Expert Interview
Overview of Migraine therapies - Biohaven - 2nd look
Ticker(s): BHVN, ABBVInstitution: Dartmouth-Hitchcock Medical Center
- Clinical Neurologist. Director of the Dartmouth Headache Center, and Professor of Neurology at Geisel School of Medicine, Dartmouth.
- Treats~150 migraine patients per month.
- Previously investigator in the rimegepant Phase 2 trial when it was owned by BMS. and has published over 330 peer-reviewed manuscripts, editorials, and books.
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_adminSo 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_adminOf your patients currently on Nurtec, what percentage do you think are taking it in an abortive context vs a preventative one?
Added By: wilson_adminIt 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_adminLooking 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_adminThe 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_adminHave 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_adminfor your patients currently on injectable CGRPs, how many would you say are episodic vs chronic?
Added By: wilson_adminLooking 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_adminHow 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_adminFor 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_adminIs 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_adminCan 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 DHE fit in there?
Added By: wilson_adminThe patients that you see, are they mostly referrals? And of your patients, what percentage would you say are chronic vs episodic?
Added By: wilson_adminCan you discuss your clinical practice and research focus?
Added By: wilson_adminDo you want answers to these questions?
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