Buckle up AbbVie, Amgen: Biohaven's oral CGRP drug is gaining traction in migraine, doctors' survey shows

With recent FDA approvals, the race for supremacy in migraine treatment is heating up among oral CGRP inhibitors, and a doctors’ survey is offering an early look at the winners.

Biohaven’s Nurtec ODT is pulling away from AbbVie’s Ubrelvy in the acute treatment of migraine, Piper Sandler analyst Christopher Raymond noted based on a survey of 99 U.S. primary care doctors. In the migraine prevention field, Nurtec and AbbVie’s newly approved Qulipta could pressure the growth potential of their injectable peers, the survey showed.

The feedback from primary care doctors mirrors similar findings from a recent survey Piper Sandler did among neurologists. Based on the results, Raymond projects Nurtec could reach $1.38 billion in 2023 sales, compared with $769 million for Ubrelvy and $437 million for Amgen’s under-the-skin injectable, Aimovig. He’s also bullish on Qulipta’s opportunity, having pegged its 2023 sales at $735 million, way above Wall Street consensus of $370 million.

For now, Nurtec has captured 16% of market share among primary care doctors for acute treatment of migraine, up from 13% in Piper’s last survey. In contrast, Ubrelvy’s share stayed flat at 13% between the two polls. The gap between the two meds is only going to widen; looking ahead, doctors expect the Biohaven drug to capture 21% of acute share by the first quarter of 2022, versus 14% for Ubrelvy.

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Prevention of migraine represents a more crowded field, where several injectable and infusion CGRP agents are also competing. But there, primary care doctors are already using Nurtec in 12% of both episodic and chronic prevention patients, above Aimovig, which is the leading injectable CGRP agent.

Primary care doctors appear to use Nurtec more often than specialists, Raymond noted. But both groups of physicians expect Nurtec’s prevention share will grow from its current level.

Two-thirds of doctors said that Nurtec’s dual indications for both prevention and acute treatment offer patients convenience and simplicity, the survey showed. But at the same time, 44% of doctors said they’re concerned that patients may run out of medication if using the same drug for the two settings, given quantity limits.

Compared with primary care doctors, neurologists appear to more often use Nurtec only as an acute therapy. Raymond suspects the gap likely stems from the differences in the kind of patients who would seek care from a specialist versus a primary care doctor. But he also thinks this reflects primary care doctors’ preference for oral, dual-indication therapies and therefore questions whether Qulipta will be as welcomed among these physicians. Qulipta is only approved for migraine prevention.

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Piper Sandler conducted the survey with Spherix Global Insights a few weeks ahead of Qulipta’s FDA go-ahead in late September. When asked to project each drug’s prevention share by first-quarter 2022, physicians reported only a small disruption for Nurtec if Qulipta reaches the market, putting Biohaven med’s at a 17% share without the AbbVie option or 16% in the case of the competitive launch.

However, Raymond noted Qulipta’s label, with specific mention of several side effects such as constipation, was less favorable than expected.

“We think Nurtec’s relatively clean label and simpler dosing for acute and prevention ([Qulipta] has multiple dose options) will offer an advantage among PCP prescribers and thus expect that Nurtec will remain the preferred oral CGRP in the prevention space,” Raymond wrote in a Friday note.