EXTON, Pa., Sept. 11, 2019 /PRNewswire/ -- Contributing
physicians appear to underestimate their use of the anti-calcitonin
gene-related peptide (CGRP) therapies in patients with episodic
migraine. Neurologists and migraine specialists self-reported that
less than half of their patients currently on Amgen/Novartis'
Aimovig, Teva's Ajovy, or Eli Lilly's Emgality were diagnosed with
episodic migraine at the time of the decision to prescribe the
brand. However, data captured from 1,016 patients currently treated
with an anti-CGRP and/or Allergan's Botox as part of Spherix's
inaugural RealWorld Dynamix™: Migraine Prevention
(US) audit service showed that the majority of
anti-CGRP-treated patients were initiated on their current brand
while diagnosed with episodic, often low frequency (<10 monthly
migraine days), migraine. A similar dynamic exists for Botox,
although the misalignment between physicians' perception and actual
treatment patterns is not quite as stark, likely attributed to the
brand's label restricted to chronic migraine prevention.
The episodic migraine segment represents the greatest market
expansion opportunity for the anti-CGRP brands, due to higher
patient volume and historically low treatment rate. Spherix
real-world data indicate that anti-CGRP uptake in this segment may
be stronger than managing physicians and other secondary data
sources suggest. As a result, anti-CGRP marketers could only
benefit competitively by highlighting available clinical data
supporting brand use among patients with less severe current
migraine disability who are at risk of migraine chronification.
At this time, Novartis appears to be the only company with an
ongoing Phase 4 clinical program aimed at supporting such messaging
with the head-to-head HER-MES trial (NCT03828539) evaluating
Aimovig to topiramate in patients with episodic migraine. With
two-thirds of the audit patients treated with concomitant
topiramate still on one of the branded versions of the molecule
(i.e., Janssen's Topamax, Supernus' Trokendi XR, Upsher-Smith's
Qudexy XR), a positive readout of the HER-MES trial in mid-2020
would be influential in shifting payer support and physician
prescribing patterns towards even greater Aimovig use in this large
segment.
Botox, the current market leader for chronic migraine prevention
among the injectable options, won almost all cases where the brand
was considered an appropriate therapeutic option. In comparison,
stressing strong within-class competition, individual anti-CGRP
brands were prescribed in only about half of cases where the brand
was considered a viable option. Along with efficacy and
tolerability, positive long-term safety perceptions and patient
requests played a significantly greater role in the selection of
Botox over other potential competitors.
As an example, when Emgality lost out to Botox for a potential
new patient start, patient request for Botox was influential in
almost half of the lost opportunities. As one managing physician
described the Botox selection process: "The patient had friends
receiving botulinum toxin injections and it had helped them. They
were uncomfortable with newer medications on the market due to lack
of safety data." When Botox did lose to an anti-CGRP therapy,
preference for the subcutaneous administration method and better
convenience expectations were typically the reasons for the
preferential selection of the monoclonal antibody.
Among the pipeline anti-CGRP therapies in late-stage clinical
development, specifically Alder BioPharmaceutical's eptinezumab,
Biohaven Pharmaceutical's rimegepant, and Allergan's atogepant,
most US neurologists and migraine specialists already project at
least moderate use for the prevention of migraine upon approval.
Assuming availability at the time of the current brand selection,
audit patients who were considered very likely candidates for
rimegepant, an oral CGRP receptor antagonist dosed once every two
or three days, instead of their current preventive therapy are
significantly more likely to be prescribed Ajovy and less likely to
be prescribed Botox compared to noncandidates. This pattern
suggests that oral anti-CGRP therapies may put a disproportionate
amount of pressure on the Teva brand, which is already struggling
in the face of the current injectable anti-CGRP therapies.
Regardless of the pipeline agent and/or the route of
administration, Botox appears to remain insulated from the
competitive pressure from the expanding anti-CGRP class in the
migraine prevention market.
About RealWorld Dynamix™
RealWorld Dynamix™:
Migraine Prevention (US) is an independent,
data-driven service unmasking real patient management patterns
through annual reports based on chart audits of ~1,000 patients
currently treated with an anti-CGRP and/or Botox. The report
uncovers the "why" behind treatment decisions, includes year over
year trending to quantify key aspects of market evolution, and
integrates specialists' attitudinal & demographic data to
highlight differences between stated and actual treatment patterns.
The first annual audit published in August
2019.
About Spherix Global Insights
Spherix Global Insights is a hyper-focused market intelligence firm
that leverages its own independent data and expertise to provide
strategic guidance so biopharma stakeholders can make decisions
with confidence.
All company, brand or product names in this document are
trademarks of their respective holders.
For more information contact:
Kristen Henn, Neurology Franchise
Insights Analyst
Email: info@spherixglobalinsights.com
www.spherixglobalinsights.com
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SOURCE Spherix Global Insights