Persistence, switching, and healthcare use after initiating calcitonin gene-related peptide inhibitors: a real-world assessment
Bibliographic record
Abstract
BACKGROUND: Migraine is a prevalent and disabling condition affecting one billion people worldwide. calcitonin gene-related peptide (CGRP) inhibitors have transformed migraine management. We describe real-world trends in CGRP inhibitor treatment, switching, discontinuation, and migraine-related health care use (including emergency department, ED, and ambulatory care visits). METHODS: Research data, providing data on inpatient and outpatient healthcare use and drug dispensation from a large sample of individuals with employer-sponsored health insurance in the United States. We identified adults using CGRP inhibitors (comprising both monoclonal antibodies, mAbs, and small-molecule CGRP receptor antagonists, gepants) as preventive treatment for migraine between May 2018 and December 2022. We evaluated treatment patterns, including switching between CGRP agents or other prophylactic migraine treatments, and therapy discontinuation. Healthcare and migraine-related medication use were compared one year pre- and post-CGRP inhibitor initiation. Migraine-related medications included preventive migraine-specific treatments (e.g., onabotulinumtoxinA), non-specific preventives (e.g., antidepressants), and acute treatments-both migraine-specific (e.g., triptans) and non-specific (e.g., opioids). RESULTS: We studied 148,100 adults with at least one CGRP inhibitor dispensation. CGRP inhibitor use increased over time, with newer agents being more commonly dispensed in recent years. Within the first year, 10.3% of individuals switched between CGRP inhibitors, and an additional 13.5% discontinued their first CGRP inhibitor without switching to another. Post-initiation, there was a 4.5% reduction in migraine-related medication use (95% confidence interval, CI: -4.9% to -4.0%, and 12.8% reduction in healthcare use (95% CI: -13.2% to -12.3%). CONCLUSIONS: CGRP inhibitors are increasingly used over time. About 10% switch between CGRP agents within the first year of initiation. There was reduction in other migraine-related medications and healthcare visits following CGRP initiation. TRIAL REGISTRATION: N/A.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".