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Expert Interview

Slingshot members are talking to an expert! The topic is:

Overview of Migraine therapies - Biohaven

Ticker(s): BHVN, ABBV

Who's the expert?

Institution: Portland VA Medical Center

  • Private practice neurologist 
  • Manages over 100 patients for epilepsy 

Interview Questions
Q1.

Can you discuss your clinical practice and research focus?

Added By: wilson_admin
Q2.

The patients that you see, are they mostly referrals? And of your patients, what percentage would you say are chronic vs episodic?

Added By: wilson_admin
Q3.

Can you discuss what the current treatment paradigm might look like nowadays for abortive agents? Is it mostly over the counter NSAIDs, triptans, then CGRPs? Where does botox and IHE fit in there?

Added By: wilson_admin
Q4.

Is it generally fair to say that patients with episodic migraine are more likely to just use abortive agents, where as chronic migraine patients are more likely to use both preventative and abortive agents?

Added By: wilson_admin
Q5.

For patients who take Nurtec ODT,  how common do you think it is that patients are taking Nurtec for both abortive and preventative use? Or is it more likely patients taking medications for both abortive and preventative use would take different classes of drugs respectively?

Added By: wilson_admin
Q6.

How has your experience with insurance coverage with CGRPs been? Have you noticed any significant differences in coverage between the SC and oral agents?

Added By: wilson_admin
Q7.

Looking at the preventative SC CGRP agents, do you have a preference? Emgality doesn't have dosing flexibility, but is also indicated for cluster headache. Aimovig has two different monthly doses and Ajovy has monthly and quarterly dosing flexibility. Do those play into your decisions at all? Do you find these differences particularly meaningful for patients?

Added By: wilson_admin
Q8.

for your patients currently on injectable CGRPs, how many would you say are episodic vs chronic?

Added By: wilson_admin
Q9.

Have you prescribed Qulipta yet? For people on preventative CGRPs, how many would you say are using any injectable CGRPs vs Nurtec ODT or Qulipta?

Added By: wilson_admin
Q10.

The data from Nurtec on the preventative indication doesn't seem very strong. Of your patients who are taking Nurtec for preventative use, how many would you estimate report no significant change in monthly migraines?

Added By: wilson_admin
Q11.

Looking at Vyepti, the IV CGRP, it seems to have similar efficacy as the SC agents. Is it fair to say that this isn't a very popular choice due to the downsides of logistics and convenience?

Added By: wilson_admin
Q12.

It seems like Ubrelvy has more dosing flexibility, where you can redone if the first dose doesn't abort the migraine, but patients might like the ODT formulation of Nurtec, maybe increased tolerability for patients with severe nausea or vomiting. Do you or your patients have a preference for Ubrelvy or Nurtec? Are there any other key differences between the two which are significant for patients?

Added By: wilson_admin
Q13.

Of your patients currently on Nurtec, what percentage do you think are taking it in an abortive context vs a preventative one?

Added By: wilson_admin
Q14.

So the CGRP space is dominated by big Pharma, but BioHaven has managed to do quite well versus the much bigger competition. Do you have any big theories as to why that is? Maybe analgesic rebound?

Added By: wilson_admin
Q15.

Are you familiar with their intranasal CGRP, I think it's called zavegepant? Besides efficacy, what do you think would be the key considerations for an intranasal CGRP wrt market adoption?

Added By: wilson_admin

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