TY - JOUR
T1 - Relevant factors for neurologists to define effectiveness of migraine preventive drugs and take decisions on treatment. My‐LIFE European delphi survey
AU - Pozo‐Rosich, Patricia
AU - Gil‐Gouveia, Raquel
AU - Donnet, Anne
AU - Poole, Anne‐Christine
AU - Gendolla, Astrid
AU - Afridi, Shazia
AU - Rosa, Rainel Sanchez‐De la
AU - Terwindt, Gisela M.
AU - Tassorelli, Cristina
N1 - Funding Information:
SA has received personal fees from Novartis Pharma AG during the conduct of the project. Outside the submitted work, SA has perceived personal fees from Teva as a speaker and personal fees from Eli Lilly for advisory board participation. AD has received personal fees from Novartis Pharma AG during the conduct of the project. Outside the submitted work, AD has received fees from Allergan, Eli Lilly, Grünenthal, MSD, Novartis, Orkyn, Pfizer, Saint‐Jude, Sanofi and Teva. AG has received personal fees from Novartis Pharma AG during the conduct of the project. Outside the submitted work, AG has received fees for advisory boards and lectures from Allergan, Eli Lilly, Grünenthal, Hexal, Novartis, Sanofi and Teva. RG has received personal fees from Novartis Pharma AG during the conduct of the project. Outside the submitted work, RGG has received fees for advisory board's contribution, clinical trials participation or medical education from Allergan, Amgen, Lundbeck, Novartis, Pfizer and Teva. RG has received support for headache research from Sociedade Portuguesa de Cefaleias and Fundação para a Ciência e Tecnologia. AP has received personal fees from Novartis Pharma AG during the conduct of the project. Outside the submitted work she has received fees for advisory board's contribution, clinical trials or medical education from Allergan, Eli Lilly, Lundbeck, Novartis and Teva. PP has received personal fees from Novartis Pharma AG during the conduct of the project. Outside the submitted work, PP‐R has received fees for advisory board's contribution, clinical trials participation or medical education from Allergan, Almirall, Amgen, Biohaven, Chiesi, Eli Lilly, Medscape, Novartis and Teva. PP has received support for headache research from La Caixa Foundation, AGAUR, European Commission (ERANet Neuron), Instituto de Salud Carlos III, Migraine Research Foundation, Novartis and PERIS. RS is an employee and stakeholder of Novartis Pharma AG. CT has received personal fees from Novartis Pharma AG during the conduct of the project. Outside the submitted work, CT has received fees for advisory board's contribution, clinical trials participation or medical education from Allergan, Amgen, Eli Lilly, Teva and Medscape. CT has received independent support from the Italian Ministry of Health, European Commission and Migraine Research Foundation. GT has received personal fees from Novartis Pharma AG during the conduct of the project. Outside the submitted work, GT has received grants or consultancy support from Allergan, Eli Lilly, Novartis, Teva, and independent support from Dutch Research Council, NIH, European Community, Dutch Heart Foundation and Dutch Brain Foundation.
Publisher Copyright:
© 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®
PY - 2021/6/26
Y1 - 2021/6/26
N2 - Background: Clinical guidelines agree that preventive treatment should be considered in patients with uncontrolled migraine despite acute medications or patients with ≥4 migraine days per month. However, the criteria to define the effectiveness of treatment and the factors that inform the decision to (dis)continue it are not clearly defined in clinical practice. Methods: Overall, 148 healthcare practitioners from five European countries completed a two-wave questionnaire. The Steering Committee defined a simulated set of 108 migraine patient profiles based on the combination of five factors (frequency of the attacks, intensity of the attacks, use of acute migraine medications, patient perception and presence/absence of tolerable side effects). These profiles were used in a Delphi survey among European neurologists to identify the criteria that should be used to decide treatment response and continuation using a conjoint analysis approach. Results: Consensus was reached for 82/108 (76%) of profiles regarding treatment response, and for 86/108 (80%) regarding treatment continuation. Multivariable logistic regression analysis showed that a ≥50% reduction in the use of acute migraine medications and positive patient's perception of treatment were the most important factors that lead to the decision of continuing (combined factors, OR = 18.3, 95% CI 13.4–25.05). Conclusions: This survey identifies two relevant outcome measures: one objective (use of acute migraine treatment medications) and one subjective (positive patient perception) that guide the clinician decision to continue preventive treatment in migraine patients. Significance: In clinical practice, criteria to define the effectiveness of migraine preventive treatment and factors that guide treatment stop or continuation are not clearly defined. In this simulated clinical setting study, a reduction in the use of acute migraine medications was the factor associated with preventive treatment effectiveness definition. This study also revealed that factors strongly associated with the decision of treatment continuation in real life are the acute migraine medications use and a positive patient's perception of treatment effectiveness.
AB - Background: Clinical guidelines agree that preventive treatment should be considered in patients with uncontrolled migraine despite acute medications or patients with ≥4 migraine days per month. However, the criteria to define the effectiveness of treatment and the factors that inform the decision to (dis)continue it are not clearly defined in clinical practice. Methods: Overall, 148 healthcare practitioners from five European countries completed a two-wave questionnaire. The Steering Committee defined a simulated set of 108 migraine patient profiles based on the combination of five factors (frequency of the attacks, intensity of the attacks, use of acute migraine medications, patient perception and presence/absence of tolerable side effects). These profiles were used in a Delphi survey among European neurologists to identify the criteria that should be used to decide treatment response and continuation using a conjoint analysis approach. Results: Consensus was reached for 82/108 (76%) of profiles regarding treatment response, and for 86/108 (80%) regarding treatment continuation. Multivariable logistic regression analysis showed that a ≥50% reduction in the use of acute migraine medications and positive patient's perception of treatment were the most important factors that lead to the decision of continuing (combined factors, OR = 18.3, 95% CI 13.4–25.05). Conclusions: This survey identifies two relevant outcome measures: one objective (use of acute migraine treatment medications) and one subjective (positive patient perception) that guide the clinician decision to continue preventive treatment in migraine patients. Significance: In clinical practice, criteria to define the effectiveness of migraine preventive treatment and factors that guide treatment stop or continuation are not clearly defined. In this simulated clinical setting study, a reduction in the use of acute migraine medications was the factor associated with preventive treatment effectiveness definition. This study also revealed that factors strongly associated with the decision of treatment continuation in real life are the acute migraine medications use and a positive patient's perception of treatment effectiveness.
UR - http://www.scopus.com/inward/record.url?scp=85110052904&partnerID=8YFLogxK
U2 - 10.1002/ejp.1831
DO - 10.1002/ejp.1831
M3 - Article
C2 - 34173301
SN - 1090-3801
VL - 25
SP - 2177
EP - 2189
JO - European Journal of Pain
JF - European Journal of Pain
IS - 10
ER -