Amgen, Teva and Eli Lilly may be racing to scoop up market share in the new CGRP field of migraine prevention drugs, but Allergan executives say they're not worried the new drug class will hurt their market share for Botox, which is used to help patients who suffer from chronic migraines.
So far, after months on the market for CGRPs from Amgen, Teva and Eli Lilly, Allergan has “not experienced a visible impact” in demand for Botox, Chief Commercial Officer Bill Meury said on the company’s fourth-quarter conference call Tuesday. In fact, Botox has held a 50% share of new patient starts since Aimovig, Amgen's entrant, launched last year, Meury said.
As Allergan sees it, Botox and newly approved CGRP drugs will “coexist in a much larger market” that's still growing, Meury said. The Allergan exec predicted mid- to high-single-digit growth for Botox in the treatment area this year.
“It's too early to call this, but the business looks very healthy right now,” Meury said.
Since its first-to-market launch in May, Aimovig has taken off the most among drugs in the new class. At the J.P. Morgan Healthcare Conference in San Francisco, Amgen CEO Bob Bradway said about 150,000 patients had started on the drug. However, speaking with analysts on Tuesday, Meury estimated only 2% of those patients were switched from Botox.
Botox is approved for patients who suffer from chronic migraines, or migraines 15 or more days per month. CGRP drugs don't carry that stipulation, so many patients with episodic migraines, or less than 15 migraine days per month, have started on the newer drugs.
Allergan’s CEO Brent Saunders also voiced confidence in Botox against the new competition on Tuesday's call. While Wall Street and pharma watchers are excited about the new CGRP launches, headache specialists see CGRP drugs as “just another tool," he said. Doctors “will select for their patients as they feel appropriate between the two therapies,” Saunders added.
Earlier this month, Bernstein analyst Ronny Gal pointed out the 50/50 split between Botox and CGRP patient starts and asked Allergan to confirm as the trend "sounded odd," he wrote in a note. Sure enough, Botox had been outpacing Aimovig in recent weeks, Allergan representatives told the analyst. Even with that considered, Gal wrote that it "seems unlikely that Botox is adding patients as fast as the new class."
"One could conceive a scenario where patients hearing about CGRP go to the physician and once presented with their options, pick Botox," Gal wrote. "If that is the case, even if the magnitude is lower, it would be significant upside to Botox expectations in 2019."
Partners Amgen and Novartis won the first CGRP approval for Aimovig back in May, and Teva and Eli Lilly followed up with September FDA nods for Ajovy and Emgality, respectively. Teva and Lilly haven’t reported fourth-quarter sales, but Amgen reported $119 million in Aimovig sales in 2018.
Meanwhile, Botox therapeutic remains an important product for Allergan. The company reported $1.64 billion in therapeutic sales for Botox in 2018, up 13.4% over 2017. The sales figure includes other indications for Botox as well as migraine.