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RealWorld Dynamix: Anti-CGRP Monoclonal Antibody Uptake in Migraine Prevention US

With the May approval of Amgen/Novartis’ Aimovig, an anti-CGRP monoclonal antibody (mAb), quickly followed by the approval of two additional anti-CGRP mAbs, Teva’s Ajovy and Eli Lilly’s Emgality, migraine prevention options in the US have expanded substantially, setting up a highly competitive market. With three additional preventive therapies in the late-stage pipeline, the complexity of therapy selection will continue to intensify. While the availability of multiple therapeutic tools is theoretically beneficial to the patient and physician, deciphering which treatment is best for which patient at which point in the treatment algorithm is a major challenge. Understanding when, why, and to which preventive therapy a physician will initiate or switch a migraine patient is critical to building an effective commercial strategy for both first-line and later-line therapies.

RealWorld Dynamix™: Anti-CGRP mAb Uptake in 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 marketed anti-CGRP mAbs 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.

Spherix Global Insights conducts an online survey with ~200 US neurologists/migraine specialists combined with a large-scale patient record audit of over 1,000 of their migraine patients that were recently initiated or switched to an anti-CGRP mAb within the past three months. Each respondent completes an in-depth retrospective review of their last 3-7 patients who meet specific study criteria. Respondents are recruited from the Spherix Network, a proprietary group of physicians meeting our strict screening criteria. Our relationship with this network leads to more engaged respondents resulting in higher quality output. Additionally, this gives us the opportunity to more easily revisit physicians in order to uncover even more insight on strategically important findings.

The 2019 wave is the first wave of the report.

Learn more about RealWorld Dynamix™ reports here.

  • What are the current prescribing patterns for the prevention of migraine? How does it differ for episodic versus chronic migraine?
  • Which anti-CGRP mAbs are being used as first-line therapies? What differentiates these patients from those who are switching to the class?
  • What are the most frequently prescribed agents for efficacy/safety/tolerability/patient/payer-driven switches?
  • How do second-line switches differ from third and later line switches? How much time do patients spend on their previous agent before switching?
  • How do switching decisions differ between migraine patients based upon their presentation (i.e., episodic versus chronic)? Based upon switching from Allergan’s Botox or topiramate versus another one of the anti-CGRP mAbs?
  • To what degree are the new launches growing the migraine prevention market versus stealing share form existing products? Are physicians prescribing the anti-GCRP mAbs as part of a combination therapy or as monotherapy? How do payers influence continuation of existing preventive therapies?
  • What is the opportunity cost for each brand (e.g., where would their brand have been selected if the first choice was not available)? What positioning or data could have made the brand more competitive in those situations?
  • What is the patient profile for switching to Alder’s eptinezumab? Allergan’s atogepant? Biohaven Pharma’s rimegepant?
Commercial Products
Allergan (Botox), Amgen/Novartis (Aimovig), Eli Lilly (Emgality), Teva (Ajovy)

Pipeline Agents
Alder (eptinezumab), Allergan (atogepant), Biohaven Pharma (rimegepant)

Download Report Overview (PDF)


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