Patient preferences for the preventive treatment of episodic migraine in the United States: A discrete-choice experiment.

Objectives: This study was conducted among participants with episodic migraine, to (i) assess patient preferences for attributes associated with calcitonin gene-related peptide-targeting therapies to prevent migraine and (ii) predict the probability that a real-world patient would prefer an atogepant-like treatment profile over monoclonal antibody-like profiles.

Background: Calcitonin gene-related peptide-targeting therapies have emerged as safe and effective first-line preventive treatments for migraine. Given the expansion of the treatment landscape, it is important to understand what drives treatment choices among patients with migraine. However, few studies have quantified patient preferences for attributes of preventive treatments for migraine.

Methods: A discrete-choice experiment survey was administered to adults (aged 18-80 years and <50 years at age of migraine onset) with episodic migraine who were naïve to calcitonin gene-related peptide-targeting therapies between November and December 2020. Respondents were presented with pairs of hypothetical treatment profiles defined by seven attributes with varying levels. Preference weights were used to estimate the conditional relative importance of each attribute and the probability that an average respondent in the sample would prefer an atogepant-like treatment relative to monoclonal antibody-like treatment profiles. No a priori hypotheses were evaluated related to treatment preference.

Results: Across the attributes and levels included in the study, the relative importance estimates revealed that, on average, the two most important changes in treatment attributes were (i) having a treatment with no nausea instead of a treatment with moderate-to-severe nausea and (ii) having a treatment administered by oral pill or tablet instead of a self-injection once every month or intravenous infusion once every 3 months. For example, respondents valued having a treatment administered by daily oral pill instead of by quarterly intravenous infusion ~2.5 times more than avoiding a treatment with mild nausea. The predicted probability that an average respondent in the sample would prefer an oral, once-daily atogepant-like profile was higher than the predicted probability that an average respondent in the sample would prefer a specific monoclonal antibody-like injectable profile (range, 70.9%-85.4%) or a composite profile representing monoclonal antibodies as a class of drugs (range, 70.7%-73.8%), even when efficacy of the monoclonal antibody-like profile was similar to the atogepant-like profile.

Conclusion: Relative importance estimates suggest that, on average, respondents with episodic migraine preferred an oral pill over monthly or quarterly injections and infusions. Respondents also preferred to avoid treatment-related nausea and constipation. The predicted choice probability results further suggest a preference for a daily oral pill, given that seven of 10 respondents, on average, would prefer a profile similar to atogepant over profiles similar to monoclonal antibodies administered intravenously or by self-injection.