n = 69) had higher rates of medication overuse (30 vs 18%, P =.04) and were more likely to have ever used opioids for migraine treatment (57 vs 38%, P =.006) as well as higher MIDAS (mean 63 vs 37, P =.001) and BDI scores (mean 10.4 vs 7.4, P =.009). Compared with discontinued users, current triptan users were more likely to have had their triptan prescribed by a specialist (neurologist, headache specialist, or pain specialist) (74 vs 54%, P =.002) and were more likely to report headache resolution (53 vs 14%, P <.001) or a reduction in pain intensity (71 vs 28%, P <.001) most of the time from their triptan. On a 1-5 scale (1 = disagree, 5 = agree), triptan users felt they had more: control over their migraine attacks (2.9 vs 2.1), confidence in their prescribing provider (4.5 vs 4.0), and were more educated about triptan use (4.2 vs 3.7) compared with triptan discontinuers (P <.001 for all comparisons). Although both current and prior users reported similar rates of side effects (48 vs 43%, P =.44), of those who discontinued use, the main reasons were for lack of effect (44%) and side effects (29%). Our multivariable modeling revealed that the strongest correlate of triptan discontinuation was lack of efficacy (odds ratio = 17, 95% confidence interval [8.8, 33.0]). Other factors associated with discontinuation included MIDAS > 24 (2.6, [1.5, 4.6]), BDI >4 (2.5, [1.4, 4.5]), and a history of ever using opioids for migraine therapy (2.2, [1.3, 3.8]). Having a triptan prescribed by a specialist and using at least 1 other abortive medication with the triptan were associated with a decreased likelihood of triptan discontinuation (0.41, [0.2-0.7] and 0.44 [0.3, 0.8], respectively). Conclusions As expected, discontinuation was most correlated with lack of efficacy, but other important factors associated with those who had discontinued use included greater migraine-related disability, depression, and the use of opioids for migraine attacks. Compared with patients who had discontinued triptans, current triptan users felt more: educated about their triptan, control over their migraine attacks, and confidence in their prescribing provider. Current triptan users had their triptan prescribed by a specialist and used other abortive medications with their triptan more often compared with patients who had discontinued triptans. Given the cross-sectional nature of this study, we cannot determine if these factors contributed to triptan discontinuation or reflect the impact of such discontinuation. Interventions that address modifiable risk factors for triptan discontinuation may decrease the likelihood of triptan discontinuation and thus improve overall migraine control. Because lack of efficacy was most strongly associated with triptan discontinuation, future research should determine why triptans are effective for some patients but not others.

KW - adherence

KW - discontinuation

KW - migraine

KW - treatment

KW - triptan

UR - http://www.scopus.com/inward/record.url?scp=84893937469&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893937469&partnerID=8YFLogxK

U2 - 10.1111/head.12198

DO - 10.1111/head.12198

M3 - Article

C2 - 24001117

AN - SCOPUS:84893937469

VL - 54

SP - 278

EP - 289

JO - Headache

JF - Headache

SN - 0017-8748

IS - 2

ER -