Spherix Global Insights

June 13, 2020

Trending the First Two Years of Anti-Calcitonin Gene-Related Peptide Class Availability for Migraine Prevention: Results from an Independent Quarterly US Survey of Neurologists and Migraine Specialists

Authors: Virginia R. Schobel, MSc; Kristen Henn, MHSc; Jennifer Robinson

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Multiple anti-calcitonin gene-related peptide (CGRP) therapies have recently been approved for the prevention of episodic and chronic migraine, including erenumab-aooe (available since May 2018), fremanezumab-vfrm (September 2018), and galcanezumab-gnlm (October 2018). Approved in February 2020, eptinezumab introduced a fourth preventive therapy to the anti-CGRP class. The purpose of this research was to trend preventive therapy share and assess impact of anti-CGRP class uptake on onabotulinumtoxinA, approved only for the prevention of chronic migraine, over the first two years of availability.

Quarterly online survey with ~100 US neurologists and migraine/headache specialists fielded by an independent market intelligence firm. Seven quarters of physician-reported share data will be available at presentation (July 2018-February 2020). Attribute importance and brand performance ratings are assessed each November.

In February 2020, physicians reported significantly more chronic migraine patients being treated with an anti-CGRP (31% vs. 26%; p<0.05) and/or onabotulinumtoxinA (25% vs. 11%; p<0.05) compared to episodic migraine patients (Figure 1). Anti-CGRP class share for the episodic migraine segment increased significantly over the prior six months (May 2019: 19%; p<0.05), driven predominantly by increased galcanezumab use (Feb 2020: 10% vs. May 2019: 4%; p<0.05; Figure 2). Conversely, class share growth for the chronic migraine segment was nonsignificant over the same time period (May 2019: 27%), with significant growth among the anti-CGRP agents limited to galcanezumab (Feb 2020: 10% vs. May 2019: 7%; p<0.05; Figure 3). Prelaunch, 54% of physicians anticipate initial trial of eptinezumab within the first six months of availability (Figure 4). Since July 2018, reported onabotulinumtoxinA shares for episodic and chronic migraine segments have remained flat (Figure 1). When selecting a preventive therapy for migraine patients, “high responder rate” (i.e., patients experiencing ≥50% decrease in monthly migraine days) was the only attribute rated significantly more important in physicians’ decision-making process compared to Nov 2018 (8.74 vs. 8.27 on 10-point scale; p<0.05; Figures 5 and 6). The individual anti-CGRP therapies were more likely to be rated as performing well (i.e., 8-10 on 10-point scale) on “high responder rate” by physicians compared to onabotulinumtoxinA (50-53% vs. 39%; Figure 7). In February 2020, more physicians agree (42%) than disagree (27%) that the responder rate observed with anti-CGRP therapies is superior to that achieved with onabotulinumtoxinA (Figure 8). Mean performance rating for galcanezumab increased significantly over the past year (7.13 vs. 6.74; p<0.05); the mean ratings for the other therapies remained stable (Figure 9).

During the second year of availability, anti-CGRP class use has increased significantly among patients diagnosed with episodic migraine, likely driven by a desire to prevent migraine chronification. Preferential uptake of galcanezumab, the only agent with data for multiple response rates (i.e., ≥50%, ≥75%, ≥100%) in its label, could be tied to the increasing importance of high responder rates when selecting a therapy. Eptinezumab, a once-quarterly infusion anti-CGRP, could introduce greater competitive pressure on onabotulinumtoxinA share, specifically in the chronic migraine segment.

Kristen Henn and Virginia R. Schobel are employees of Spherix Global Insights, an independent market intelligence firm and have 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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