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RealWorld Dynamix: Migraine Prevention US

Prior to May 2018, only topiramate (branded and generic) and Allergan’s Botox were approved for the preventive treatment of migraine in the US. With the approval of Amgen/Novartis’ Aimovig, an anti-CGRP monoclonal antibody (mAb), followed quickly 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. The complexity is only set to intensify with three preventive therapies in the late-stage pipeline, including the first oral and infusion anti-CGRP therapies. While the availability of multiple therapeutic tools is theoretically beneficial to the patient and physician, deciphering which treatment is best for which patient and 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™: Migraine Prevention (US) blends attitudinal and demographic physician survey data with patient record data to uncover how practice demographics and certain beliefs influence the treatment pathway and to understand how different brands, specifically Botox and the anti-CGRP therapies, 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 migraine prevention treatment paradigm.

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 currently treated with Botox or an anti-CGRP therapy. 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? Difficult to treat migraine?
  • What are the most frequently prescribed agents for efficacy/safety/tolerability/patient/payer-driven therapy selections? How does this differ when patients are selecting an anti-CGRP therapy versus Botox or topiramate ?
  • Which migraine therapies are being used as first-line therapies? What differentiates patients who initiate an anti-CGRP therapy first line from those who are switching to the class?
  • How do second-line switches differ from third and later line switches? How does persistency differ by brand?
  • How has migraine severity and characteristics changed since first being prescribed the current anti-CGRP therapy or Botox? What is the conversion rate from chronic to episodic migraine by brand?
  • Are physicians prescribing the anti-GCRP therapies 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?
Commercial Products
Allergan (Botox), Amgen/Novartis (Aimovig), Eli Lilly (Emgality), Janssen’s Topamax, Supernus (Trokendi XR), Teva (Ajovy), Upsher-Smith (Topiragen, Qudexy XR)

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

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