Therapy Trends KOL Insight: Migraine [2019]

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Publication Date:
February 2019
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How will anti-CGRP monoclonal antibodies influence the current treatment paradigm?

Significant unmet needs exist in the migraine market as a high percentage of patients do not respond to current treatments. Key opinion leaders (KOLs) discuss how migraine is presently treated, and how this is likely to change in the near-future. Have the recently launched anti-CGRP monoclonal antibodies (Aimovig, Ajovy and Emgality) had any impact on the treatment paradigm? How are the oral CGRP receptor antagonists, in late-stage development, expected to fare as preventative and therapeutic options? And is lasmiditan a potential threat to the well-established triptans?

Learn how KOLs see the market evolving, and how they expect developers to differentiate their marketed and pipeline therapies in Therapy Trends KOL Insight: Migraine. Twelve of the world’s most prominent KOLs provide their candid insights on four marketed products, five Phase III pipeline programmes and one Phase II agent.

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Top takeaways

  • What are the major unmet needs in migraine treatment? What are KOLs’ frustrations when treating migraine and what are the current limitations of available therapies?
  • How do KOLs expect to use newer calcitonin gene related peptide (CGRP) antagonists for the treatment of migraine? Are KOLs excited about these products and how clinically attractive are they?
  • What are KOLs’ opinions on the long-term safety of blocking CGRP for the treatment of migraine? Do they have any concerns regarding this mechanism of action?
  • Which of the four monoclonal anti-CGRPs holds most promise for migraine? According to KOLs, will one of these drugs come out on top?
  • How do KOLs compare oral gepants and lasmiditan with well-established triptans? Will oral gepants or lasmiditan be a threat to current triptans?
  • How do KOLs expect the treatment paradigm of migraine to evolve in the future? Will triptans remain the second-line therapy of choice in acute treatment and will  monoclonal anti-CGRPs challenge Botox in the prevention of migraine?
  • What advice do KOLs have for companies developing migraine treatments? What should companies be doing in order to facilitate treatment choice?
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“With triptans, about 40 percent of the patients get headache-free in two hours. That is not enough. Half of the patients do not reach this endpoint. More patients should be headache-free.”
EU Key Opinion Leader

“We want a treatment that works quickly at any stage of the migraine attack. The main objective is to get a patient back to being able to work and continue at their routine daily activities without relapse of the symptoms.”
EU Key Opinion Leader

Sample of therapies covered

Marketed Therapies

  • Botox (onabotulinum toxin A; Allergan)
  • Aimovig (erenumab; Amgen/Novartis)
  • Emgality (galcanezumab; Lilly)
  • Ajovy (fremanezumab;Teva)

Pipeline Therapies

  • lasmiditan (Lilly)
  • eptinezumab (Alder BioTherapeutics)
  • ubrogepant (Allergan)
  • atogepant (Allergan)
  • rimegepant (Biohaven)
  • AMG 301 (Amgen)

KOLs interviewed

KOLs from North America

  • Charles E. Argoff. Professor of Neurology at Albany Medical College, and Director of the Comprehensive Pain Center at Albany Medical Center, New York, NY
  • Andrew Charles. Professor of Neurology and Meyer and Renee Luskin Chair in Migraine and Headache Studies at the UCLA School of Medicine, Los Angeles, CA, and executive board member of the American Headache Society
  • Michael J Marmura. Assistant Professor of Neurology, Department of Neurology, Jefferson Headache Clinic, Thomas Jefferson University, Philadelphia, PA
  • Alan M. Rapoport. Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA, Los Angeles, CA, and immediate Past President, The International Headache Society
  • Stewart Tepper. Professor of Neurology at the Geisel School of Medicine at Dartmouth, Director of the Dartmouth Headache Center, Lebanon, NH, and a board member of the American Headache Society
  • Anonymous US KOL

KOLs from Europe

  • Peter Goadsby. Professor of Neurology, King's College London, Director, National Institute for Health Research-Wellcome Trust Clinical Research Facility, King's College Hospital, London, and Chair of the British Association for the Study of Headache, U
  • Fayyaz Ahmed. Consultant Neurologist and Hon. Senior Lecturer at Hull and Yorkshire Hospitals NHS Trust and Hull York Medical School, UK
  • Anne MacGregor. World leader in the link between the menstrual cycle and migraine. Doctorate in Medicine from the University of London and a Masters in Medical Education from the Royal College of Physicians and University College London, and is an honorary professor at the Centre for Neuroscience and Trauma, the Blizard Institute of Cell and Molecular Science and Barts and the London School of Medicine and Dentistry, UK
  • Norbert Nighoghossian. Professor and Consultant at the department of Neurology, University Hospital of Lyon and lecturer at Pierre Wertheimer Hospital, Lyon, France
  • Anonymous German KOL. Professor of Neurology, and head of a leading German migraine and headache clinic
  • Anonymous German KOL. Professor of Neurology, and head of a leading German migraine and headache clinic

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