Lilly could build upon their existing payer relationships to construct favorable migraine portfolio contracting and position Reyvow as the preferred acute treatment for patients concurrently treated with calcitonin gene-related peptide monoclonal antibodies – a growing segment of the population
EXTON, Pa., June 30, 2020 /PRNewswire/ — The number of companies active in the migraine space continues to expand, with Biohaven and Lundbeck providing the newest additions following their respective launches of Nurtec ODT and Vyepti. However, only AbbVie and Eli Lilly offer multiple options for both the acute and preventive treatment of migraines. While AbbVie’s Botox and Eli Lilly’s Emgality are both executing well in the preventive segment, AbbVie’s Ubrelvy consistently outperforms Eli Lilly’s Reyvow in the acute segment, according to the most recent quarterly report included in Spherix’s RealTime Dynamix™: Migraine (US) service.
The report, which collected the responses of 101 migraine specialists and neurologists in the United States surveyed between May 18th and May 22nd, found that reported Ubrelvy share has more than doubled over the past three months, while Reyvow share has remained almost flat. In addition, the Ubrelvy prescriber base is now twice that of Reyvow, although both brands were launched in January. Perhaps more concerning for the Lilly brand, physicians now estimate fewer of their patients to be appropriate candidates for Reyvow compared to last quarter – a trend which is going in the opposite, more favorable, direction for Ubrelvy.
Reyvow’s opportunity within the migraine market appears to be weakening due to strong acceptance of the calcitonin gene-related peptide (CGRP) receptor antagonists or gepants (i.e., Ubrelvy and Nurtec ODT), as well as concern over potential safety and tolerability issues associated with the brand. Compared to the gepants, few physicians perceive Reyvow to offer a substantial advance over triptans, historically the standards of care and still the first- (and often second-) line treatment for acute control of migraines.
With the new therapies relegated to patients who are covered by the medical necessity clause (i.e., contraindicated for or have previously failed triptans), it is especially notable that physicians are less likely to prescribe Reyvow to patients who are contraindicated for triptan use compared to its competitors. Reyvow reluctance appears tied to the brand’s risk profile, with long-term safety profile, driving impairment, and dizziness among the most common barriers to greater uptake.
AbbVie looks to be benefiting from increased familiarity, patient support programs—including their Upscript collaboration to support Ubrelvy access through telemedicine during the COVID-19 pandemic—and patient requests. While face-to-face interactions have been greatly curtailed in light of the coronavirus, one-third of physicians have participated in some form of personal Ubrelvy engagement with AbbVie representatives over the previous month. These engagements appear effective, as lack of familiarity has decreased significantly as a barrier to brand adoption compared to the previous quarter.
In addition, recently detailed physicians are more likely to recall discussing patient support services, such as the Upscript partnership, compared to three months ago. While Ubrelvy lags behind Nurtec ODT on telemedicine platform awareness and use, many recent Ubrelvy prescriptions were prescribed following remote evaluation. Highlighting the importance of patient engagement, physicians are increasingly likely to not only report receiving patient requests for Ubrelvy, but also to start these patients on the brand compared to in February. Conversely, Reyvow has remained flat or declined on these metrics.
Digging into the most recent Spherix data, some glimmers of hope for Lilly and Reyvow do emerge. Current prescribers report that significantly more Reyvow-treated patients are concurrently treated with CGRP monoclonal antibodies (mAbs) for prevention compared to patients treated with the CGRP receptor antagonists. The manufacturer has an opportunity to position Reyvow as the most appropriate acute treatment option in the growing pool of patients being treated concurrently with Amgen/Novartis’ Aimovig, Teva’s Ajovy, Lundbeck’s Vyepti, or Lilly’s own Emgality for migraine prevention. In addition, slightly fewer prescribers have experienced extremely difficult payer approval processes with Reyvow, which was an early and impactful differentiator for Emgality from its competitors, suggesting that Lilly could benefit from constructive migraine portfolio contracting with payers.
Similarly, not all is rosy for AbbVie and Ubrelvy, with Biohaven’s recently launched Nurtec ODT proving to be a formidable adversary. Out of the gate, Nurtec ODT is gaining a greater share of its recent business from Biohaven’s telemedicine platform collaboration with Cove compared to the AbbVie and Upscript partnership. In addition, physicians are more likely to believe that Nurtec ODT performs better than Ubrelvy on effect duration and less redosing need, providing a rationale for the greater willingness to use the Biohaven therapy in patients with migraine recurrence and those who overuse or re-dose acute migraine medications. All told, Nurtec ODT has already garnered a slightly higher reported share among patients treated with an acute therapy compared to that obtained by Ubrelvy in the first quarter postlaunch, and the prescriber bases for both gepants are anticipated to be similar by year’s end.
In the future, AbbVie and Biohaven are also positioned to compete directly within the preventive segment of the migraine market. While AbbVie’s atogepant is top-of-mind as a late-stage pipeline therapy for few physicians, those with at least moderate familiarity tend to be extremely interested in the gepant, impelled by a desire for a greater number of therapeutic options and its familiar CGRP receptor antagonistic mechanism of action. For Biohaven, after a positive March readout of the pivotal rimegepant prevention trial, the company plans to submit an sNDA for preventive treatment with Nurtec ODT, which could result in the first dual-indication label for migraine. Data suggest that, if atogepant and Nurtec ODT receive favorable regulatory decisions, the migraine prevention landscape would drastically change over the next two years, with oral anti-CGRPs capturing an estimated half of the anti-CGRP class share, primarily at the expense of the existing subcutaneous CGRP mAbs.
About RealTime Dynamix™
RealTime Dynamix™: Migraine (US) is an independent service providing strategic guidance through rapid and comprehensive quarterly reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave. The 9th wave of research will publish in September 2020.
About Spherix Global Insights
Spherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.
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