According to DRG epidemiology, more than 35 million people in the United States suffer migraines, and more than 10% of migraineurs suffer from chronic migraine (CM). Migraine prophylaxis is a core, but underused, treatment approach to reduce migraine frequency, severity, and duration in high-frequency episodic migraine and CM patients. Treatment options are primarily a mix of off-label and approved AEDs, beta blockers, and TCAs, as well as Botox (Allergan’s onabotulinumtoxinA), one of the few agents approved specifically for CM. However, given the heterogeneous patient population, chronic prophylactic treatment is individualized and can evolve over time. Understanding patient pathways and drivers of treatment decision-making is key for new players entering this large but mostly generic market.

QUESTIONS ANSWERED

  • What factors do U.S. physicians look for when determining if a patient is fit for prophylactic treatment?
  • What are the drivers and constraints influencing physicians’ treatment decisions for migraine prophylaxis?
  • How long does it take for patients to progress between lines of therapy? How are patients being treated across different lines of therapy?
  • To what extent is polypharmacy prescribed for prophylaxis, and what are physicians’ preferred drug class combinations?
  • How has the use of key prophylactic therapies changed in the past year, and what changes do physicians expect in their prescribing of these drugs in one year?
  • How do Botox (Allergan) and Trokendi XR (Supernus) compete in the generics-heavy migraine market? What drivers and constraints will aid or restrict their future use?

PRODUCT DESCRIPTION

Current Treatment:

Provides physician insights on prescribing behavior, treatment paths, and the factors and perceptions driving brand use so that you can understand each brand’s performance and improve or defend your competitive position.

Table of contents

  • Migraine - Current Treatment - Detailed, Expanded Analysis (US) : Migraine Prophylaxis
    • Key Updates
      • December 2017
        • August 2017
        • Introduction to Current Treatment for Migraine Prophylaxis
          • Key Findings
          • Introduction to Current Treatment and Medical Practice for Migraine Prophylaxis
          • Drugs Included in This Study of Current Treatment of Migraine
        • Physician Prescribing Practices
          • Key Findings
          • Patient Characteristics
            • More than Half of Migraine Patients Under Respondents’ Care Suffer from EM, and Most Are Insured
            • Distribution of Episodic and Chronic Migraine Patients in Surveyed Neurologists’ and PCPs' Practices
            • Insurance Status of Migraineurs Across Specialties
          • Treatment Practices
            • Topiramate Products, Propranolol, and TCAs Are Core Drugs for Migraine Prophylaxis
            • The Approach to Initiating Migraine Prophylaxis Is Similar Across Specialties
            • Most Neurologists and PCPs Use Both Pharmacological and Nonpharmacological Therapies When Initiating Migraine Prophylaxis
            • Migraine Frequency and Severity Are the Top Two Reasons Why Neurologists and PCPs Initiate Migraine Prophylaxis
            • Number of Migraine Days per Month Required for Neurologists and PCPs to Initiate Prescription Prophylactic Treatment
            • Neurologists Prescribe Prophylactics to a Greater Percentage of Migraineurs than PCPs Do
            • Prescription Drug Treatment Rates for Episodic and Chronic Migraineurs Being Managed by Surveyed Neurologists and PCPs
            • Top Reasons Why Some Migraineurs Do Not Receive Any Prescription Prophylactic Therapy
            • Neurologists Prescribe More Botox, and PCPs Prescribe More Propranolol
            • Treatment Patient Shares Among Prophylactically Managed EM and CM Patients Across Specialties
            • Migraineurs Typically Experience a Meaningful Therapeutic Response by One Year
            • Total Duration of Prophylactic Treatment Among EM and CM Patients Across Specialties
            • Time Needed to Achieve Meaningful Migraine Response, Across Specialties
            • Most Respondents Prescribe Prophylactic Treatment Until Patient Experiences Meaningful Improvement in Migraine or Discontinues
            • Physicians Rely on Various Lifestyle Changes and OTC Medications to Treat Migraine
            • Percentage of Physicians Who Recommend Select Nonpharmacological Approaches
            • Neurologists Tend to Prefer Topiramate and PCPs Tend to Prefer Propranolol in the First Line
            • A Sizable Percentage of Respondents’ Drug-Treated Migraineurs Are on Their First-Line Treatment
            • Percentage of Drug-Treated Migraineurs on the First Three Lines of Prescription Prophylactic Treatment
            • Time Taken by Migraineurs to Progress Between Lines of Therapy
            • Line of Therapy Analysis Shows Differences Between PCPs and Neurologists Prescribing Patterns
            • Product Patient Share by Line of Therapy Across Specialties
            •  Combination Prophylactic Regimens Commonly Include Topiramate
            • Percentage of Drug-Treated Migraine Patients Receiving More than One Prescription Treatment for Migraine Prophylaxis
            • Most Common Prophylactic Combinations for Managing Episodic Migraine Across Specialties
            • Most Common Prophylactic Combinations for Managing Chronic Migraine Across Specialties
          • Persistency and Compliance
            • Chronic Migraineurs Are Treated for Longer than Episodic Migraineurs
            • Total Estimated Duration of Treatment for Key Prophylactic Therapies in EM Patients, According to Survey Respondents
            • Total Estimated Duration of Treatment for Key Prophylactic Therapies in CM Patients, According to Survey Respondents
            • Surveyed Neurologists and PCPs Indicate a Range of Treatment Patterns in Migraine
          • Sequencing of Treatment
            • The Migraine Patient Journey Is Complex, Fluid, and Individualized
            • Most Common Scenario for Prescribing Key Prophylactic Therapies Across Specialties
            • Most Common Scenario Following Discontinuation of Key Prophylactic Therapies Across Specialties
          • Recent/Anticipated Changes in Brand Use/Treatment Approach
            • Neurologists Expect to Increase Their Use of Botox to Treat Migraines
            • Anticipated Changes in the Use of Prophylactic Therapies for EM Patients Across Specialties
            • Anticipated Changes in the Use of Prophylactic Therapies for CM Patients Across Specialties
            • Anticipated Reasons to Increase Botox Use
        • Physician Insight on Medical Practice
          • Key Findings
          • Drivers of Treatment Selection
            • Many Factors Influence Migraine Treatment
            • A Variety of Clinical and Nonclinical Factors Influence Migraine Treatment
            • Factors Influencing the Choice of Prescription Prophylactic Treatment Across Specialties
            • Factors Influencing the Choice to Prescribe Specific Prophylactic Treatments Across Specialties
            • Botox Prescription Is Mostly Driven by Failure of Prior Therapies
            • Factors Driving Prescribing of Botox for Migraine Prophylaxis Across Specialties
            • Factors Driving Prescribing of Botox for Migraine Prophylaxis Across Specialties (Mean)
            • Botox Prescription Is Often Constrained by Cost/Payer Pressures
            • Obstacles That Constrain Botox Prescribing for Migraine Prophylaxis Across Specialties
            • Obstacles That Constrain Botox Prescribing for Migraine Prophylaxis Across Specialties (Mean)
            • Most Common Reasons for Switching to Key Prophylactic Therapies Across Specialties
            • Most Common Reasons for Switching from Key Prophylactic Therapies Across Specialties
            • Concerns About Side Effects and Chronic Treatment Lead to Deferral
            • Reasons Why Neurologists and PCPs Do Not Initiate Migraine Prophylaxis Immediately
        • Methodology
          • Primary Market Research Methodology
          • Split of Board-Certified Practicing Physicians
          • Years in Practice Postresidency
          • Number of Migraine Patients Managed per Month Across Specialties
          • Number of Migraine Patients Managed per Month Across Specialties (Mean)
          • Drugs Used for Migraine Prophylaxis Across Specialties
          • Regional Distribution of Surveyed Neurologists and PCPs
          • Statewide Distribution of Surveyed Neurologists and PCPs
          • Primary Practice Locations Across Specialties
          • Percentage of Neurologists Who Identified Themselves as Headache Specialists
          • Personnel Who Administer Botox
        • Appendix
          • Bibliography
          • Key Abbreviations
          • Primary Market Research
            • Treatment Rates for Mini Prophylaxis of Menstrual Migraine
            • Patient Shares of Key Drug Classes Used for Mini Prophylaxis
            • Anticipated Reasons for Reducing Use of Botox

      Author(s): Audreza Das, P.G. Dip. ; Jonathan Searles

      Audreza Das is a Senior Analyst in the CNS/Ophthalmology team at Decision Resources Group

      She has authored content across indications, including neuropathic pain, age-related macular degeneration, treatment-related depression, painful diabetic neuropathy, and migraine. Ms. Das has previously worked at Novo Nordisk, as a Market Analyst for European markets. Previous experience at a SME, included developing disease competitive landscapes, covering global conferences etc. Ms. Das received her B.E. degree in Biotechnology from Birla Institute of Technology, a deemed university and her P.G. Diploma in Cancer Immunology & Biotechnology from University of Nottingham.

      Jonathan W. Searles is a Senior Director in the CNS/Ophthalmology unit at DRG, overseeing the neurology research stream. Prior to joining DRG, Mr. Searles received a B.A. degree, summa cum laude, from Brandeis University; during this time, Mr. Searles conducted research projects at the Harvard University Peabody Museum and at Brandeis.


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