Spherix Global Insights

October 12, 2021

Amgen’s Aimovig and Eli Lilly’s Emgality Feel the Heat From Strong Uptake of Biohaven’s Nurtec ODT Among Primary Care Physicians for Migraine Prevention, According to Spherix Global Insights

New research suggests that Amgen’s and Eli Lilly’s increased promotional efforts towards PCPs will be vital to minimizing the future impact of Nurtec ODT and AbbVie’s recently approved Qulipta

EXTON, Pa., October 12, 2021 /PRNewswire/ — Following the May 2021 FDA approval of Biohaven’s Nurtec ODT for the preventive treatment of episodic migraine, primary care physicians (PCPs) have readily adopted the gepant into their treatment armamentarium. However, PCP prescribing patterns appear ready to disrupt, rather than merely expand, CGRP prescribing in migraine prevention.

Indeed, while uptake of Nurtec ODT among specialists (i.e., general neurologists and migraine specialists) appears to be increasing calcitonin gene-related peptide (CGRP) class share, the rapid growth seen among PCPs appears to be heavily fueled by switches from the subcutaneous (SC) CGRP monoclonal antibodies (mAbs) – Amgen’s Aimovig, Eli Lilly’s Emgality, and Teva’s Ajovy.

In the most recent semiannual report included in Spherix’s RealTime Dynamix™: Migraine – PCP Perspective (US) service, data collected from 99 PCPs revealed that, just three months after the label expansion, estimated Nurtec ODT share among episodic migraine patients has already matched or exceeded that of each individual SC CGRP mAb. The gepant is poised to continue growing within the PCP segment of the market, with reported new prescription share far outpacing that of the overall share.

Compared to data collected as part of the parallel quarterly RealTime Dynamix™: Migraine – Specialty Perspective (US) service, episodic migraine is estimated to be substantially more prevalent among patients managed by PCPs. While these physicians report a relatively low preventive treatment rate among low-frequency episodic migraine patients, the rate more than doubles among high-frequency episodic migraine patients. As such, PCPs appear to be influential contributors to the success (or failure) of preventive therapies within the episodic migraine segment of the market.

With PCP-reported Nurtec ODT share among patients with episodic migraine twice as high as that reported by specialists, competitive pressure introduced by the brand for prevention could be forceful. Indeed, since the introduction of Biohaven’s gepant, PCP-reported shares for the SC CGRP mAbs has declined – with especially strong erosion of the first-to-market CGRP antagonist, Aimovig. In comparison, topiramate share appears to be largely holding steady in the face of Nurtec ODT adoption (unlike the erosion pattern seen among specialists).

Based upon a competitive advantage analysis, PCPs generally view Nurtec ODT as comparable, if not superior, to the prior CGRP antagonist class leader, Aimovig, across assessed clinical and commercial attributes. Eli Lilly’s planned clinical trial comparing Emgality to Nurtec ODT in patients with episodic migraine will provide PCPs with useful information on whether there is a clinically significant difference between the two CGRP antagonists on key clinical endpoints.

According to the Spherix report, PCPs also strongly agree that Nurtec OTD, the only therapy approved to both treat and prevent migraine, offers patients convenience and simplicity. Supporting this sentiment, PCPs estimate that nearly one-half of their patients treated with Nurtec ODT for migraine prevention were initially prescribed the gepant as an acute option.

However, the future of Nurtec ODT in the prevention segment is not without some notable obstacles. Outside of the all-too-common typical market access issues mentioned by the majority of PCPs, physicians also worry that patients may be confused by how to dose the gepant if it is used to treat migraine attacks as needed, as well as every other day (EOD) for the prevention of migraine. In addition, there is a concern that patients may run out of Nurtec ODT doses, given payer restrictions on quantity limits.

In addition, both Amgen and Eli Lilly appear to be addressing the Nurtec ODT threat head on. One-third of PCPs recall increased promotional activity for both Aimovig and Emgality over the past three months, with Eli Lilly being especially successful at expanding recent detailing rate supporting PCPs’ Emgality education. With high levels of existing satisfaction for both mAbs and a number of PCPs believing that patients will prefer the once-monthly subcutaneous over EOD oral dosing, focused promotional efforts will likely find a receptive audience among PCPs and could be crucial for minimizing the impact of Nurtec ODT.

Finally, the recent FDA approval of Qulipta (atogepant), a once-daily gepant developed exclusively for the prevention of migraine by AbbVie (formerly Allergan, an AbbVie company), will likely intensify the pressure on the SC CGRP mAbs originating from PCP prescribing patterns. Two-thirds of PCPs rated Qulipta as one of the three most desirable late-stage migraine pipeline therapies, with expanded therapeutic choice, the prevention indication, and the CGRP mechanism of action all drivers of PCP interest.

Indeed, the projected Qulipta uptake pattern suggests that the introduction of this second gepant for the prevention of episodic migraine will not only further erode Aimovig, Emgality, and Ajovy shares, but will also blunt the current uptake trajectory for Nurtec ODT. To keep a pulse on these market events, Spherix will track and compare Nurtec ODT and Qulipta perceptions and prescribing patterns within the PCP segment in future RealTime Dynamix™: Migraine – PCP Perspective (US) offerings.

About RealTime Dynamix™
RealTime Dynamix™ is an independent service providing strategic guidance through quarterly or semiannual reports, which include market trending and a fresh infusion of event-driven and variable content with each wave. The reports provide an unbiased view of the competitive landscape within rapidly evolving specialty markets, fueled by robust HCP primary research and our in-house team of experts.

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