The migraine market has been stagnant for a number of years with very few novel therapies entering either the acute or preventative space.
The majority of drugs are genericised across the seven major markets (7MM) of the US, France, Germany, Italy, Spain, the UK, and Japan. The only exception is Pfizer’s Relpax, which sees its patent expire globally this year.
Figure 1: Global Sales in the Migraine Market from 2016 to 2026 Split by Drug Class
According to GlobalData’s upcoming Migraine PharmaPoint report, the 2016 market was worth $3.26bn in the 7MM. The majority of these sales were generated from the triptan market, which contributed $2.05bn, as seen in Figure 1.
The late-stage pipeline has three new classes of drugs across both the acute and preventative segments that have all been developed with novel mechanisms of action. They are also expected to address long-standing unmet needs and revolutionise the market.
In the acute segment, a ditan (Eli Lilly’s lasmiditan) and a gepant (Allergan’s ubrogepant) are expected to be launched in the next five years. Both of these drugs are superior to triptans due to an improved safety profile and a better efficacy profile. Lasmiditan is anticipated to launch a year earlier and is forecast to be the top-selling drug in the acute space by 2026, with sales of $0.54bn, which will be a main driver of its overall growth.
In the preventative segment, the industry will see the first drugs specifically approved for migraine prevention. They all target the molecule calcitonin gene related peptide (CGRP), which is thought to be a key component of migraine pathophysiology.
There are currently five products that are expected to launch in this segment. Amgen’s erenumab, Eli Lilly’s galcanezumab, Teva’s fremanezumab, and Alder’s eptinezumab are CGRP monoclonal antibodies.
Results from clinical trials show that these drugs, with their novel mechanism of action as CGRP antagonists, are more efficacious than any other preventative treatment on the market. The monthly / quarterly dosing regimen and improved safety profile are also likely to increase compliance. Amgen’s erenumab is forecast to be the first-in-class monoclonal antibody and is expected to be the top seller in this class, with peak sales of $1.36bn by 2026. However, pricing may play a big role in deciding market share.
The final drug to enter the market is gepant Allergan’s atogepant. It is anticipated to launch in 2022 and offers the advantage of being orally administered instead of an injectable, which is likely to be preferred by patients. However, previous safety failures from this class may limit uptake of the drug until more safety data are available. These preventative treatments are expected to be one of the major drivers of growth and anticipated to contribute $4.57bn to the migraine market by 2026, as seen in Figure 1.