Gepants and monoclonal antibodies (mAbs) against calcitonin gene-relate peptide (CGRP) have transformed the treatment paradigm for migraine. However, despite a growth in the number of therapies available to address the clinical unmet needs in migraine, key environmental unmet needs remain. Based on results from a high-prescriber survey conducted by GlobalData, across the seven major markets (7MM: US, France, Germany, Italy, Spain, UK, and Japan), on average, only 49% of those with migraine have been diagnosed. Closing the diagnosis gap is imperative for improving migraine treatment.
In the past three years, seven agents targeting CGRP have launched in the US, offering acute and prophylactic treatment of migraine: Teva’s Ajovy (fremanezumab), Eli Lilly’s Emgality (galcanezumab), Lundbeck’s Vyepti (eptinezumab), Amgen’s Aimovig (erenumab), AbbVie’s Ubrelvy (ubrogepant), Biohaven’s Nurtec (rimegepant), and AbbVie’s Qulipta (atogepant). The availability of these drugs has addressed a significant amount of unmet need in the market as they are well tolerated, produce freedom from headache, and/or reduce the mean number of monthly migraine days. Furthermore, unlike the triptans, the gepants and mAbs against CGRP are not contraindicated in patients with or at risk of cardiovascular disorders.
Despite the availability of treatments that can effectively provide headache relief and prevent migraine attacks, the majority of patients remain undiagnosed. Key opinion leaders (KOLs) interviewed by GlobalData noted that physician education and awareness of migraine in the general population were the biggest hurdles for effective migraine treatment. The low diagnosis rate originates from a variety of factors including a lack of knowledge among physicians and an insufficient consultation time allowed for patient history-taking. Additionally, migraine is often misdiagnosed due to the absence of a specific diagnostic test and the similarity of migraine to other indications such as tension-type headache. Misdiagnosis can result in patients potentially taking medication that is not specific for their type of attack, which may actually make symptoms worse.
Furthermore, due to easily accessible over-the-counter (OTC) painkillers, patients can be resistant to consulting a medical professional. As a consequence, patients may remain unaware of the superior therapeutic options available and fail to seek out care from primary care physicians, neurologists, or headache specialists when appropriate. OTC non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol/acetaminophen are less efficacious in aborting migraine headaches compared to migraine-specific acute treatments such as the triptans, ergot alkaloids, gepants, and ditans. They also cannot act as preventative therapy like certain gepants and the CGRP-targeting mAbs. Moreover, overuse of NSAIDs and paracetamol/acetaminophen can induce medication-overuse headaches.
Although recently launched drugs targeting CGRP may have rekindled some interest in the migraine therapeutic area among clinicians and patients, increased outreach regarding disease awareness and education is necessary to ensure these drugs are accessible to the patients in need. These initiatives could help boost diagnosis rates and accuracy, in turn increasing specialist-prescribed treatment and improving disease management.