Allergan’s Botox appears indifferent to the chatter surrounding the anti-CGRP class launch, benefitting from high patient awareness and switch business opportunities following anti-CGRP discontinuations, according to the fifth wave of the quarterly Spherix Global Insights series
EXTON, Pa., September 26, 2019 ― Nine months post launch, specialists’ self-reported share for Eli Lilly’s Emgality has surpassed (for the first time) that of Teva’s Ajovy among patients treated with a preventive therapy for migraine. While Amgen/Novartis’ Aimovig retains its class-leading share, data from 100 neurologists and migraine specialists surveyed in August for the current wave of the Spherix’s RealTime Dynamix™: Migraine Prevention (US) service confirm consistent quarter-over-quarter growth in Emgality share, especially strong among episodic migraine patients, that has boosted the brand into the second-most prescribed position within the anti-calcitonin gene-related peptide (CGRP) class.
Emgality’s success over the past six months has been driven by growth in the number of preventive-treated episodic migraine patients, as well as consistent Emgality uptake among neurologists and migraine specialists. According to Dr. Robert P. Cowan, a recognized migraine expert and advisor to Spherix Global Insights, “Similar to what I have seen in practice, surveyed physicians estimate that more than two-thirds of patients with episodic migraine are now treated with a preventive therapy ― up eight percentage points from just six months ago. This shift has resulted in a greater number of treated episodic migraine patients compared to before the introduction of the anti-CGRP class to the market.” The uptick in treatment rate among these less severe migraine patients is likely tied to the strong agreement among physicians that the timely initiation of effective preventive treatment can stop progression of migraine chronification. Physicians anticipate initiating even more of their episodic migraine patients on preventive therapy within the next six months.
Second only to topiramate (i.e., Janssen’s Topamax, Supernus’ Trokendi XR, Upsher-Smith’s Qudexy XR, generics), the anti-CGRP class is the most common preventive therapy for episodic migraine patients. Physician-reported Emgality share has increased by 50% over the past six months, while Aimovig share has remained flat and Ajovy share has actually declined within the episodic migraine segment. Approved only for the treatment of chronic migraine prevention, Allergan’s Botox has also experienced a consistent downward trend in physician-reported episodic migraine share, reflecting competition from the anti-CGRP therapies approved with broad migraine prevention labels. These drivers of Emgality growth are commercially important because analyses from Spherix’s recent RealWorld Dynamix™: Migraine Prevention (US) audit uncovered that, when comparing physician-reported estimates to actual patient-level data, physicians are vastly underestimating how much the preventive treatment of episodic migraine (especially low-frequency episodic migraine) dominates their prescribing of the anti-CGRP brands. As a result, Emgality’s superior uptake among an expanding episodic migraine candidate pool suggests the brand’s actual gains may be even bigger than specialists are aware of.
One key source of new business for Emgality may actually be discontinuation from other anti-CGRP brands as physicians report similarly high discontinuation rates for both Aimovig and Ajovy. While unconvincing efficacy is the most common reason for discontinuations regardless of anti-CGRP therapy, Aimovig is also plagued by tolerability issues and Ajovy by market access barriers. When patients have discontinued the two aforementioned brands, they were more likely to switch to Emgality next line than to a different anti-CGRP therapy, Botox, or one of the small molecule classes (i.e., topiramate, other anticonvulsants, beta blockers, etc.). Emgality may be seen as an ideal choice for these anti-CGRP failures because physicians rate Emgality insurance coverage better than the other brands, the patient support program is often selected as the best-in-market, and Emgality payer approvals are rated significantly easier to obtain compared to Ajovy. Finally, unlike with Aimovig, tolerability, specifically injection site reactions in Emgality’s case, is rarely reported as an obstacle to greater use or as a reason for discontinuation.
Spherix’s quarter-over-quarter trending of the migraine prevention market continues to stress the virtual indifference of Botox to the noise surrounding the anti-CGRP class launches, especially in the chronic migraine segment where physician-reported Botox share ties that of the entire anti-CGRP class. A major contributor to Botox resilience is the frequency of patient requests, with half of physicians reporting frequent requests for the toxin (compared to only 14% for Emgality). Supporting physicians’ perceptions on this metric, Botox-treated patient charts reviewed in the RealWorld Dynamix™: Migraine Prevention (US) audit confirm that patient requests (often based upon the personal experience of a family member, friend, or coworker) were influential in brand selection in one-third of cases. If Eli Lilly was able to harness this kind of community-based buzz for Emgality, we could foresee the day where the headline reads “Eli Lilly’s Emgality surpasses Amgen/Novartis’ Aimovig as the class leader in the migraine prevention market.” Ironically, under such a scenario, Botox would still come out ahead as patients discontinuing Emgality are more likely to switch to Botox than to another anti-CGRP agent or preventive therapy class.
About RealTime Dynamix™
RealTime Dynamix™: Migraine Prevention (US) is an independent service providing strategic guidance through rapid and comprehensive quarterly reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave. The 6th wave of research will publish in December 2019.
About RealWorld Dynamix™
RealWorld Dynamix™: Migraine Prevention (US) is an independent, data-driven service unmasking real patient management patterns through annual reports based on chart audits of ~1,000 patients treated with an anti-CGRP and/or Botox. The report uncovers the “why” behind treatment decisions, integrates specialists’ attitudinal & demographic data to highlight differences between stated and actual treatment patterns, and will include year over year trending to quantify key aspects of market evolution. This first annual report published in August 2019.
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.
Spherix was recently recognized by Philadelphia Business Journal as a 2019 Soaring 76 recipient for the fastest growing companies in the Greater Philadelphia area and by The Philadelphia Inquirer as an Entrepreneurs’ Forum 2019 Philadelphia 100® Winner for the fastest growing privately-held companies in the Greater Philadelphia area.
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