Time-series clustering analysis for treatment pattern of lasmiditan for 2 years from the initial prescription

Background: Migraine is a highly prevalent neurological disorder and a leading cause of disability worldwide. Although triptans and non-steroidal anti-inflammatory drugs are widely used, a substantial proportion of patients show inadequate responses. Lasmiditan, a selective 5-HT1 F receptor agonist introduced in Japan in January 2022, represents a novel acute treatment option that lacks vasoconstrictive activity and can be prescribed even in patients with cardiovascular risk. However, little is known about the trend of its long-term real-world use. Objectives: To characterize 2-year lasmiditan prescription patterns using time-series clustering. Design: A retrospective observational study using nationwide health insurance claims data in Japan. Methods: Data were extracted from the REZULT database for patients aged ⩾15 years diagnosed with migraine (ICD-10 code G43) between January 2022 and December 2024. Prescription claims were analyzed in 90-day intervals for up to 24 months after the initial lasmiditan prescription. Time-series clustering was applied to identify subgroups with distinct trajectories of lasmiditan use. Results: Lasmiditan was prescribed to 21,199 of 167,461 (12.7%) migraine patients (mean age 33.8 ± 10.3 years; 76.6% female). In the first 3 months, 86.2% received 50 mg, 12.8% received 100 mg, and 1.0% received both doses. About half were also prescribed analgesics, 66.7% triptans, and 33.9% prophylactic drugs. Lasmiditan prescriptions were gradually tapered over 2 years, with the most common long-term pattern being combination therapy with analgesics and triptans. Clustering identified three groups: Cluster 1 (massively continuous use), Cluster 2 (gradual tapering), and Cluster 3 (early discontinuation). Conclusion: This nationwide claims-based study provides the first real-world evidence of long-term lasmiditan prescribing patterns. The identification of three distinct trajectories highlights the heterogeneity of clinical practice. It underscores the need for further research on lasmiditan’s optimal use, particularly regarding combination therapy and potential medication overuse.