PHILADELPHIA — Results of a survey on early prescribing patterns of emerging treatments for migraine prophylaxis indicated that clinicians anticipate decreased use of onabotulinumtoxinA and increased use of erenumab for episodic migraine treatment, according to a study presented at the 61st Annual Scientific Meeting of the American Headache Society, held in Philadelphia, Pennsylvania, July 11 to 14.

Researchers compared early launch perceptions and self-reported prescribing patterns for anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs; eg, erenumab, fremanezumab, galcanezumab) against existing standard-of-care therapies for the prevention of episodic and chronic migraine. Data were collected through a quarterly survey of 104 US neurologists and migraine/headache specialists that was distributed by an independent market intelligence agency between December 2018 and April 2019. Survey data were compared against market trends and launch benchmarks for erenumab, fremanezumab, and galcanezumab.

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Physicians surveyed indicated prescribing prophylactic treatments to 90% of their patients with chronic migraine compared with 63% of patients with episodic migraine. Preventive treatments consisted of anti-CGRP mAbs for 16.1% and 14.8% of patients with chronic and episodic migraine, respectively, with erenumab accounting for 9.0% and 7.5% of those treatments, respectively. Physicians reported estimating that erenumab (40%), galcanezumab (31%), and fremanezumab (28%) represented significant advances over onabotulinumtoxinA for migraine prophylaxis.

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Patients treated with an anti-CGRP mAb medication were found to be likely to have previous unsuccessful treatment with onabotulinumtoxinA. However, among patients for whom an anti-CGRP mAb treatment was initiated and who continued on their previous prophylactic regimen, onabotulinumtoxinA, topiramate, antidepressants and beta-blockers were common options.

Physicians also reported anticipating an increased use of anti-CGRP mAbs for migraine prevention (erenumab: chronic, +6.6%; episodic, +5.1%; fremanezumab: chronic, +4.1%; episodic, +3.1%; and galcanezumab: chronic, +4.6%; episodic: +3.8%) by May 2019, and a significant reduction in the use of onabotulinumA for both chronic and episodic migraine, with a preference for erenumab for episodic migraine prevention.

“With the availability of the new anti-CGRP mAb class, offering a unique mechanism of action and approved with a broad label, migraine prevention management and treatment patterns are evolving towards greater complexity in multi-class therapy regimens,” concluded the study authors. ”While topiramate and onabotulinumtoxinA are expected to continue to dominate in the chronic migraine market, onabotulinumtoxinA will become less relevant in the episodic migraine segment limited by its restrictive label and positive perceptions associated with the anti-CGRP mAb therapies.”


Schobel V, Robinson J. Episodic and chronic migraine prevention: Trending the first year of US adoption. Presented at: 61st Annual Scientific Meeting of the American Headache Society; July 11-14, 2019; Philadelphia, Pennsylvania. Abstract 632421.