With numerous approvals over the last few years, the migraine field—both acute treatment and prevention—has been heating up. That was clear at this year’s American Headache Society (AHS) annual meeting, where despite the virtual format, doctors were “excited” to learn more about new options, SVB Leerink analysts wrote in a note to clients.
In recent months, Biohaven’s Nurtec ODT, AbbVie's Ubrelvy and Eli Lilly’s Reyvow have launched as acute treatments, or to treat migraines as they happen. And this year, the “tone of the AHS meeting noticeably shifted toward acute therapy,” from prevention, where several CGRP drugs won approval in 2017, SVB Leerink’s Marc Goodman and his team wrote in a note to clients.
For the new acute treatments, cross-trial comparisons are “coming to the forefront” as “physicians are excited to figure out how and when to use these newly available drugs,” Goodman added.
The analysts see safety—rather than efficacy—becoming a differentiating factor for new acute drugs. Amgen’s Aimovig, the first CGRP prevention drug to launch, has more constipation burden for patients than its rivals, the analysts wrote, so doctors have responded by putting a “persistent focus” on side effects for new medicines.
The analysts also noted enthusiasm around Lundbeck’s Vyepti in migraine prevention, even though it’s the only IV-administered med in the CGRP class so far. The med, which launched amid the COVID-19 pandemic, helped reduce patients’ migraines as early as day one, and the benefit was seen for 12 weeks, the analysts wrote.
“We think payers also will be particularly interested in the onset of effect and ability to sustain the magnitude of efficacy for a longer period of time, as this could lead to a reduction in migraine burden to the patient and to the medical system,” the analysts wrote.
When the drug won its FDA approval, some analysts predicted its less convenient IV formulation would keep it in the “niche” category. But a Lundbeck executive argued it's “not overly burdensome” to have a 30-minute infusion every three months. Plus, he said, many doctors see migraine prevention patients typically once per quarter, so the dosing schedule “fits nicely” with current practices, he argued.
Coming out of the AHS meeting, the analysts wrote that they’re “incrementally more positive” around the prospects for therapies from Biohaven, Lundbeck and Satsuma, which is advancing the late stage drug STS101 in acute migraine.