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RealWorld Dynamix: Preventive Treatment Switching in Migraine 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. More recently, the complexity has only intensified with the introduction of Lundbeck’s Vyepti, the first infusion anti-CGRP monoclonal antibody. Looking to the future, Allergan and Biohaven are in a race to offer the first oral “-gepant” for the prevention of migraine. 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 switch a migraine patient is critical to building an effective commercial strategy for both first-line and later-line therapies.

RealWorld Dynamix™: Preventive Treatment Switching in Migraine (US) is an independent, data-driven service unmasking real patient management patterns through annual reports based on chart audits of ~1,000 patients. The report uncovers the “why” behind treatment decisions, includes year over year trending to quantify key aspects of market evolution, and integrates specialists’ attitudinal & demographic data to highlight differences between stated and actual treatment patterns.

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 switched to or added on an anti-CGRP therapy or Botox no more than three months prior. 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.

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?
  • How do second-line switches differ from third and later line switches? How does persistency differ 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 (Topamax), Lundbeck (Vyepti), Supernus (Trokendi XR), Teva (Ajovy), Upsher-Smith (Topiragen, Qudexy XR)

Pipeline Agents
Allergan (atogepant), Biohaven Pharma (rimegepant for prevention, vazegepant)


Recent Label Revisions Related to Constipation and Hypertension Generate Minimal Drag on the Decision to Prescribe Amgen/Novartis’ Aimovig as a Preventive Treatment for Migraine – August, 18 2020

COVID-19 Pandemic in the US May Curtail Uptake of Recent Acute Migraine Market Entrants, Diminishing Specialists’ Prelaunch Expectations that Biohaven’s Nurtec ODT Would Challenge Allergan’s Ubrelvy and Eli Lilly’s Reyvow – April, 2 2020