Patient Preferences Toward CGRP-Targeting Preventive Migraine Treatments in Japan: Discrete Choice Experiment

To date, no Japanese study on migraine has evaluated how treatment characteristics affect patient preferences between novel gepants and subcutaneous or novel intravenous calcitonin gene-related peptide (CGRP) monoclonal antibodies. A survey using a discrete choice experiment (DCE) was therefore conducted to identify treatment preferences for CGRP-targeting preventive therapies in this population.

Preventive-treatment attributes and levels were identified via a literature review, pivotal clinical trials, and international regulatory documents. These levels included those of CGRP-targeting therapies under development in Japan. A five-patient focus group was conducted to confirm patient understanding of the attribute descriptions and identify other potential attributes. Results from the focus group interview and from clinician input informed a questionnaire, which was revised following a pilot survey (N = 39), then an online main survey was conducted in May-June 2025 with eligible patients. A DCE was used to quantify patient preferences, and a conditional logit model was used to calculate preference weights and 95% confidence intervals.

The questionnaire included six attributes: 50% reduction rate of migraine frequency, speed of effect, effect on impairment of daily activities, frequency of side effects, frequency of injection-site reactions, and administration method. The main survey included 324 patients (79% women; mean age 47 years) who experienced an average of eight migraine days per month. The survey revealed that effect on impairment of daily activities was the most important attribute, followed by administration method, and frequency of injection-site reactions. Regarding attribute levels, oral CGRP-targeting formulations were preferred over injectables within the specific attribute combinations used in this DCE.

These findings suggest that, under the design conditions used in this DCE, participants with migraine in Japan favored non-invasive oral CGRP-targeting treatments that effectively reduce impairment of daily activities.