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Barbanti P, Allais G, Cevoli S, Guerzoni S, Valeriani M, Vernieri F. The Role of the Combination Paracetamol/Caffeine in Treatment of Acute Migraine Pain: A Narrative Review. Pain Ther 2024:10.1007/s40122-024-00581-x. [PMID: 38446344 DOI: 10.1007/s40122-024-00581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Thirty years ago, the first migraine-specific drugs (triptans) appeared. Today two new categories (gepants and ditans) are marketed for acute migraine treatment. That said, is there still a role for conventional therapy? The aim of the present narrative review is to provide an expert overview examining the possible role of the combination paracetamol/caffeine in treatment of acute migraine pain. METHODS To understand possible settings for more appropriate use of paracetamol/caffeine (1000 mg/130 mg) in treatment of acute migraine, a structured literature search was performed using the PubMed database by a panel of experts from major Italian headache centers; articles not referring to migraine pain were excluded from this review; review articles were prioritized. RESULTS Overall response, even to newer specific and selective trigeminal targeted drugs (TTTs), is not over 60%; thus, there is still room for conventional therapies in acute migraine treatment. The panel identified settings in which the use of paracetamol/caffeine combination to treat acute migraine attacks might offer benefit considering the consolidated use through years, despite the lack of studies directly addressing the efficacy of paracetamol/caffeine in the identified populations: subjects > 65 years of age; presence of cardiovascular (CV) comorbidities; TTTs non-responders; pregnancy and breastfeeding; subjects < 18 years of age; paracetamol/caffeine as add-on therapy. CONCLUSIONS Paracetamol is included in the World Health Organization (WHO) essential drug list and has a high level of popularity among patients. Caffeine enhances the analgesic effect of other drugs including paracetamol. In early treatment of acute migraine pain, prescribing physicians might consider using the paracetamol/caffeine combination among other options.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit-IRCCS San Raffaele, via della Pisana 235, 00163, Rome, Italy.
- University San Raffaele, Rome, Italy.
| | - Gianni Allais
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Turin, Italy
| | - Sabina Cevoli
- Sabina Cevoli IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Simona Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, IRCSS Ospedale Pediatrico Bambino Gesù, Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Fabrizio Vernieri
- Headache Unit, Fondazione Policlinico Campus Bio-Medico, Rome, Italy
- Neurology, Università Campus Bio-Medico di Roma, Rome, Italy
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Varnado OJ, Ye W, Mi X, Burge R, Hall J. Annual indirect costs savings in patients with episodic or chronic migraine: a post-hoc analysis of phase 3 galcanezumab clinical trials in the United States. J Med Econ 2023; 26:149-157. [PMID: 36601798 DOI: 10.1080/13696998.2023.2165365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Galcanezumab (GMB) improved quality-of-life and reduced disability of patients with episodic (EM) and chronic migraine (CM) in Phase 3 trials. AIM To estimate indirect cost savings associated with GMB treatment in patients with migraine in the United States (US). METHODS We analyzed data of patients from the US from three randomized, Phase 3, double-blind, placebo (PBO)-controlled GMB studies: EVOLVE-1 and EVOLVE-2 (EM patients), REGAIN (CM patients). Annual indirect costs were calculated using items of the Migraine Disability Assessment (MIDAS) questionnaire: lost time/productivity at work/school, household work, and leisure time. All costs were annualized and expressed in 2019 US dollars. While the main analysis considered lost time/productivity at work/school and household work as a full day, a sensitivity analysis was performed by discounting them by half. For EM, annual indirect costs savings were estimated using mixed model repeated measures analysis. For CM, ANCOVA models were used to estimate annual indirect costs savings as change from baseline. RESULTS The analysis included 805 patients with EM (mean age = 41.4 years; PBO = 534; GMB = 271) and 423 patients with CM (mean age = 38.9 years; PBO = 279; GMB = 144). Compared to PBO, GMB significantly reduced annual indirect costs among patients with EM at 3 months (least square mean [95% confidence interval] work/school = $1,883.6 [603.64-3,163.65], p = .0040, household work = $628.9 [352.95-904.88], p <.0001, and leisure activity = $499.17 [42.36-955.98], p = .0323) and 6 months (work/school = $2,382.29 [1,065.48-3,699.10], p = .0004, household work = $559.45 [268.99-849.90], p = .0002, and leisure activity = $753.81 [334.35-1,173.27], p = .0004), whereas a significant difference was not observed among patients with CM. Sensitivity analysis results were similar to primary analysis results. CONCLUSIONS GMB treatment versus PBO resulted in significantly greater indirect cost savings in patients with EM through improved productivity at work/school, household work, and leisure days. Patients with CM receiving GMB versus PBO attained greater cost savings, although not statistically significant, through reduced lost productivity at work/school.
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Affiliation(s)
| | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Xiaojuan Mi
- TechData Services Company, King of Prussia, PA, USA
| | | | - Jerry Hall
- Eli Lilly and Company, Indianapolis, IN, USA
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Nguyen JL, Munshi K, Peasah SK, Swart ECS, Kohli M, Henderson R, Good CB. Trends in utilization and costs of migraine medications, 2017–2020. J Headache Pain 2022; 23:111. [PMID: 36031609 PMCID: PMC9420279 DOI: 10.1186/s10194-022-01476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective This study examines changes in utilization and costs trends associated with migraine medications. Background Migraine attacks are a burden to many patients. There are many pharmacotherapy options available with newer migraine drug classes entering the market in the past decade. Little is known about the use, associated costs, and the impact of the newer agents. Methods This retrospective, cross-sectional study examined 2017–2020 administrative claims from a large national pharmacy benefits manager. Patients aged ≥ 18 years enrolled in commercial, Medicare, Medicaid, or health insurance exchange insurance plans who filled ≥ 2 prescription claims for triptans, ergotamines, isometheptenes, gepants, ditans, and CGRP mABs were included. A two-sample t-test was conducted to estimate whether differences in mean utilization and costs between 2017 and 2020 were statistically significant for migraine drug classes, except for CGRP mABs, which were estimated between 2018 and 2020. Results The sample ranged from 161,369 (2017) to 240,330 (2020) patients. 84.5% (n = 203,110; 2020) of patients were women. The number of 30-day adjusted prescription fills for prophylaxis remained stable over the four-year period, except for CGRP mABs, which increased from 0.5% (n = 0.007; 2018) to 5.3% (n = 0.075; 2020). Antiepileptics, antidepressants and beta blockers were the most common prophylaxes, while triptans, non-steroidal anti-inflammatory drugs/non-narcotic analgesics and opioids were the most common treatments utilized. CGRP mABs were the most expensive, while utilization of triptans were the highest. CGRP mABs had the largest increase in utilization (177.5%) and costs (166.3%) PPPM in 2020 ($291.17) compared to 2018 ($109.35), the year they were first available (p < 0.001). Between 2018 and 2020, costs increased overall and for commercial and Medicare enrollees, but remained unchanged for Medicaid and HIX members. Conclusion Our study demonstrates a shift in migraine medication utilization from 2017–2020, where increased use of CGRP mABs had a significant contribution to increased costs. These increased pharmacy costs must be weighed against the improved tolerability of these agents likely resulting in other healthcare and indirect cost savings. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01476-y.
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Kim Y, Han S, Suh HS. The impact of migraine and probable migraine on productivity loss in Korea: A cross-sectional online survey. PLoS One 2022; 17:e0277905. [PMID: 36441801 DOI: 10.1371/journal.pone.0277905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
Migraine is an enormous burden on society, but relevant studies are limited. The population of interest of this study was migraine or probable migraine (PM) in Korea. In this population, we aimed to assess the productivity loss through the level of severity defined by monthly migraine days (MMD) and analgesic frequency and to estimate costs and associated factors of productivity loss. We conducted an online survey of adults with migraine symptoms. We defined migraine and PM using the modified International Classification of Headache Disorders, second edition. Severity level was defined by subgroups of MMD (0-3, 4-14, and ≥15 days) and analgesic frequency (0, 1, 2, 3, and ≥4 per week). Productivity loss was assessed using the Work Productivity and Activity Impairment questionnaire and consisted of absenteeism, presenteeism, overall work productivity loss, and activity impairment. The costs of productivity loss due to absenteeism and presenteeism were calculated in 2020 USD. We used negative binomial regression to identify the factors associated with the costs of productivity loss. We identified 362 respondents with migraine or PM. Mean age was 41.7 years, 75.7% were female (N = 274), and 73.2% (N = 265) were employed. On average, productivity losses due to absenteeism and presenteeism were 8.1% and 39.7%, respectively. As MMD increased, there was a trend toward increased activity impairment, presenteeism, and overall work productivity loss. The mean overall productivity loss cost was USD 44.61 per person per day. Duration of migraine attacks was significantly associated with higher absenteeism costs. The results of this study indicate that the higher the MMD, the greater the productivity loss in patients with migraine or PM in Korea. We also found that patients with low-frequency migraine and PM experienced substantial productivity loss. This study provides comprehensive evidence of the burden of migraine in Korea using a representative sample.
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Riccò M, Ferraro P, Camisa V, Di Palma P, Minutolo G, Ranzieri S, Zaffina S, Baldassarre A, Restivo V. Managing of Migraine in the Workplaces: Knowledge, Attitudes and Practices of Italian Occupational Physicians. Medicina (B Aires) 2022; 58:medicina58050686. [PMID: 35630103 PMCID: PMC9144137 DOI: 10.3390/medicina58050686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives: Migraine is a debilitating disorder, whose incidence peak in the age group of 30–39 years overlaps with the peak of employment years, potentially representing a significant issue for occupational physicians (OP). The present study was performed in order to characterize their knowledge, attitudes and practices on migraine in the workplaces. Materials and Methods: A convenience sample of 242 Italian OP (mean age 47.8 ± 8.8 years, males 67.4%) participated in an internet-based survey by completing a structured questionnaire. Results: Adequate general knowledge of migraine was found in the majority of participants. Migraine was identified as a common and severe disorder by the majority of respondents (54.0% and 60.0%). Overall, 61.2% of participants acknowledged migraine as difficult to manage in the workplace, a status that made it more likely for OP understanding its potential frequency (Odds Ratio [OR] 3.672, 95% confidence interval [95%CI] 1.526–8.831), or reported previous managing of complicated cases requiring conditional fitness to work judgement (OR 4.761, 95%CI 1.781–2.726). Moreover, professionals with a qualification in occupational medicine (OR 20.326, 95%CI 2.642–156.358), acknowledging the difficult managing of migraine in the workplaces (OR 2.715, 95%CI 1.034–7.128) and having received any request of medical surveillance for migraine (OR 22.878, 95%CI 4.816–108.683), were more likely to recommend specific requirements for migraineur workers. Conclusions: Migraine was recognized as a common disorder, but also as a challenging clinical problem for OP. Participating OP exhibited a substantial understanding of migraine and its triggers, but residual false beliefs and common misunderstanding may impair the proper management of this disorder, requiring improved and specifically targeted interventions.
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Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, Via Amendola n.2, I-42122 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-339-2994-343
| | - Pietro Ferraro
- Occupational Medicine Unit, Direzione Sanità, Italian Railways’ Infrastructure Division, RFI SpA, I-00161 Rome, Italy;
| | - Vincenzo Camisa
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, I-00146 Rome, Italy; (V.C.); (S.Z.)
| | - Pasquale Di Palma
- Istituto nazionale Assicurazione Infortuni sul Lavoro, INAIL—DM2, Roma Tuscolano, Via Michele de Marco, 20, I-00169 Rome, Italy;
| | - Giuseppa Minutolo
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties “G. D’Alessandro”—Hygiene Section, University of Palermo, I-90127 Palermo, Italy; (G.M.); (V.R.)
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy;
| | - Salvatore Zaffina
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, I-00146 Rome, Italy; (V.C.); (S.Z.)
| | - Antonio Baldassarre
- Occupational Medicine Unit, Careggi University Hospital, I-50134 Florence, Italy;
| | - Vincenzo Restivo
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties “G. D’Alessandro”—Hygiene Section, University of Palermo, I-90127 Palermo, Italy; (G.M.); (V.R.)
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Ambat FDF, Bentivegna E, Martelletti P. Novel Migraine Therapies May Reduce Public and Personal Disadvantages for People with Migraine. BioDrugs 2022; 36:337-339. [PMID: 35575969 PMCID: PMC9109201 DOI: 10.1007/s40259-022-00532-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/03/2022]
Abstract
The introduction of new drug classes for migraine, such as monoclonal antibodies that target the calcitonin gene-related peptide (CGRP) or its receptor and small-molecule antagonists of CGRP, have opened a new scenario in a large population of individuals suffering from migraines. The provision of an effective and safe therapy can help overcome the high social and personal costs together with the burden of this disease by offering social, work and economic recovery to the people affected by migraine. Whether the satisfaction of personal and collective unmet needs will be achieved in the vast majority of migraine sufferers now depends only on the efficiency of the organizational care structures dedicated to this socially impactful disease. This path will offer personal benefits and significant psychosocial relief that will help to reduce the enormous current healthcare expenditure necessary for the management of the huge number of individuals suffering from migraines. The new pharmacological classes for prevention must be applied as an interdiction to the chronic phase to express their full rehabilitation potential.
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Affiliation(s)
| | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy. .,Emergency Medicine Unit, Regional Referral Headache Center, Sant'Andrea University Hospital, Rome, Italy.
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Tobin JA, Joshi S, Ford JH, Nichols RM, Foster SA, Ruff D, Detke HC, Aurora SK. Reductions in acute medication use and healthcare resource utilization in patients with chronic migraine: a secondary analysis of a phase 3, randomized, double-blind, placebo-controlled study of galcanezumab with open-label extension (REGAIN). J Med Econ 2022; 25:1030-1038. [PMID: 35971655 DOI: 10.1080/13696998.2022.2109335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AIMS To analyze secondary objectives of the REGAIN study related to acute headache medication use and healthcare resource utilization (HCRU) in patients with chronic migraine treated with galcanezumab, a monoclonal antibody to calcitonin gene-related peptide. METHODS Adults with chronic migraine (N = 1,113) were randomized (2:1:1) and treated with double-blind monthly injections of placebo, galcanezumab-120 mg, or galcanenzumab-240 mg for 3 months, followed by a 9-month open-label extension with 120 or 240 mg/month galcanezumab. Headache and medication information was collected by daily eDiary. HCRU was reported for the 6 months before randomization, monthly thereafter, and converted to rate per 100-patient-years. RESULTS At baseline, 63-64% of patients met criteria for acute headache medication overuse. At Month 3, incidence of headache medication overuse in the galcanezumab groups (33% and 33%) was significantly lower than in the placebo group (46%, both p < .001) and was 16% and 23% in the previous-galcanezumab groups at Month 12. From a baseline of 14.5 to 15.5, reduction in mean number of monthly migraine headache days with acute headache medication use was also significantly greater in the galcanezumab groups at Month 3 (-4.2 and -4.9) than in placebo (-2.6, both p < .001), with reductions of -6.8 and -7.6 in the previous-galcanezumab groups at Month 12. Migraine-specific HCRU rates decreased for all groups, with no significant between-group differences at Month 3. At Month 12, in the two previous-galcanezumab groups, emergency room visits decreased by 58% and 75%, hospital admissions by 100%, and healthcare professional visits by 54% and 67%. LIMITATIONS Only 3 months of double-blind, placebo-controlled data, a longer HCRU recall period for baseline than postbaseline, and patients receiving care in the clinical trial itself, may limit generalizability. CONCLUSIONS Treatment with galcanezumab resulted in significant reductions in headache medication overuse and migraine headache days requiring acute medication use, with notable reductions in migraine-specific HCRU.
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Affiliation(s)
| | - Shivang Joshi
- University of Buffalo School of Pharmacy, Buffalo, NY, USA
| | | | | | | | - Dustin Ruff
- Eli Lilly and Company, Indianapolis, IN, USA
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Tobin J, Ford JH, Tockhorn-Heidenreich A, Nichols RM, Ye W, Bhandari R, Mi X, Sharma K, Lipton RB. Annual indirect cost savings in patients with episodic or chronic migraine: post-hoc analyses from multiple galcanezumab clinical trials. J Med Econ 2022; 25:630-639. [PMID: 35510376 DOI: 10.1080/13696998.2022.2071528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM This post-hoc analysis estimated annual indirect cost savings with galcanezumab (GMB) treatment in patients with episodic migraine (EM) or chronic migraine (CM). METHODS Data from 4 randomized, Phase 3, double-blind (DB), placebo (PBO)-controlled studies of GMB were analyzed: EVOLVE-1 and EVOLVE-2 (EM, 6-months DB), REGAIN (CM, 3-months DB), and CONQUER (previous failure of 2-4 migraine preventive medication categories, 3-months DB). Indirect costs were calculated at baseline and Month 3 using the first 2 items in Migraine Disability Assessment (MIDAS): (A + B)/60*country specific annual wage (A = days of missed work/school; B = days of reduced productivity at work/school; assuming 60 working days in 3 months). All costs were annualized and expressed in international dollars (Int$) in 2018. ANCOVA models estimated the indirect cost savings as a change from baseline. Secondary analyses determined cost savings by employment and responder status. RESULTS Patients (>80% females) from EVOLVE-1 and -2 (n = 1,201; mean age 41.9 years), REGAIN (n = 759; mean age 41.3 years), and CONQUER (n = 453; mean age ∼46.0 years) were analyzed. GMB showed significant indirect cost savings for EM (Int$6256, p < .0001) and CM (Int$7129, p = .0002), with substantial savings for patients with previous failure of 2-4 migraine preventive medication categories (EM: Int$5664, p = .0030; CM: Int$5181, p = .1300). Compared with PBO, GMB showed significantly greater indirect cost savings for EM (p = .0156) and patients with previous failure of 2-4 migraine preventive medication categories (p = .0340). Employed patients with CM (p = .0018) and with previous failure of 2-4 migraine preventive medication categories (p < .0001) had significant cost savings after GMB treatment. GMB showed significant indirect cost savings in patients with a reduction in migraine headache days. CONCLUSION GMB treatment resulted in annual indirect cost savings in patients with EM, CM, and with previous failure of 2-4 migraine preventive medication categories, with similar observations in the sensitivity analyses.
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Affiliation(s)
- Joshua Tobin
- Neurosciences Clinic, Banner University Medical Center, Phoenix, AZ, USA
| | - Janet H Ford
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | | | - Russell M Nichols
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Wenyu Ye
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Rohit Bhandari
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Xiaojuan Mi
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
- TechData Service Company, King of Prussia, PA, USA
| | - Karan Sharma
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa 1035, Rome 00189, Italy
- Regional Referral Headache Centre, Sant'Andrea University Hospital, Rome, Italy
| | - Martina Curto
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa 1035, Rome 00189, Italy
- International Consortium for Mood Psychotic and Mood Disorders Research, McLean Hospital, Belmont, MA, USA
- Department of Mental Health, Rome, Italy
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