Assuming positive regulatory outcomes for the preventive treatment of migraine, Biohaven Pharmaceuticals’ rimegepant and Allergan’s atogepant will quickly erode injectable anti-CGRP therapy share, resulting in a dominant position within the class, according to the 4th wave of Spherix Global Insights’ report series
EXTON, Pa., July 2, 2019 ― US neurologists and migraine specialists typically report few clinically relevant points of differentiation between the three brands in the new class of anti-calcitonin gene-related peptide (CGRP) therapies. However, data highlighted in the recent Q2 wave of Spherix’s ongoing quarterly RealTime Dynamix™: Migraine Prevention (US) report series reveal several potential bright spots emerging for Eli Lilly’s Emgality, indicating that the brand may be overcoming some of its third-to-market position baggage:
Compared to three months ago, self-reported anti-CGRP class share of the chronic migraine preventive therapy market has increased by four percentage points, driven predominantly by expanded Emgality share. Surveyed physicians (n=104) anticipate Emgality growth to continue to outpace Amgen/Novartis’ Aimovig uptake over the next six months. Indeed, while Emgality had trailed Aimovig on chronic migraine candidate volume since launch, quarter-over-quarter gains in the estimated Emgality candidacy rate has now even the playing field. That being said, Emgality prescriber base expansion has slowed compared to the prior quarter’s growth and two out of five non-prescribers appear reluctant to ever trial the brand, suggesting the prescriber base may plateau at a slightly lower level compared to its competitors and brand growth will be heavily dependent upon increased uptake among existing prescribers.
Emgality’s recent FDA approval for the treatment of episodic cluster headache may have some limited spillover influence on migraine prevention prescribing patterns, especially in the more severe chronic migraine segment. Although physicians are divided on the degree of advance the new indication will confer to Emgality over the other anti-CGRP brands as a migraine prevention therapy, Emgality will be more competitive with topiramate and Allergan’s Botox. With more than half of physicians most preferring one of these two agents for the preventive treatment of chronic migraine, clinical data providing a competitive edge over Botox or topiramate could shift the therapy selection discussion in Emgality’s favor.
Eli Lilly has touted Emgality’s broad market access, estimating as recently as last month that approximately four out of five Emgality candidates would have commercial plan coverage following prior authorization. While physicians do not discriminate between the anti-CGRP brands in terms of payer influence on their prescribing decision and market access remains the most common barrier to uptake across brands, Emgality is now rated significantly higher compared to Aimovig on the ease with which they received payer approval. With clinical metrics rated equally highly across the brands, ease of access could have a significant impact on future prescribing patterns benefiting Emgality. Not surprisingly, recall of a local reimbursement landscape discussion during recent Emgality discussions has increased substantially over the past six months.
With growing brand familiarity and expanding clinical experience, overall prescriber satisfaction with Emgality has improved significantly over the past quarter and is now slightly higher than both Aimovig and Teva’s Ajovy.
Two orally-administered CGRP receptor antagonists, Biohaven Pharmaceuticals’ rimegepant and Allergan’s atogepant, are in late-stage clinical development for the preventive treatment of migraine, with possible FDA submission for rimegepant as early as 2020. Surveyed physicians estimate that, assuming successful approval of these oral CGRP therapies (as well as Alder BioPharmaceuticals’ infusion eptinezumab), half of patients treated with an anti-CGRP therapy will be prescribed an oral option two years from now. Assuming favorable market access with limited step edit restrictions, physicians’ anticipated preference for using oral options as first-line preventive therapy will be instrumental in the quick shift towards an oral-dominated market. In contrast, eptinezumab adoption, currently under regulatory review by the FDA for migraine prevention, will be heavily influenced by the availability of onsite infusion capabilities within physicians’ primary practice settings. In the currently fielding RealWorld Dynamix™: Migraine Prevention (US) patient audit, Spherix Global Insights will further assess the switch potential for the emerging anti-CGRP therapies among patients currently treated with Aimovig, Ajovy, Emgality and/or Botox for the prevention of episodic or chronic migraine.
About RealTime Dynamix™
RealTime Dynamix™: Migraine Prevention (US) is an independent report series published on a quarterly basis since Q3 2018. The series provides a close-quarters analysis of key performance metrics, focusing on brand gains and losses, industry contact rates, familiarity and adoption patterns of recently launched products (e.g., Aimovig, Ajovy, and Emgality) and awareness of products in development. Product perceptions, disease awareness and attitudes, practice management and other topics are rotated throughout the year to provide an ongoing probe of the crucial drivers of change. The 5th wave of research will be published in September 2019.
About RealWorld Dynamix™
RealWorld Dynamix™: Migraine Prevention (US) blends attitudinal and demographic physician survey data with patient record data to uncover how practice type and setting and certain beliefs influence the treatment pathway and to understand how anti-CGRP therapies and Botox are being used by physicians and for what patient types. The report also captures physician’s perspectives about products in development and the impact they will have on the current treatment paradigm for migraine prevention. The first annual audit will publish 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.
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