SAN DIEGO, California — A review of prescription patterns reveals calcitonin gene-related peptide (CGRP) and gepant medications for migraine reveals significant gender and racial disparities that may affect access to care and health equity.
“The study serves as an early steppingstone in identifying opportunities for further research and intervention to expand access to migraine therapeutics,” lead investigator Kenneth Tan, MD, a neurology resident at Stanford Health Care, Palo Alto, California, told Medscape Medical News.
The findings were presented on June 15 at the American Headache Society (AHS) 2024 Annual Meeting.
The retrospective observational study used a Stanford database that includes de-identified data for patients attending the Stanford Headache Clinic. It included 1434 adults diagnosed with chronic migraine without aura who had received at least one prescription for either a CGRP from 2018 to 2022 (erenumab, fremanezumab, galanezumab, or eptinezumab) or gepant, a CGRP small molecule inhibitor, from 2020 to 2022 (ubrogepant, rimegepant, or atogepant).
The analysis did not include zavegepant, the first nasal spray for migraine, which was approved in 2023 outside the study period.
From the dataset, researchers extracted sex, age, race, ethnicity, and zip code, which they used as a surrogate for income. They divided zip codes into quartiles with the first quartile representing the lowest average annual earnings (up to $42,212), and the fourth the highest earnings ($77,250-$236,912).
Racial, Gender Differences
For CGRPs investigators found that men consistently received more prescriptions compared to females (P=.035). “This was an unexpected finding” because research shows that men tend to delay seeking treatment for migraine, said Tan.
A potential contributing factor is that CGRPs are contraindicated in pregnancy and women of childbearing age, he added.
The average age of patients who received a CGRP prescription varied over time from 41.5 and 42.5 years although this wasn’t statistically significant.
White patients consistently received significantly more prescriptions than did other racial groups although in about 2021, and there was a spike in Black patients receiving prescriptions. “There are many possible reasons for this spike, and we hope future studies can better understand this increase,” said Tan.
In terms of ethnicity, non-Hispanic, non-Latino patients consistently received more prescriptions compared wth Hispanic or Latino patients (P
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