Ajovy's lack of an autoinjector may not be an obstacle for the brand as neurologists and migraine specialists report a sizeable percentage of patients treated with Amgen/Novartis' Aimovig and Eli Lilly's Emgality choosing to use the prefilled syringe option over the heavily promoted Aimovig SureClick and Emgality Pen devices.
EXTON, Pa., March 25, 2019 /PRNewswire/―With the 2018 launches of the new class of anti-calcitonin gene-related peptide (CGRP) therapies, specifically Amgen/Novartis' Aimovig, Teva's Ajovy, and Eli Lilly's Emgality, for the prevention of migraine, the preventive treatment rate of chronic migraine has increased significantly compared to six months ago. In the current wave of the ongoing quarterly RealTime Dynamix™: Migraine Prevention (US) report series, US neurologists and migraine specialists (n=99) report that the vast majority of their patients with chronic migraine are now treated with at least one preventive therapy, while the treatment rate for the prevention of episodic migraine has remained unchanged. The relatively low episodic treatment rate is due to low unmet perceptions driven by a belief that such patients have migraine characteristics (i.e., frequency, severity, duration) that do not meet the criteria for preventive therapy and/or their migraines are adequately controlled with acute therapy. Among patients treated with preventive migraine therapies, the segment share leaders remain topiramate for episodic migraine and topiramate and Allergan's Botox for chronic migraine. However, not for long, as the chronic migraine treatment pattern is projected to shift within the next six months as anti-CGRP class share, with Aimovig in the lead, overtakes both Botox and topiramate shares.
Following an explosive launch, Aimovig uptake, now dependent upon deeper adoption among a nearly ubiquitous prescriber base, has slowed with nonsignificant share gains among both episodic and chronic patients over the last three months. Instead, this past quarter was dominated by the trial and uptake of the later anti-CGRP entrants, with Ajovy outpacing Emgality across physicians' brand perceptions and prescribing volume even though the launches differed by only a few weeks. Teva is considered top-of-class across multiple physician and patient support metrics, including best sales/medical affairs team and exceeding physicians' expectations on sales representatives, patient support program, and field reimbursement support. In addition, Ajovy's recent detailing rate is already similar to that reported for Aimovig providing Teva with a platform to educate physicians on the brand's clinical profile, including the quarterly dosing option that differentiates the brand from its anti-CGRP competitors, and support programs. Further analysis revealed that physicians who believe that Teva is supporting their migraine prevention therapy with the best sales and medical affairs team report significantly higher Ajovy shares for both the episodic and chronic migraine segments compared to physicians who select the teams from Allergan, Amgen, Novartis, or Eli Lilly. In fact, Ajovy was their class-leading anti-CGRP therapy, surpassing even Botox in episodic migraine, emphasizing the vital importance of a strong promotional and support infrastructure to drive competitive success in the migraine prevention market.
Interestingly, Ajovy's lack of an autoinjector may not be as great of an obstacle as previously thought. Although launched with autoinjectors, almost one-quarter of recent Aimovig- and Emgality-treated patients are reported to be using the alternatively available prefilled syringe option for drug administration, suggesting that there is a subset of patients who would benefit from or be more comfortable with the prefilled syringe. Indeed, less than 10% of physicians mention the prefilled syringe as the primary barrier to Ajovy use, and Teva nets out positively on meeting physicians' expectations on Ajovy's injector device.
That being said, even when Ajovy is chosen as the best anti-CGRP therapy for a patient, concerns related to Ajovy's unique quarterly dosing may be hampering the selection of the extended dosing option. Previously, Teva has reported that between 10%-11% of Ajovy prescriptions (or 30% of Ajovy-treated patients) are prescribed the quarterly dosing. However, Spherix data suggest that the use of the extended dose among the most recent Ajovy-treated patients may be only half that number. Concerns over having to administer three consecutive injections with the prefilled syringe or related to waning durability of benefit over the three months are the most common barriers to expanded use of the quarterly dosing. Some physicians also highlight that the once-monthly dosing is easier for patients to remember reinforcing greater compliance. While message recall from recent Ajovy details shows that Teva is prominently promoting the unique dosing flexibility, representatives need to be prepared to address the above objections, especially as the availability of quarterly dosing does not positively influence willingness to prescribe for the majority of physicians.
Unconvincing efficacy, the most common driver of discontinuations across all of the brands, could be a significant risk to continued adoption of the anti-CGRP therapies. With the highest current discontinuation rate, lack of convincing efficacy was the primary driver of almost half of Aimovig discontinuations. However, the majority of Aimovig failures went on to switch to a different anti-CGRP therapy (typically Ajovy). A similar pattern was seen for Emgality failures. Thus, although the therapeutic target is the same between brands, physicians' self-reported switching patterns indicate optimism that a patient could have different response to the anti-CGRP brands due to differences in antibody structure and mechanisms of action. In the upcoming RealWorld Dynamix™: Anti-CGRP Switching in Migraine Prevention (US) patient audit, Spherix Global Insights will further analyze real-world switch patterns among patients recently switched to or from an anti-CGRP brand in order to understand switch drivers and reasons for brand selection, especially within the anti-CGRP class.
RealTime Dynamix™: Migraine Prevention (US) is an independent report series published on a quarterly basis. The series provides a close-quarters analysis of key performance metrics, focusing on brand gains and losses, industry contact rates, familiarity and adoption patterns of recently launched products (e.g., Aimovig, Ajovy, and Emgality) and awareness of products in development. Product perceptions, disease awareness and attitudes, practice management and other topics are rotated throughout the year to provide an ongoing probe of the crucial drivers of change. The next wave of research will be published in June 2019.
RealWorld Dynamix™: Anti-CGRP Switching in Migraine Prevention (US) blends attitudinal and demographic physician survey data with patient record data to uncover how practice type and setting and certain beliefs influence the treatment pathway and to understand how marketed anti-CGRP therapies are being used by physicians and for what patient types. The report also captures physician's perspectives about products in development and the impact they will have on the current treatment paradigm for migraine prevention. The inaugural audit will publish August 2019.