Relevant factors for neurologists to define effectiveness of migraine preventive drugs and take decisions on treatment. My-LIFE European Delphi survey.
Journal
European journal of pain (London, England)
ISSN: 1532-2149
Titre abrégé: Eur J Pain
Pays: England
ID NLM: 9801774
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
15
03
2021
accepted:
24
06
2021
pubmed:
27
6
2021
medline:
28
10
2021
entrez:
26
6
2021
Statut:
ppublish
Résumé
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. 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. 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). 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 34173301
doi: 10.1002/ejp.1831
pmc: PMC8596543
doi:
Substances chimiques
Pharmaceutical Preparations
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2177-2189Informations de copyright
© 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.
Références
Qual Life Res. 2007 Sep;16(7):1231-7
pubmed: 17468941
Headache. 2000 Mar;40(3):204-15
pubmed: 10759923
Eur J Neurol. 2018 Aug;25(8):1069-e83
pubmed: 29617060
J Med Internet Res. 2004 Sep 29;6(3):e34
pubmed: 15471760
J Headache Pain. 2019 May 21;20(1):57
pubmed: 31113373
Headache. 2018 Nov;58 Suppl 3:218-229
pubmed: 30137671
Eur J Pain. 2021 Nov;25(10):2177-2189
pubmed: 34173301
Cochrane Database Syst Rev. 2019 Apr 02;4:CD010528
pubmed: 30938843
Neurol Ther. 2020 Dec;9(2):535-549
pubmed: 32542532
Lancet Neurol. 2018 Nov;17(11):954-976
pubmed: 30353868
Cephalalgia. 2008 May;28(5):510-23
pubmed: 18384420
Neurology. 2020 Aug 18;95(7):e878-e888
pubmed: 32747522
Headache. 2011 Oct;51(9):1358-73
pubmed: 21883197
Qual Life Res. 2003 Dec;12(8):963-74
pubmed: 14651415
J Headache Pain. 2019 Jan 16;20(1):6
pubmed: 30651064
Headache. 2019 Jan;59(1):1-18
pubmed: 30536394
Cephalalgia. 2018 Jun;38(7):1374-1386
pubmed: 28920448
J Headache Pain. 2018 Feb 1;19(1):10
pubmed: 29392600
PLoS One. 2014 Jun 16;9(6):e98933
pubmed: 24932784
Cochrane Database Syst Rev. 2019 Jan 23;1:CD007076
pubmed: 30673120
Headache. 2019 Jul;59(7):1052-1062
pubmed: 31152441
Lancet. 2019 Nov 9;394(10210):1765-1774
pubmed: 31668411
Neurology. 2015 Feb 17;84(7):688-95
pubmed: 25609757
J Headache Pain. 2020 Jul 11;21(1):88
pubmed: 32652924
J Headache Pain. 2014 Jan 08;15:2
pubmed: 24400971
Cephalalgia. 2018 Apr;38(5):815-832
pubmed: 29504482
Headache. 2008 Sep;48(8):1157-68
pubmed: 18808500
J Headache Pain. 2018 Feb 21;19(1):17
pubmed: 29468450
Neurology. 2001;56(6 Suppl 1):S20-8
pubmed: 11294956
BMC Neurol. 2019 Apr 4;19(1):53
pubmed: 30947702
Headache. 2019 Mar;59(3):306-338
pubmed: 30589090
Health Qual Life Outcomes. 2016 Oct 6;14(1):143
pubmed: 27716228
Headache. 2006 Feb;46(2):240-52
pubmed: 16492233
Cephalalgia. 2020 Sep;40(10):1026-1044
pubmed: 32722936
J Headache Pain. 2017 Oct 4;18(1):101
pubmed: 28980171
Neurology. 2002 Oct 8;59(7):1011-4
pubmed: 12370454