Spherix Global Insights

September 09, 2021

Following the Recent Label Expansion, Biohaven’s Nurtec ODT Has Come Out Strong in the Migraine Prevention Market

Spherix Global Insights data show Nurtec ODT expanding its dominance of the CGRP class for migraine prevention with little anticipated share erosion for its closest competitors – Amgen’s Aimovig, Teva’s Ajovy, and Eli Lilly’s Emgality

EXTON, Pa., September 9, 2021 /PRNewswire/ — In May 2021, the FDA approved the label expansion of Biohaven’s Nurtec ODT for the preventive treatment of episodic migraine, making the gepant the first and only migraine therapy to both prevent and treat migraines. Spherix data show that, three months after the approval, early uptake of Nurtec ODT for migraine prevention has resulted from physicians’ virtually universal aided awareness of the approval and extensive prior experience with the gepant as an acute therapy.

In the inaugural quarterly deep dive report included in Spherix’s Launch Dynamix™ : Nurtec ODT (Biohaven) in Migraine Prevention (US) service, data collected from 74 US neurologists and migraine specialists found that physicians have higher familiarity with Nurtec ODT as a preventive therapy compared to familiarity reported for the established subcutaneous (SC) calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs), specifically Amgen’s Aimovig, Teva’s Ajovy, and Eli Lilly’s Emgality, and the intravenous CGRP mAb (Lundbeck’s Vyepti), at a similar time in their respective launches.

With most physicians agreeing that they are comfortable transitioning patients from acute to preventive dosing as needed, it is not surprising that the prescriber base for preventive use appears to be on an equally robust trajectory to that seen one year ago for acute treatment. As a result, physician-reported share of Nurtec ODT among patients treated with preventive therapy is already half that reported currently for Emgality.

Looking ahead to February 2022, physicians expect share of Nurtec ODT to rise rapidly at the expense of preventive agents with more established mechanisms of action (e.g., topiramate, anti-depressants, beta blockers), which are typically available as generics and so preferred by payers for earlier-line use. Indeed, physicians report usually prescribing Nurtec ODT as a later-line option with topiramate, antidepressants, and beta blockers the most common prior therapies. If given the option by payers, there appears to be an eager subgroup of prescribers willing to initiate Nurtec ODT earlier in the treatment algorithm, especially if the patient has responded well to the gepant as acute migraine therapy.

In contrast, failing a CGRP mAb appears not to be a prerequisite to initiation of Nurtec ODT. Instead, the SC CGRP mAbs, along with AbbVie’s (formerly Allergan, an AbbVie company) Botox, are considered to be the closest competitors to Nurtec ODT for new prescription opportunities. As a result, the Spherix data suggest Nurtec ODT pressure may primarily be felt through a blunting of competitors’ individual growth trajectories, as evidenced by the flat share projected over the next six months for these brands, instead of pulling existing share from these brands through switches.

Qualitative interviews conducted with a subsample of respondents reveal that these physicians are generally attracted to the simplicity and convenience afforded to patients by using the same agent to both treat and prevent migraine. As one physician noted “It’s easier for the patient to use. One product for acute and preventive medicine.” Regardless, the most influential driver of Nurtec ODT is its anticipated efficacy, which is largely expected to be on par with the CGRP mAbs.

Biohaven’s gepant is also considered by some physicians to offer a favorable alternative to SC CGRPs for patients who are needle phobic or who require improved tolerability. Finally, the frequent every-other-day (EOD) dosing may provide more consistent CGRP antagonism for patients experiencing a “wearing off” of efficacy with the less frequently dosed CGRP mAbs.

Nurtec ODT success in the prevention segment is not without obstacles. Currently, the main barrier to prescribing Nurtec ODT is market access. Four out of five respondents select one of the market access issues as their primary barrier to Nurtec ODT trial or expanded use for the preventive treatment of migraine. Some physicians also worry that patients may run out of medication, given the potential for quantity limits, if using Nurtec ODT to both treat and prevent migraines.

In addition, Nurtec ODT’s dosing profile may turn out to be a double-edged sword for the brand, with specialists concerned that patients may find it more challenging to remember to take a pill every other day, which, in turn, may reduce medication adherence.

The Biohaven brand may have less than a month to cement its position as a preferred preventive option before the competitive pressure ramps up yet again in the segment. AbbVie’s atogepant, an once-daily oral tablet, is expected to be approved for the preventive treatment of migraine later this month. Atogepant’s more frequent dosing schedule and the established position of legacy Allergan and its migraine portfolio may give the brand an advantage over Biohaven’s Nurtec ODT.

Assuming a positive PDUFA outcome later this month, the atogepant launch will be closely assessed through a parallel brand-specific Launch Dynamix™ service from October 2021 to March 2023. In addition, Spherix will continue their monitoring of the overall migraine market via their ongoing RealTime Dynamix™ services, which provide an unbiased view of the competitive landscape within rapidly evolving specialty markets. Learn more about our services here

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.

All company, brand or product names in this document are trademarks of their respective holders.