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. 2024 May 1;119(5):965-976.
doi: 10.14309/ajg.0000000000002628. Epub 2023 Dec 13.

Epidemiology, Comorbidities, and Treatment of Cyclic Vomiting Syndrome in the United States

Yaozhu Juliette Chen  1 , Nicole Princic  2 , Isabelle Winer  2 , Camilla Richmond  1 , James Williams  1 , Aravind Thavamani  3 , David J Levinthal  4 , Thangam Venkatesan  5
Affiliations

Epidemiology, Comorbidities, and Treatment of Cyclic Vomiting Syndrome in the United States

Yaozhu Juliette Chen et al. Am J Gastroenterol. .

Abstract

Introduction: Cyclic vomiting syndrome (CVS) imposes a substantial burden, but epidemiological data are scarce. This study aimed to estimate the incidence and prevalence of CVS, comorbid conditions, and treatment patterns, using administrative databases in the United States.

Methods: This cross-sectional study used claims data from Merative MarketScan Commercial/Medicare Supplemental and Medicaid databases in all health care settings. Incidence and prevalence rates for 2019 were calculated and stratified by age, sex, region, and race/ethnicity. Patient characteristics were reported among newly diagnosed patients with CVS (i.e., no documented claims for CVS before 2019). CVS was defined as having 1+ inpatient and/or 2+ outpatient CVS claims that were 7+ days apart.

Results: The estimated prevalence of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals. The incidence of CVS was estimated to be 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. Both prevalence and incidence rates were higher among female individuals (for both Commercial/Medicare and Medicaid). Comorbid conditions were common and included abdominal pain (56%-64%), anxiety (32%-39%), depression (26%-34%), cardiac conditions (39%-42%), and gastroesophageal reflux disease (30%-40%). Despite a diagnosis of CVS, only 32%-35% had prescriptions for prophylactic treatment and 47%-55% for acute treatment within the first 30-day period following diagnosis.

Discussion: This study provides the first population-level estimates of CVS incidence and prevalence in the United States. Comorbid conditions are common, and most patients with CVS do not receive adequate treatment. These findings underscore the need for improving disease awareness and developing better screening strategies and effective treatments.

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Conflict of interest statement

Guarantor of the article: Camilla Richmond, MD.

Specific author contributions: Y.J.C., N.P., and I.W.: contributed to conception, design, and planning of the study, analysis of the data, interpretation of the results, drafting of the manuscript, and approving the final draft submitted. C.R., J.W., A.T., T.V., and D.J.L.: contributed to conception of the study and interpretation of the results, critically reviewed the manuscript for important intellectual content, and approved the final draft submitted.

Financial support: This study was funded by Takeda Development Center Americas.

Potential competing interests: Y.J.C., C.R., and J.W. are current or former employees of Takeda Development Center Americas, Inc., and own stock or stock options. N.P. and I.W. are/were employed by Merative, which received funding from Takeda to conduct this study. D.J.L. is a consultant for Takeda, Alexza, and Aditum Pharmaceuticals. T.V. is a consultant for Takeda. A.T. has nothing to disclose.

Figures

Figure 1.
Figure 1.
Patients with prevalent and incident CVS in 2019 MarketScan commercial, Medicare supplemental, and Medicaid databases. CVS, cyclic vomiting syndrome; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification.
Figure 2.
Figure 2.
Overall incidence and prevalence of CVS in 2019 (per 100,000 person-years). (a) Incidence. (b) Prevalence. *Base case CVS definition: at least 1 inpatient or 2 outpatient claims for CVS at least 7 days apart. **Sensitivity 1 less restrictive: at least 1 inpatient or outpatient claim for CVS. ***Sensitivity 2 more restrictive: at least 1 inpatient or 2 outpatient claims for CVS at least 7 days apart and at least 1 claim for nausea/vomiting in the 6 months preceding diagnosis (including diagnosis date). CVS, cyclic vomiting syndrome.
Figure 3.
Figure 3.
Incidence and prevalence rates of CVS among Commercial/Medicare and Medicaid US populations in 2019 by age groups. (a) Incidence. (b) Prevalence. CVS, cyclic vomiting syndrome.
Figure 4.
Figure 4.
Incidence and prevalence rates of CVS in 2019 stratified by region or race. (a) Region. (b) Race/ethnicity. CVS, cyclic vomiting syndrome.
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