July 11, 2019
Early Prescribing Patterns of the Anti-Calcitonin Gene-Related Peptide Monoclonal Antibodies Are Dominated by Adjunctive Use for Episodic and Chronic Migraine Prevention: Trending the First Year of US Adoption
Authors: Virginia R. Schobel, MSc; Jennifer Robinson MSc
Compare early launch perceptions and self-reported prescribing patterns for the anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) class, specifically erenumab-aooe (available since May 2018), fremanezumab-vfrm (September 2018), galcanezumab-gnlm, (October 2018), for the preventive treatment of episodic and chronic migraine. Assess how anti-CGRP mAb class uptake impacts prescribing of prior standard-of-care therapies, including onabotulinumtoxinA, approved for the preventive treatment of chronic migraine.
Quarterly survey fielded by an independent market intelligence agency which specializes in tracking the US preventive migraine market, including benchmarking new launch metrics. US neurologists and migraine/headache specialists provide responses to an online survey fielded in July 2018 (n=98), November 2018 (n=104), February 2019 (n=99), and May 2019 (n=104).
In May 2019, significantly more episodic (64% vs. 57%, p<0.05) and chronic (89% vs. 82%, p<0.05) migraine patients are believed to be treated with preventive migraine therapies compared to in July 2018 (Fig. 1). Physicians report 19.3% of episodic migraine patients and 26.9% of chronic migraine patients are treated with an anti-CGRP mAb (Fig. 2 and 3). OnabotulinumtoxinA treatment rates among episodic (Δ-0.2 percentage points) or chronic (Δ-1.5 percentage points) migraine patients have not changed over the last six months with reported share similar to that of erenumab among episodic migraine patients (9.7% vs. 8.4%; Fig. 2) but higher share among chronic migraine patients (26.4% vs. 11.5%; Fig. 3). OnabotulinumtoxinA is most preferred by 33% and topiramate by 25% of physicians for the preventive treatment of chronic migraine (Fig. 4) with preference for these therapies significantly more influenced by familiarity/comfort and long-term data/proven track record (Fig. 5). Approximately one-third of patients recently prescribed an anti-CGRP mAb had previously failed onabotulinumtoxinA (erenumab: 32%; fremanezumab: 32%; galcanezumab: 28%; Fig. 6). Among the more than two-thirds of patients who continued previous preventive therapies when initiating an anti-CGRP mAb, topiramate, antidepressants, and/or beta blockers were more frequently reported as concomitant therapy compared to onabotulinumtoxinA (Fig. 7).
With the availability of the new anti-CGRP mAb class, offering a unique mechanism of action and approved with a broad label, migraine prevention management and treatment patterns are evolving towards greater complexity in multi-class therapy regimens. Ten months after the launch of the first anti-CGRP mAb, self-reported onabotulinumtoxinA and topiramate use remains resilient protected by physician preference, early placement in the preventive treatment algorithm, and concomitant use with the anti-CGRP class.
Virginia Schobel is an employee of Spherix Global Insights, an independent market intelligence firm, and has received no industry funding to conduct and report on this study.
Jennifer Robinson is the founder of Spherix Global Insights, an independent market intelligence firm and has received no industry funding to conduct and report on this study.
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