目的:偏头痛是世界范围内最常见的慢性神经系统疾病之一。尽管已经推荐了多种治疗方案,没有足够的证据证明哪种治疗模式适用于常规临床.
方法:我们使用了韩国2015-2021年的全国索赔数据,以确定至少有一种偏头痛处方的偏头痛患者。根据患者的初始治疗类别对患者进行分类,并从治疗开始之日起进行随访。治疗方案包括预防性治疗(抗抑郁药,抗惊厥药,β受体阻滞剂,钙通道阻滞剂,和肾素-血管紧张素-醛固酮系统[RAAS]抑制剂)和急性治疗(对乙酰氨基酚,止吐药,阿司匹林,麦角胺,非甾体抗炎药[NSAIDs],阿片类药物,和曲坦)。对偏头痛的治疗模式进行评估,直至研究期结束。包括长期趋势,患病率,持久性,和偏头痛治疗的变化。
结果:在761,350名接受偏头痛治疗的患者中,最常见的急性治疗是NSAID(69.9%),其次是对乙酰氨基酚(50.0%)。处方最多的预防性治疗是氟桂利嗪(36.9%),其次是普萘洛尔(24.4%)。在患者中,54.8%接受急性治疗,13.5%接受预防性治疗,31.6%接受两种治疗。然而,65.7%的患者在3个月内停止治疗。在急性治疗中,曲坦类药物的3个月存留率最高(25.2%),在预防性治疗中,RAAS抑制剂的3个月存留率最高(62.0%)。
结论:虽然发现药物使用的患病率与当前的偏头痛指南一致,在常规临床环境中观察到药物的频繁转换和快速停药.
OBJECTIVE: Migraine is one of the most common chronic neurological diseases worldwide. Although diverse treatment regimens have been recommended, there is insufficient evidence for which treatment patterns to apply in routine clinical settings.
METHODS: We used nationwide claims data from South Korea for 2015-2021 to identify incident migraine patients with at least one prescription for migraine. Patients were categorized according to their initial treatment classes and followed up from the date of treatment initiation. Treatment regimens included prophylactic treatments (antidepressants, anticonvulsants, beta blockers, calcium-channel blockers, and renin-angiotensin-aldosterone system [RAAS] inhibitors) and acute treatments (acetaminophen, antiemetics, aspirin, ergotamine, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, and triptans). The treatment patterns of migraine were evaluated until the end of the study period, including the secular trends, prevalence, persistence, and changes in migraine treatment.
RESULTS: Among the 761,350 included patients who received migraine treatment, the most frequently prescribed acute treatment was an NSAID (69.9%), followed by acetaminophen (50.0%). The most-prescribed prophylactic treatment was flunarizine (36.9%), followed by propranolol (24.4%). Among the patients, 54.8% received acute treatment, 13.5% received prophylactic treatment, and 31.6% received both treatment types. However, 65.7% of the patients discontinued their treatment within 3 months. The 3-month persistence rate was highest for triptans (25.2%) among the acute treatments and for RAAS inhibitors (62.0%) among the prophylactic treatments.
CONCLUSIONS: While the prevalence rates of medication use were found to align with current migraine guidelines, frequent switching and rapid discontinuation of drugs were observed in routine clinical settings.