The FDA approved Ubrelvy, Allergan’s new oral medication for migraine treatment, on Monday, December 23. The news isn’t only good for Allergan— this drug is one in a larger migraine medication revolution that has been occurring over the past several years.
This new class of drugs, called CGRP medications because they target the protein calcitonin gene-related peptide and its receptor, offer hope to migraine sufferers who have historically had, until recently, few treatment options for what can be a debilitating chronic disease. This is the fourth new CGRP medication to reach the market in less than two years, and the first one that is in pill form and not an injection.
“We’re very pleased with the results,” Bill Meury, chief commercial officer at Allergan, told Forbes. In clinical trials, Ubrelvy relieved migraine-related pain for a majority of migraine patients, often within two hours.
A fifth CGRP medication is expected to follow soon. Biohaven Pharmaceuticals anticipates approval for their CGRP medication, Rimegepant, in the first quarter of 2020, CEO Vlad Coric told Forbes. For Biohaven, founded relatively recently in 2013, it will be its first approved drug. Unlike the Allergan drug, Biohaven is also offering its medication in the form of a nasal spray. This is especially important for migraine sufferers who experience nausea and may not be able to take pills, Coric says.
When the first three CGRP migraine medications hit the market in 2018, it was a landmark moment for migraine treatment. The medications are Aimovig from Novartis and Amgen, Emgality, from Eli Lilly, and Teva’s Ajovy. These were the first new medications specifically created to target migraines in almost 25 years, as well as the first medications ever to be approved specifically for the prevention of migraines— a chronic illness that affects about one in seven Americans.
All three are delivered via injection once a month. Allergan and Biohaven are banking on a pill and nasal form as an attractive alternative for migraine sufferers.
For decades, the only medications available to prevent migraines were initially developed for other illnesses. Some common examples include seizure medications such as Topamax; Amitriptyline, an antidepressant; and propranolol, a blood pressure medication.
In the early 2000s, researchers began to link the pain caused by migraine headaches to an increase in calcitonin gene-related peptide (CGRP). By lowering the amount of protein floating around in the brain, researchers found it was possible to reduce the frequency and severity of migraines. A new era in migraine medication bloomed, and companies have scrambled to get a share of U.S. market of 38 million migraine sufferers, each pharmaceutical manufacturer claiming their medication is best in class.
Biohaven CEO Coric says he sees one big advantage for Biohaven’s drug: They’re testing its use as a treatment for migraines as well as a preventive medication. Not only could people take it at the time of a migraine to fend off the headache, but they could potentially take it every few days to prevent migraines occurring in the first place. This would be the only medication on the market that can function as both treatment and prevention. “We’re really disrupting the space, because either people have a preventative agent or an acute agent,” Coric says.
Biohaven, a new player compared to giants like Allergan, which will soon merge with Abbott’s biopharmaceutical spinoff, AbbVie, may have trouble competing in the pharmaceutical market. Yet Coric says he is confident that they will able to manufacture and distribute Rimegepant on a large scale. “We are ready to launch this drug upon approval,” he says, “we are ready to do this alone.”
Allergan’s Meury says he isn’t worried about the competition.“I certainly don’t see this as a marketshare battle,” he told Forbes. With an illness as common as migraines, “more options are better.”