Abstract text (incl. figure legends and references)

Objective: Evaluate real-world persistence rates and costs among patients with chronic migraine (CM) treated with onabotulinumtoxinA (onabotA) or calcitonin gene–related peptide monoclonal antibody (CGRP mAb).

Methods: This retrospective, longitudinal, observational study analyzed the IBM MarketScan® Commercial and Medicare Supplemental databases (7/1/17-2/29/20). Adults treated with onabotA or CGRP mAbs (based on overall migraine ICD-10 codes) and having continuous coverage ≥6 months prior and ≥12 months after treatment initiation were included. Persistence to treatment was assessed at 6, 9, and 12 months, and all-cause and migraine-related costs were evaluated during the 12-month follow-up period. Persistence and costs were adjusted for potential confounders (demographics, comorbidities, oral migraine preventive medication [OMPM] use) using generalized linear model regression.

Results: Of 66,303 patients with onabotA or CGRP mAb claims, 2697 CM patients met inclusion/exclusion criteria. In the total population, patients were primarily female (86%) with a mean age of 44 y, which was consistent among the individual CGRP mAbs. Persistence was higher among those receiving onabotA vs the combined CGRP mAbs group at 6 (67% vs 47%; P<.001), 9 (51% vs 37%; P<.001), and 12 (40% vs 27%; P<.001) months. OnabotA and CGRP mAbs were associated with comparable 12-month all-cause ($16,681 vs $16,666) and migraine-related ($8198 vs $8518) costs. Compared to CGRP mAbs, onabotA was associated with lower 12-month acute medication ($763 vs $1240; P<.001), OMPM ($685 vs $993; P<.01), and migraine-related inpatient ($224 vs $728; P<.01) costs. Migraine-related emergency department costs were comparable between both groups ($149 vs $129). Findings were sustained after regression adjustment for confounders.

Conclusions: Patients with CM initiating onabotA had higher persistence and comparable all-cause and migraine-related costs over 12 months compared to those taking CGRP mAbs.