Unmet Acute Treatment Needs From the 2017 Migraine in America Symptoms and Treatment Study
Unmet Acute Treatment Needs From the 2017 Migraine in America Symptoms and Treatment Study
复制标题
DOI：
10.1111/head.13588
复制
发表时间：
2019-08-13
期刊：
影响因子：
5
通讯作者：
Dodick, David W.
中科院分区：
文献类型：
--
作者：
Lipton, Richard B.;Munjal, Sagar;Dodick, David W.
目的描述美国偏头痛症状和治疗（MAST）研究参与者使用口服急性偏头痛处方药样本中未满足的治疗需求。MAST研究是一项2017年针对美国成年偏头痛患者的研究，旨在了解当前的治疗模式，并确定和量化未满足的治疗需求。方法横断面数据来自一项对符合ICHD-3 β偏头痛标准的美国成年人进行的在线调查。为了纳入本文，受访者自我报告在过去3个月内每月头痛日（MHD）≥ 3次，在过去30天内至少有1次MHD，目前使用口服急性处方药治疗头痛。确定了三个未满足需求的领域：治疗反应不足（即，2小时疼痛缓解不足，初始缓解后24小时内复发），要求性发作特征（发作迅速，与睡眠相关的头痛）和独特的患者特征（阿片类药物或巴比妥类药物过度使用，心血管合并症）。对每个领域和未满足需求领域的数量评估了社会人口统计学、口服药物使用以及共存疾病和症状（即，治疗优化水平、心理症状、发作相关皮肤异常性疼痛和偏头痛症状严重程度）。结果15,133名受试者符合纳入标准，26.0%（3930/15,133）的受试者报告目前使用口服急性处方药治疗头痛。合格受试者的平均年龄为45.0岁，73.6% [2892/3930]为女性，81.1% [3186/3930]为白色。共有95.8%（3765/3930）的受访者至少有1个未满足的急性治疗需求; 89.5%（3516/3930）报告了要求性发作特征，74.1%（2912/3930）报告了治疗反应不足，16.1%（634/3930）存在独特的患者特征。未满足需求的常见领域为快速头痛发作（65.3% [2567/3930]）、中度至重度残疾（55.6% [2187/3930]）、2小时疼痛缓解不足（49.0% [1892/3930]）和24小时内头痛复发（38.0% [1493/3930]）。越来越多的未满足的治疗需求领域与心理症状恶化、发作相关的皮肤异常性疼痛和偏头痛症状严重程度相关。结论：几乎所有使用急性口服处方药治疗偏头痛的MAST研究受访者报告至少有1个未满足的治疗需求。随着未满足需求的增加，共存条件和症状严重程度也在增加。
Objectives To characterize unmet treatment needs in a sample of Migraine in America Symptoms and Treatment (MAST) Study participants using oral, acute prescription migraine medications. Background The MAST Study is a 2017 study of US adults with migraine that profiles current treatment patterns and identifies and quantifies unmet treatment needs. Methods Cross-sectional data from an online survey of US adults meeting ICHD-3 beta criteria for migraine. For inclusion in this paper, respondents self-reported a history of 3 or more monthly headache days (MHDs) in the past 3 months and at least 1 MHD in the past 30 days, and current use of orally administered acute prescription medication for headache. Three domains of unmet need were identified: inadequate treatment response (ie, inadequate 2-hour pain freedom, recurrence within 24 hours of initial relief), demanding attack characteristics (rapid onset of attack, headache associated with sleep), and unique patient characteristics (opioid or barbiturate overuse, cardiovascular comorbidity). Sociodemographics, oral medication use, and coexisting conditions and symptoms (ie, level of treatment optimization, psychological symptoms, attack-related cutaneous allodynia, and migraine symptom severity) were assessed for each domain and by the number of unmet need domains. Results Overall, 15,133 respondents met inclusion criteria, 26.0% (3930/15,133) reported current use of oral acute prescription medication to treat headache. Eligible participants had a mean age of 45.0 years, 73.6% [2892/3930] were women and 81.1% [3186/3930]) were White. A total of 95.8% (3765/3930) of respondents had at least 1 unmet acute treatment need; 89.5% (3516/3930) reported demanding attack characteristics, 74.1% (2912/3930) reported inadequate treatment response, and 16.1% (634/3930) presented with unique patient characteristics. Common areas of unmet need were rapid headache onset (65.3% [2567/3930]), moderate to severe disability (55.6% [2187/3930]), inadequate 2-hours pain freedom (49.0% [1892/3930]), and headache recurrence within 24 hours (38.0% [1493/3930]). An increasing number of unmet treatment need domains was associated with worsening psychological symptoms, attack-related cutaneous allodynia and migraine symptom severity. Conclusion Nearly all MAST Study respondents using acute oral prescription medications for migraine reported at least 1 unmet treatment need. As unmet needs increased, so did coexisting conditions and symptom severity.