Abstract
INTRODUCTION: Self-injectable calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) and oral CGRP antagonists are currently available for migraine prevention. This study elicited the preferences of participants with migraine for self-injectable CGRP mAb autoinjectors and non-CGRP oral medication and determined the relative importance of autoinjector attributes. METHODS: Adults from the USA, the UK, and Germany with episodic or chronic migraine who had taken migraine preventive treatments within the past 5 years completed a discrete choice experiment (DCE) online. Participants completed 12 experimental choice tasks, choosing their preferred treatment from three options (two hypothetical self-injectable CGRP mAbs autoinjectors, a non-CGRP oral medication), described by seven autoinjector attributes varied by levels. DCE data were analyzed using an error-component logit model to obtain relative attribute importance (RAI) and to estimate predicted choice probabilities (PCP) for autoinjector profiles. RESULTS: In total 1067 participants (51.3% with episodic migraine; 52.6% female; median age 40 years) completed the DCE. Common preventive treatments used were anti-epileptics (47.3%), beta blockers (41.4%), and antidepressants (36.7%). Throughout the DCE, autoinjectors were chosen in 86.3% of cases over non-CGRP oral medication. The most important attribute in participants' treatment choices was injection duration, with a preference for shorter injection duration (RAI 37.0%), followed by auto-retractable needle removal over manual pull-out (RAI 30.8%), longer storage at room temperature (RAI 15.2%), and no pinching over pinching (RAI 12.5%). Participants were less concerned by dose confirmation (RAI 3.4%), injection steps (RAI 0.6%), and dosing schedule (RAI 0.5%). Elicited preferences suggest that an autoinjector profile comparable to galcanezumab (PCP 44.6%) had a higher likelihood (p < 0.001) of being chosen over profiles comparable to erenumab (PCP 28.8%) or fremanezumab three injections quarterly (PCP 26.6%). CONCLUSION: Participants tended to prefer self-injectable CGRP mAb autoinjectors over non-CGRP oral preventive medications for migraine. Preferences among autoinjectors were driven by injection duration, auto-retractability of needle removal, storage requirements, and autoinjector base and pinching requirements.