Real-World Characteristics and Treatment Patterns of Calcitonin Gene-Related Peptide Monoclonal Antibody Users: a Japanese Claims Database-Based Study.
CGRP monoclonal antibodies are getting real-world traction in migraine research, especially in Japan. A new study out of Keio University and Eli Lilly Japan dug through claims data to see what’s actually happening when researchers and clinicians put these peptides into practice.
Pain Ther
by Takizawa T, Takemura R, Ueda K et al.
“Real-World Characteristics and Treatment Patterns of Calcitonin Gene-Related Peptide Monoclonal Antibody Users: a Japanese Claims Database-Based Study. Takizawa T(1), Takemura R(2), Ueda K(3), Miki Y(4), Hashimoto C(4). Author information: (1)Department of Neurology, Keio University School of Medicine, Tokyo, Japan. (2)Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan. (3)Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., 5-1-28 Isogami-Dori, Chuo-Ku, Kobe, 651-0086, Japan. ueda_kaname@lilly.com. (4)Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., 5-1-28 Isogami-Dori, Chuo-Ku, Kobe, 651-0086, Japan. INTRODUCTION: Understanding real-world calcitonin gene-related peptide monoclonal antibodies' (CGRP mAbs) use in patients with migraine is necessary to potentially guide treatment strategies. METHODS: This retrospective cohort study analyzed administrative claims data from the IQVIA claims data for Japan. It included CGRP mAb-naïve individuals with confirmed migraine diagnosis and ≥ 1 CGRP mAb prescription (January 2021-June 2023). Index date was the first CGRP mAb prescription. Patient characteristics, treatment patterns, adherence (proportion of days covered ≥ 0.80), persistence, and migraine-related direct costs were assessed. Persistence was measured as the proportion of patients continuing treatment for ≥ 3 or ≥ 6 months (≤ 90-day gap between fills). Factors predicting adherence to CGRP mAb treatment were assessed using multivariate logistic regression. Subgroup analyses were conducted for galcanezumab users. RESULTS: Of the 1781 patients included (mean age 41.8 years [standard deviation, SD 10.3]; 79.3% female patients), 55.0% received galcanezumab, followed by fremanezumab (29.7%), and erenumab (15.3%). The prescription rates of concomitant acute and oral preventive medications were 86.1% and 51.3%, respectively, in the first 3 months after initiating CGRP mAb treatment but numerically decreased to 49.8% and 22.5%, respectively, in the fourth to sixth month. The index CGRP mAb persistence rates were 91.9% for ≥ 3 months and 76.9% for ≥ 6 months, and adherence rate was 51.7%. Multiple positive and negative predictors of adherence to CGRP mAbs were observed. Index to 3 months after initiating index CGRP mAbs, the median average monthly migraine-related costs were JPY 75,320 (Q1, Q3 61,593, 89,843) (USD 592), and non-CGRP mAb migraine-related costs were JPY 15,702 (Q1, Q3 8845, 27,848) (USD 123). These costs tended to reduce or plateau for up to 12 months thereafter. The galcanezumab subgroup showed a similar trend. CONCLUSIONS: CGRP mAb adherence and ≥ 6 months persistence rates were 51.7% and 76.9%, respectively, in CGRP mAb-initiating adults with migraine in Japan. During CGRP mAb treatment, acute and oral preventive medication prescription rates appeared to reduce, while direct costs initially increased but appeared to reduce from the post-initiation peak and plateau over time, although the underlying reasons could not be determined from claims data. © 2026. The Author(s). Conflict of interest statement: Declarations. Conflict of Interest: Tsubasa Takizawa is a consultant/adviser and/or serves on an advisory board for Eli Lilly Japan K.K., Daiichi Sankyo Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Amgen K.K., Pfizer Japan Inc., AbbVie GK, and Teijin Pharma Ltd. He received speaker honoraria from Eli Lilly Japan K.K., Eisai Co., Ltd., Daiichi Sankyo Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Amgen K.K., Kyowa Kirin Co., Ltd., Pfizer Japan Inc., and Sawai Pharmaceutical Co., Ltd., a grant from Pfizer Japan Inc., and research funding from Eli Lilly Japan K.K. and Tsumura and Co., outside the submitted work. Kaname Ueda, Yasuhiro Miki, and Chie Hashimoto are employees of Eli Lilly Japan K.K. and may own stock/stock options of Eli Lilly and Company. Ryo Takemura does not have any competing interests. Ethical Approval: The study was conducted per ethical principles originating from the Declaration of Helsinki and that were consistent with Good Pharmacoepidemiology Practices. All applicable Japanese laws and regulations were followed. Since this was a noninterventional, retrospective study that used anonymized patient data, ethical review and informed consent were not required per the Japanese Ethical Guidelines for Medical and Health Research Involving Human Subjects. Data were obtained under license from IQVIA Solutions Japan G.K. (Tokyo, Japan). Copyright IQVIA. All rights reserved.”
The study tracked 1,781 migraine patients starting on CGRP mAbs between 2021 and 2023. Galcanezumab dominated the scene, with over half of users, followed by fremanezumab and erenumab. Most users were women in their early 40s. The researchers didn’t just look at who got what—they tracked adherence, persistence, and migraine-related costs.
Key findings:
76.9% of patients stuck with their CGRP mAb for at least 6 months. That’s a strong persistence rate for any research compound in this space.
About half hit the high-adherence mark (proportion of days covered ≥ 0.80).
Use of other acute and oral preventive meds dropped sharply after starting CGRP monoclonal antibody research.
Migraine-related costs spiked initially with CGRP mAb prescriptions. But within a year, those costs dropped or leveled out.
For researchers, this is a big deal. The drop in other medication use suggests CGRP mAbs could streamline protocols. The cost pattern hints at a front-loaded investment that may pay off over time. And the adherence data? It shows a decent chunk of people are willing and able to stick with these peptides for six months or longer.
Curious about how CGRP peptides fit into the broader peptide research index? This kind of real-world evidence pushes the research conversation forward. Keep an eye on this space—CGRP mAbs aren’t just a trend; they're a serious research tool worth exploring.
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