The migraine market stands on the verge of a renaissance; new and exciting therapies targeting the CGRP peptide could reach the market beginning in 2018. Two broad types of approaches are in final stages of development: monoclonal antibodies (MAbs) against CGRP or the CGRP receptor, and oral inhibitors of the CGRP receptor. Teva, Lilly, Alder, Amgen, and Novartis are developing MAbs for the prophylactic treatment of migraine; meanwhile, Allergan and Merck are developing oral inhibitors against the CGRP receptor for the preventative and acute treatment of migraine. With the imminent release of Phase III data and unique value propositions, how will neurologists view and incorporate an array of CGRP-targeted therapies? How would these compete with the numerous generics on the market and Botox?

QUESTIONS ANSWERED

  • How will migraine prophylaxis change with the launch of the CGRP-targeted therapies? In which lines of therapy and patient types do neurologists anticipate using these agents?
  • How might neurologists use anti-CGRPMAbs versus oral inhibitors in the migraine prophylaxis treatment algorithm? What are neurologists’ views of the two therapeutic approaches?
  • Which of the CGRP-targeted MAbs do surveyed physicians find most promising? How do surveyed neurologists believe these agents compare with Botox, and how will Botox use change?
  • What are neurologists’ views on oral CGRP antagonists in development? How burdensome do surveyed neurologists expect prescribing restrictions on these agents to be?

PRODUCT DESCRIPTION
Special Topics: Primary market research studies providing physician insights on trends and events affecting the broader industry to help you better anticipate your competitive position.

Table of contents

  • Migraine - Emerging Therapies - Special Topics (US): CGRP-Targeted Therapies For The Treatment Of Migraine
    • Executive Summary
      • Background
      • Key Findings
    • Migraine Prophylaxis Today: Key Points, Factors, and Considerations
      • Percentage of Diagnosed Migraine Patients Receiving Prescription Migraine Treatment
      • Patient Share of Current Therapies for Migraine Prophylaxis
      • Top Reasons Why Surveyed Neurologists Do Not Prescribe More Botox
      • Factors Influencing the Likelihood to Prescribe a New Migraine Prophylaxis Therapy
      • Top Safety and Tolerability Concerns with Current Migraine Prophylaxis Therapies
      • Migraine Patients' Sensitivity to Out-of-Pocket Costs
      • Out-of-Pocket Cost Burden of Current Therapies for Migraine Prophylaxis
    • Anti-CGRP Monoclonal Antibodies
      • Anti-CGRP MAb Profiles
        • Drug Profile: Amgen/Novartis's Erenumab
        • Drug Profile: Alder BioPharmaceuticals' Eptinezumab
        • Drug Profile: Teva's Fremanezumab
        • Drug Profile: Eli Lilly's Galcanezumab
      • Physician Perceptions
        • Selecting Among Anti-CGRP MAbs
        • Neurologists’ Expectations and Definitions of Clinically Meaningful Reductions in Migraine Days/Month
        • Clinical Importance of a One-Day Difference in Reduction in Migraine Days/Month Among Drugs
        • Impact of a One-Day Difference in Reduction of Migraine Days/Month in Drug Choice
        • Factors Influencing Anti-CGRP MAb Selection for Migraine Prophylaxis
        • Neurologists' Preference Among Late-Phase Anti-CGRP MAbs
        • Neurologists’ Preference for Specific Anti-CGRP MAbs
        • Preferred Anti-CGRP MAbs for EM and CM Patients
        • Top Reasons for Selecting Each Anti-CGRP MAb for EM
        • Top Reasons for Not Selecting Each Anti-CGRP MAb for EM
        • Top Reasons for Selecting Each Anti-CGRP MAb for CM
        • Top Reasons for Not Selecting Each Anti-CGRP MAb for CM
        • Neurologist Perceptions on Various Clinical and Nonclinical Treatment Attributes
        • Statement Agreement: Neurologist Opinion on Clinical and Nonclinical Aspects of Anti-CGRP MAbs
        • Anticipated Improvements That Anti-CGRP MAbs May Offer Over Key Current Therapies
        • Therapeutic Value of Targeting the CGRP Receptor vs. CGRP Molecule
        • The Impact of a Lack of Phase III Data on Neurologists’ Perception of Erenumab’s Efficacy in CM
        • Unaided Long-Term Safety Concerns of Anti-CGRP MAbs
        • Anticipated Patient Compliance with the Anti-CGRP MAbs Compared with Current Options
        • Reasons for Anticipating Better Compliance with the Anti-CGRP MAbs Over Current Therapies
        • Neurologist Opinion of the Most Burdensome Reimbursement Restrictions to Face When Prescribing Anti-CGRP MAbs
      • Anticipated Use
        • Anticipated Use of Anti-CGRP MAbs in the Migraine Prophylaxis Treatment Algorithm
        • Statement Agreement: Neurologist Opinion on the Impact of Anti-CGRP MAbs on Awareness, Diagnosis, and Treatment
        • Maximum Percentage of Migraine Patients Who Would Receive an Anti-CGRP MAb
        • Migraine Patients Most Likely to Receive an Anti-CGRP MAb
        • Impact of Clinical Trial Enrollment Criteria on Neurologists’ Prescribing of Anti-CGRP MAbs
        • Probable Use of Anti-CGRP MAbs in the Treatment Algorithm
        • Drug Classes Likely to Be Prescribed Ahead of Anti-CGRP MAbs
        • Anticipated Changes in Medical Practice Following the Launch of Anti-CGRP MAbs
        • Expected Change in Migraine Prophylaxis Drug-Treatment Rates by 2020
        • Anticipated Patient Share of Migraine Prophylaxis Therapies in 2020
        • Reasons for Prescribing Anti-CGRP MAbs to Fewer EM Patients Than Botox
        • Reasons for Prescribing Anti-CGRP MAbs to Fewer CM Patients Than Botox
      • Neurologists' Feedback on Delivery as a Driver
        • Patient Preferences for Drug Delivery Options
        • Physician Opinion of Once-Monthly vs. Once-Quarterly Dosing
        • Physician Perceptions on the Use of an IV Therapy for Migraine Prophylaxis
        • Neurologists' Opinion of Anti-CGRP MAb Delivery Methods vs. Current Therapy Options
    • Oral CGRP Antagonists
      • Drug Profile: Allergan's Atogepant
      • Maximum Percentage of Migraine Patients Who Would Receive Atogepant
      • Neurologists’ Reasons for Prescribing Atogepant to More Patients Than Anti-CGRP MAbs
      • Probable Use of Atogepant in the Treatment Algorithm
      • Drug Classes Likely to Be Prescribed Ahead of Atogepant
      • Likelihood of Atogepant Use in Combination with an Anti-CGRP MAb
      • Likelihood of Ubrogepant Use in Combination with a CGRP-Targeted Prophylactic Therapy
      • Neurologists' Level of Concern for Prescribing CGRP-Targeted Therapies in Combination
    • Anti-CGRP MAbs and Cluster Headache
      • Neurologists’ Average Number of Cluster Headache Patients Under Clinical Management
      • Drug-Treatment Rates for Cluster Headache in 2017 and 2020
      • Percentage of Neurologists Who Prescribe Common Migraine Prophylactic Drugs for the Prevention of Cluster Headache
      • Neurologists’ Perception of the Effectiveness of Anti-CGRP MAbs for Cluster Headache Prevention vs. Current Off-Label Options
      • Current Off-Label Therapies Most Likely to Be Replaced by Anti-CGRP MAbs in Cluster Headache Prevention
    • Methodology
      • Primary Market Research Methodology
      • Years in Practice Post-Residency
      • Primary Practice Locations
      • Regional Distribution of Surveyed Neurologists
      • Statewide Distribution of Surveyed Neurologists
      • Percentage of Neurologists Who Identified Themselves as Headache Specialists
    • Appendix
      • Bibliography
      • Key Abbreviations
      • Average Number of Migraine Patients Treated or Managed per Month
      • Surveyed Neurologists' Familiarity with CGRP-Targeted Therapies
      • Percentage of Surveyed Neurologists’ Diagnosed Migraine Patients Who Suffer EM and CM
      • Patient Share of Current Therapies for Migraine Prophylaxis, by Specialist
      • Maximum Percentage of Migraine Patients Who Would Receive an Anti-CGRP MAb, by Specialist
      • Expected Change in Chronic Migraine Prophylaxis Drug-Treatment Rates by 2020, by Specialist
      • Expected Change in Episodic Migraine Prophylaxis Drug-Treatment Rates by 2020, by Specialist
      • Anticipated Patient Share of Migraine Prophylaxis Therapies for CM in 2020, by Specialist
      • Anticipated Patient Share of Migraine Prophylaxis Therapies for EM in 2020, by Specialist
      • Maximum Percentage of Migraine Patients Who Would Receive Atogepant, by Specialist
      • Percentage of Surveyed Neurologists Who Treat Cluster Headache Patients
      • Maximum Percentage of Cluster Headache Patients Who Would Receive an Anti-CGRP MAb
      • Percentage of Diagnosed Cluster Headache Patients Receiving Prescription Therapies
      • Drug-Treatment Rates for Cluster Headache in 2017 and 2020, by Specialist

Author(s): Angela Sparrow, Ph.D.

Angela Sparrow provides expert insight and authors primary market research and forecasting content as a member of the Central Nervous System and Ophthalmology Team. During her time with the company, Angela has extensively covered migraine, contributing to numerous reports while staying up-to-date on the latest trends and news. Additionally, she provides detailed responses to client inquiries and has authored content focused on psychiatric indications, including opioid addiction and depression, as well as neuropathic pain.

Dr. Sparrow holds a Ph.D. in behavioral neuroscience from the University of North Carolina at Chapel Hill and a Bachelor’s degree from Northeastern University. Before joining DRG, she was a postdoctoral fellow at McLean Hospital, Harvard Medical School, studying the role of kappa opioid receptors in addiction and withdrawal-induced depression.


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