The Antiepileptic Drug Topiramate Dominates First Line Prophylactic Treatment of Migraine, with Allergan's Botox Exhibiting Growth in Later Lines

BURLINGTON, Mass., July 16, 2015 /PRNewswire/ -- Decision Resources Group finds that, through analysis of U.S. longitudinal patient-level claims data, the antiepileptic drug (AED) topiramate (Ortho-McNeil/Janssen-Cilag's Topamax; other brands; generics) captured the greatest patient share among prophylactic treatment-naive migraine patients across the first three lines of therapy. Furthermore, topiramate patient shares among migraine patients recently treated with prophylactic therapies remained relatively constant over the previous year of analysis. These findings highlight topiramate's position as a first-line standard of care for migraine prevention. Overall, AEDs were the preferred drug class for migraine prophylaxis, with nearly half of prophylactically naive patients initiating prophylactic therapy with an AED.

Other key findings from the Treatment Algorithms report entitled Migraine Prophylaxis:

• Patient shares of Allergan's Botox (onabotulinumtoxin A), one of the few branded prophylactic therapies and the only agent approved specifically as a preventative treatment for chronic migraine, increased across lines of therapy in prophylactically naive patients, a situation that presumably reflects payer-imposed reimbursement restrictions, owing to the drug's high cost, that delays its use until later lines of therapy. Yet Botox experienced strong gains in patient share over time among both prophylactically naive and recently treated patients, due in part to its growing acceptance among physicians and payers and an absence of new therapies approved for migraine prophylaxis.
• Antidepressants, in particular amitriptyline (Gerda's Elavil; Teofarma's Laroxyl; other brands; generics), were also common first-line treatment choices among prophylactically naive patients and recently treated patients. The agents' long history of use for migraine prevention and physicians' presumed comfort with these drugs likely supports continued widespread use in clinical practice.
• Progression patterns to most key prophylactic therapies typically involve a mix of prior-line prophylactic prescriptions including AEDs, antidepressants or beta blockers. This finding underscores the variety in physicians' approaches to prophylactically treating migraines.
• Among prophylactic agents included in the analysis of recently treated patients, drug switching rates typically exceeded add-on rates, suggesting high rates of drug failure and underscoring the need for more effective therapies for migraine prophylaxis.

Comments from Decision Resources Group Senior Director Bethany Kiernan, Ph.D.:

• "Topiramate continues to be the prophylactic drug of choice, because of its formal U.S. approval for migraine prophylaxis—including an expanded labeling obtained in 2014 for use in adolescent patients—as well as its proven efficacy in treating chronic migraine and its generic availability."
• "Despite Botox's high price, which subjects it to more stringent reimbursement restrictions, it was the only prophylactic agent that posted consistent, positive growth in patient share across the previous year of analysis in an otherwise relatively flat market. This growth can be tied to its favorable tolerability profile and infrequent dosing, physicians' and payers' increasing experience with and acceptance of the product, DTC promotional efforts and greater patient awareness of conditions such as chronic migraine that can be treated prophylactically, as well as a lack of newer approved prophylactic therapies to increase competition."

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About Decision Resources Group
Decision Resources Group offers best-in-class, high-value data, analytics and insights products and services to the healthcare industry, delivered by more than 700 employees across 15 global locations. DRG companies provide the pharmaceutical, biotech, medical device, financial services and payer industries with the tools, insights and advice they need to compete and thrive in an increasingly complex and value-based marketplace. DecisionResourcesGroup.com.

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SOURCE Decision Resources Group

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