Study Details Factors Leading to Higher Constipation in Patients on Erenumab

Research looking at patients with migraine who were inpatients went into further detail about who may have a higher incidence of constipation while taking erenumab. The work was presented during the Migraine Trust International Symposium.

In general, it is known that individuals with migraine have comorbidities or use concomitant medications that increase the risk of developing constipation, the researchers said.

These investigators found that when it comes to erenumab, the overall 90-day incidence (0.6%) of constipation among new users of the calcitonin gene-related peptide (CGRP) blocker during an inpatient stay was similar to the rate observed in patients in outside of a facility.

Besides looking at inpatients, the postmarketing study of erenumab also looked at subsets of new users with certain baseline characteristics.

The observational cohort study was conducted using the Optum electronic health record database. Patients with a prescription order for erenumab were identified from May 2018 through March of 2019.

Patients were required to have at least 1 migraine diagnosis or prescription for a triptan/ergot in the prior year, and at least 1 outpatient visit at least 1 year prior to beginning erenumab. Inpatient constipation was defined by an emergency department or inpatient visit as defined by ICD-10 coding.

The study included 9994 new erenumab users; 87% were female. The mean (SD) age was 46.6 (12.7) years. Fifty-five constipation events were identified from the records of inpatients (incidence, 0.6%; 95% CI, 0.4%-0.7%).

By characteristic, incidence was as follows:

• Females, incidence, 0.6%; 95% CI, 0.4%-0.8%
• Males: incidence, 0.3%; 95% CI, 0.1%-0.8%
• Adults aged 18-64: incidence, 0.5%; 95% CI, 0.4%-0.7%
• Adults aged 65 or older: incidence 1.0%; 95% CI, 0.5%-2.0%

Incidence by select baseline characteristics, which included diabetes, irritable bowel syndrome, hemorrhoids, diverticular disease, or autonomic neuropathy, ranged from 1.0% to 11.5%. Individuals with higher body mass index (BMI) also saw higher incidence.

In addition, incidence was higher for patients already using medication therapy to treat constipation at baseline. For prescription therapy, incidence was 2.7% (95% CI, 1.6-4.6); for over-the-counter drugs, incidence was 2.8% (95% CI, 1.8-4.3).

For comorbidities related to migraine, incidence varied from .82% for patients with asthma to 1.02% in patients with depression. The majority of patients suffering from this problem had prior risk factors, the researchers concluded.

Reference

Hoffman V, Gill KS, Szekely CA, et al. Incidence of inpatient constipation among migraine patients treated with erenumab: A retrospective cohort study in a US electronic health record database. Presented at: Migraine Trust International Symposium, October 3-9, 2020. Abstract: MTV20-OR-014.