The migraine market stands at the brink of transformation. In the much talked about prevention space, three anti-CGRP MAbs—Aimovig, Ajovy, and Emgality—reached the U.S. market this year (with European entries soon to follow). A fourth from Alder Biopharmaceuticals (eptinezumab) will launch by 2020, and an oral CGRP modulator from Allergan (atogepant) is expected in 2022. DRG’s migraine experts spent 2018—and will spend much of 2019—sizing, tracking, and unpacking the market for migraine preventives through primary research with neurologists, PCPs, payers, U.S. RWD analysis, and forecasting.
Key findings from DRG’s 2018 migraine research:
- The first wave of our one-year U.S. launch-tracking series on Aimovig indicated robust physician adoption at just one month postlaunch and portends strong uptake relative to SOCs, while our recent U.S. access & reimbursement research finds newness and coverage challenges are key obstacles to uptake.
- In advance of widespread availability of the MAbs in Europe, DRG primary research finds an EU5 market primed for new alternatives.
- In our refreshed, patient-based, market model, we predict G7 sales will exceed $5 billion in 2027 for CGRP-targeted preventives, sparking over 10% annual growth and nearly quadrupling of the prophylaxis segment, which today is dominated by generics.
- We forecast another $3 billion will be added as new brands enter the acute treatment space, including NMEs targeted to underserved patient niches (e.g., Eli Lilly’s lasmiditan, Allergan’s ubrogepant, and Biohaven’s rimegepant) and novel reformulations.
- Our upcoming launch-tracker on Ajovy and Emgality will assess how these next-to-market alternatives compete through 2019, and how—in physicians minds—they compare on key metrics to first-mover Aimovig.
The “so what” for decision makers:
As these uber-tight races in the migraine space unfold, commercial success will hinge on differentiation and access. The next 12-18 months will be critical for the anti-CGRP MAbs in the United States and Europe. In that time, physician comfort and familiarity will grow, product messaging will evolve, patient preferences will crystalize, and coverage decisions will unroll. As the most underserved migraineurs seek out treatment with the latest new preventives, cost-concerned payers will likely try to control the ensuing budget impact. In this new landscape, understanding the driving forces in this market will be critical to optimizing the market positioning for each entrant and gauging long-term revenue and share potential. The same holds true for new brands entering for the saturated acute migraine market, replete with generic triptans.
Key questions answered in DRG’s new migraine research:
- Will Aimovig, Ajovy, or Emgality win out in the short term? What clinical and nonclinical factors underlie that success?
- What clinical, pharmacoeconomic, and contracting-related factors will most impress U.S. payers and spur preferred coverage for new brands?
- As IV eptinezumab and oral atogepant launch, which among the CGRP preventives will dominate the market in the next decade? What impact will they have on the use of Botox, the only other significant brand in this segment?
- What market and patient share can be expected for new non-triptan alternatives that will soon enter the acute migraine segment?
Markets covered: G7
Methodology: Primary research, secondary research, patient-based market forecasting
Key indications covered: Migraine (acute and prophylaxis)
Key drugs covered: Aimovig, Ajovy, Emgality, eptinezumab, atogepant, Botox, ubrogepant, rimegepant, lasmiditan, triptans
Key companies mentioned: Novartis, Amgen, Eli Lilly, Allergan, Teva, Alder Biopharmaceuticals
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