Clinical and genetic characterization of non-optimal triptan response among migraine patients

Abstract

Aim: This study aimed to identify risk factors associated with non-optimal triptan response among migraine patients, leveraging the unique combination of genetic and longitudinal data available in the FinnGen project. Methods: We analyzed register data from 5351 consistent triptan users within the FinnGen project, focusing on patients who switched triptan medications at least once within a two-year period. We assessed 528 variables, including disease diagnoses, drug purchases and socio-economic status, aiming to evaluate clinical risk factors. Moreover, a genome-wide association study (GWAS) was conducted to explore genetic predispositions to triptan switching behavior in the same cohort of patients. Since no significant single nucleotide polymorphisms (SNPs) were found in the GWAS, a supplementary analysis based on previously reported SNPs associated with migraine susceptibility and triptan response was performed. Results: Our cohort consisted predominantly of women (87%) with an average age of 38 years at the time of their first triptan purchase. In this population of patients who consistently use triptans, 85% of patients did not switch medications, while 9% switched once, 3% switched twice and 3% switched three or more times. Younger patients were more likely to switch medications. Clinical risk factors for switching included fibromyalgia and the use of gastro-oesophageal reflux medications for those who switched twice, and oral cavity disorders, intestinal disorders and gynecological diagnoses for those who switched three or more times. No significant genetic associations were identified. Conclusions: Non-optimal triptan response in migraine patients is associated with several clinical characteristics, including prior medical diagnoses and the use of other medications. No genetic associations were observed in this cohort.