Initiation of glucagon-like peptide-1 receptor agonists was associated with lower emergency department use, fewer hospitalizations, and reduced escalation to additional preventive therapies compared with topiramate in adults with chronic migraine, according to a real-world cohort study to be presented at the American Academy of Neurology 78th Annual Meeting.
In this active-comparator study using the TriNetX database, investigators evaluated adults with chronic migraine who initiated a glucagon-like peptide-1 receptor agonist (GLP-1 RA) within 12 months of diagnosis and compared them with those initiating topiramate. Chronic migraine was defined as headache on 15 or more days per month for at least 3 months, with at least 8 days featuring migraine symptoms. GLP-1 RAs studied included liraglutide, semaglutide, dulaglutide, exenatide, lixisenatide, and albiglutide.
After 1:1 propensity score matching for demographics, body mass index, comorbidities, and prior preventive use, 10,997 patients were included in each cohort (mean age 48 years; 88% female). Baseline characteristics were balanced.
Over 12 months, 24% of patients initiating GLP-1 RAs visited the emergency department compared with 26% of those initiating topiramate. This corresponded to a risk ratio of 0.90 for emergency department visits and 0.86 for hospitalizations. GLP-1 RA initiation was also associated with lower risk of nerve block procedures (risk ratio 0.87) and triptan prescriptions (risk ratio 0.87).
Patients initiating GLP-1 RAs were less likely to start additional preventive medications, including valproate (risk ratio 0.52), calcitonin gene-related peptide monoclonal antibodies (risk ratio 0.58), tricyclic antidepressants (risk ratio 0.65), and gepants (risk ratio 0.77). There was no statistically significant difference in beta-blocker initiation.
The investigators noted that no randomized controlled trials have assessed preventive efficacy of GLP-1 RAs in migraine and highlighted that this observational study demonstrates association, not causation. Unmeasured factors over follow-up, including weight loss, migraine severity, medication use patterns, and lifestyle changes, may have influenced outcomes.
“Seeing these patterns of lower use of emergency care and lower use of drugs to stop migraines or trying additional drugs to prevent migraines among people taking GLP-1 drugs for other conditions suggests that these therapies may help stabilize the disease burden in ways that we haven’t fully appreciated yet,” said study author Vitoria Acar, MD, of the University of Sao Paulo in Brazil.
Source: American Academy of Neurology Abstract, Press Release
