July 11, 2019
Impact of US Physicians’ Perceptions of the Distinct Pharmacological and Clinical Characteristics of the Novel Anti-Calcitonin Gene-Related Peptide Monoclonal Antibodies on Self-Reported Chronic Migraine Prevention Brand Share
Authors: Virginia R. Schobel, MSc; Jennifer Robinson MSc
Therapeutic choice for the prevention of episodic and chronic migraine increased with the recent approvals of anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) therapies, specifically erenumab-aooe, fremanezumab-vfrm, and galcanezumab-gnlm. We aim to assess how, with limited time on the market, physicians’ perceptions of these agents’ pharmacological and clinical characteristics affects adoption patterns in the chronic migraine prevention segment.
Quarterly survey fielded by an independent market intelligence agency which specializes in tracking the preventive migraine market. US neurologists and migraine/headache specialists provided responses to a quarterly online survey evaluating perceptions and prescribing patterns related to erenumab (available since May 2018), fremanezumab (September 2018), and galcanezumab (October 2018). Data from November 2018 (n=104) and May 2019 (n=104) are compared.
Similar to in November 2018, the erenumab prescriber base assessed in May 2019 remains larger (91%; one year postlaunch) compared to fremanezumab (78%; eight months postlaunch) or galcanezumab (71%; <eight months postlaunch) within the chronic migraine segment (Fig. 1). Similarly, among chronic migraine patients treated with preventive therapy, erenumab captured 11.5% of physician self-reported share compared to 8.5% for fremanezumab and 7.0% for galcanezumab (Fig. 2). However, erenumab now represents less than half of anti-CGRP class use (Fig.3). Physicians’ agreement with anti-CGRP therapy-related statements has not changed significantly over the past six months (Fig. 4). In November 2018, physicians who agreed with the statement “I believe that erenumab’s receptor antagonistic mode of action is clinically superior to the CGRP ligand-binding action of the other anti-CGRP mAbs” reported significantly higher erenumab share among their treated chronic migraine patients (14.0%) compared to physicians who were neutral (6.7%; Fig. 5). Chronic migraine erenumab share correlated positively with ratings for “I believe that erenumab’s fully human mAb will result in lower risk of immunogenicity compared to the other anti-CGRP mAbs” as physicians in agreement reported a 13.5% share compared to 6.8% among those who disagreed (Fig. 6). Physicians who agreed that “The need for a loading dose will limit my use of galcanezumab” reported significantly higher share of competitor fremanezumab (7.2%) compared to those who were neutral (2.1%), but no difference in share of galcanezumab itself. In May 2019, physicians who disagreed reported prescribing significantly more galcanezumab compared to those who disagreed (Fig. 7). In both November 2018 and May 2019, physicians who agreed that “The availability of quarterly dosing makes me more willing to prescribe fremanezumab” reported significantly higher fremanezumab share compared to those who disagreed (Fig. 8). Physicians who disagreed that “The need for simultaneous subcutaneous injections from three separate prefilled syringes will limit my use of fremanezumab ‘s quarterly dosing” reported significantly higher fremanezumab share (6.7%) compared to those who were neutral (2.1%; Fig. 9). Agreement with “The availability of both low and high dose options makes me more willing to prescribe erenumab” did not impact erenumab share (Fig. 10).
As the first-to market anti-CGRP mAb therapy with an additional four months on the US market, surveyed neurologists and migraine/headache specialists continue to have the greatest clinical experience with erenumab. Although perceptions related to pharmacological and clinical points of differentiation between the anti-CGRP mAbs have not changed over the past six months, erenumab uptake within the chronic migraine segment now appears to be less associated with favoring the agent’s unique pharmacological attributes (i.e., receptor antagonist and fully human mAb). Fremanezumab uptake benefited (and continues to benefit) from the quarterly dosing option, while the need for galcanezumab’s loading dose appears to be an obstacle for a subset of physicians.
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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