Real world treatment patterns and unmet needs of migraine preventive treatments in Japan: JMDC claims analysis.

Objective: We evaluated real-world treatment patterns and unmet needs associated with migraine preventive medications in Japan following the introduction of calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs), focusing on persistence, switching, and adherence rates.

Methods: This retrospective cohort study analyzed JMDC (previously Japan Medical Data Center) claims data (index date: April 2021 to January 2024) for treatment-naïve patients who initiated oral migraine preventive medications (OMPMs; n = 12,750) and patients initiating CGRP mAbs (n = 3,280). Persistence was defined as continuous therapy without a 60-day or longer gap. Treatment patterns were evaluated at 3, 6, and 12 months post-initiation.

Results: Most patients were female (74.1% OMPMs, 78.1% CGRP mAbs), over half of childbearing age. For OMPM initiators, persistence rates declined from 49.7% at 3 months to 21.7% at 12 months, with antiepileptics showing highest persistence (27.0%). CGRP mAb initiators demonstrated higher initial persistence (85.6% at 3 months), declining to 36.5% at 12 months. 22.9% of OMPM and 19.7% of CGRP mAb patients switched by 12 months. Among OMPM switchers, only 20% switched to CGRP mAbs. Both cohorts had a high prevalence of comorbidities, including non-migraine headaches (approx. 50%), mental health disorders (26-31%), and sleep disorders (approx. 29%).

Conclusion: Substantial unmet needs exist in migraine preventive treatment in Japan, as demonstrated by low 12-month persistence across all medication classes. Despite higher initial persistence, CGRP mAbs showed similar declining patterns over time, indicating most migraine patients do not remain on their index treatment and suggesting the need for additional options.