January 22, 2020
FDA issues its first approval for an oral CGRP formulation for migraine
Ubrelvy™ brings a new treatment option (oral) to a new drug class (CGRP) for patients with migraine. Prime stays on top of the drug pipeline so our clients don’t fall behind.
Ubrelvy™ (ubrogepant) received FDA approval on Dec. 23, 2019, for treatment of migraine.
Drug: Ubrelvy (ubrogepant)
Condition: For treatment of migraine
Migraine headaches are common in the United States, affecting nearly 1 out of 7 Americans annually. A migraine is a recurring, severe, throbbing headache that’s usually on one side of the head. Migraine attacks can last for a few hours, or a few days. Other symptoms can include nausea, vomiting, and extreme sensitivity to light and sound. Flashes of light or blind spots may happen before or during the headache. Tingling on one side of your face, or in your arm or leg, can also occur.
One or two days before the migraine, you may have warning signs including constipation, mood changes, food cravings, neck stiffness, increased thirst and urination and frequent yawning.2
- Pain-relieving medications. Also known as acute or abortive treatment, these drugs are taken during migraine attacks to stop symptoms.2
- Preventive medications. These drugs are taken regularly, sometimes daily, to reduce the severity or frequency of migraines.2
Choice of medicine depends on the frequency and severity of headaches, the degree of disability they cause, and other medical conditions.2 Patients who experience mild symptoms may be treated with over-the counter pain medications, often used in combination with caffeine.
Acute migraine attacks can be treated with triptans, ergotamine, butalbital combination products and opioids. Triptans are the current standard of care for acute treatment for moderate-to-severe symptoms of migraine; they’re available in various dosage forms including pills, nasal sprays and subcutaneous injection. Response rates to triptans may decrease over time.
A new class of drugs emerged in 2018 for the prevention of migraine – selective calcitonin gene-related peptide (CGRP) antagonists. The first three drugs approved in this class were:
- Ajovy® (fremanezumab-vfrm) from Teva Pharmaceuticals
- Emgality® (galcanezumab-gnlm) from Eli Lilly
- Aimovig® (erenumab-aooe) from Novartis and Amgen
All three drugs above are taken monthly by subcutaneous injection. Ubrelvy provides the first oral CGRP formulation for migraine.
Overview of CGRPs
CGRP is a protein released around the brain. When CGRP is released, it causes intense inflammation in the coverings of the brain (the meninges). For most migraine patients, this causes the pain of a migraine attack.3 CGRP levels rise during migraine pain and are normal when pain reduces. CGRP antagonists prevent the production of the protein or the receptors it attaches to.3
Summary of Ubrelvy:
Ubrelvy is the first oral CGRP formulation approved for treatment of migraine in adults.1
In a Jan. 10 post on FirstWord Pharma, David Rind, MD, ICER's Chief Medical Officer said: "These new [CGRP] therapies appear to be less effective overall than triptans and are expected to be much more expensive. However, for those patients who are unable to take triptans or who don't get adequate benefit from them, the evidence does demonstrate that all three new therapies [lasmiditan (Reyvow™, Eli Lilly), rimegepant (Biohaven), and ubrogepant (Ubrelvy™, Allergan)] improve or relieve migraine symptoms in 10-20% more patients than respond to placebo.
“To reach commonly cited thresholds of cost-effectiveness, these therapies would require prices significantly below what some analysts are currently projecting,” Rind added.4
A second oral CGRP receptor antagonist, rimegepant from Biohaven, has an expected PDUFA date in February 2020.
Reyvow (lasmiditan), from Lilly, is the first serotonin receptor agonist to target the 5-HT1F receptor to treat acute migraines. Due to its potential for abuse and dependence, it requires DEA review for controlled substance classification prior to launch. It is expected to launch in January 2020 after DEA scheduling.
Benefit: Both Ubrelvy and Reyvow will impact the pharmacy benefit.
Prime monitors the drug pipeline
The drug pipeline is full of new, groundbreaking specialty drugs that may help members live better and feel well. Prime focuses on clinical strategies designed to keep clients ahead of drug trends — because it’s easier to manage change when you see it coming.
1. Burch, RC, et al. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. (2015.) - PubMed - NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25600719
2. Migraine - Symptoms and causes. Mayo Clinic. (April 26, 2017). Retrieved from https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201
3. What to Know About the New Anti CGRP Migraine Treatment Options, American Migraine Foundation. Accessed at: https://americanmigrainefoundation.org/resource-library/what-to-know-about-the-new-anti-cgrp-migraine-treatment-options/
4. ICER Releases Evidence Report on Acute Treatments for Migraine, Jan. 10, 2020. First Word Pharma. © 2020 Doctor's Guide Publishing Limited. Accessed on January 13, 2020. http://www.firstwordpharma.com/node/1692730?tsid=2#axzz6AubOiQ2i
About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 28 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.
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