Stakeholder Opinions: Migraine - Lots of Experience, But Less Expertise
ntroduction
Headache is the most common complaint seen in family practice in the US, yet medical training gives little time to its diagnosis and treatment. Enabling improved diagnosis and an understanding of suitable treatment pathways for migraine will allow pharmaceutical companies to more suitably position and differentiate their product.
Scope
- A review of diagnosis and classification of migraine including epidemiology in the seven major markets
- Analysis of therapeutic classes- triptans, ergotamines and alternative treatment options. Including product profiles of key drugs within each class
- An assessment of drug delivery options
Highlights
The triptan market is highly crowded, with a perception of little to offer between available treatments. Clear needs are identified, but research shows that these are either not, or incompletely met.
As with many disorders, novel formulations and delivery systems can provide a product with a differentiator to maintain/improve its status in the market. In addition to this, such devices for migraine can help build key attributes to meet the needs in specific migraine segments.
Long-term prophylactic management of migraine offers significant commercial opportunity. Such an indication has generally been seen as an add-on, without due consideration given to an assessment of the unique needs of this area
Why you should buy this report
- Benchmark pipeline migraine treatments and currently marketed products and assess future market potential
- Understand how physicians position current therapies
- Identify potential marketing opportunities both with prescribers and consumers
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the migraine market - page 3
- Although guidelines have been developed by specialist groups, such guidelines have failed to impact everyday practice of physicians prescribing for migraine. As most initial presentations are in primary care, it is fundamental that any such guidance and education is in an accessible, simple, easy implementable format that takes into account the extensive demands on a PCP's time. Pharmaceutical companies should endeavor to bridge the gap in education between specialist migraine knowledge and PCPs/non-expert neurologists. Seeking opportunities to partner with specialist groups to do this would add credibility. This sound foundation of understanding needs to be built to provide a basis for market segmentation and product differentiation - page 5
- Public perception that headache is not a strong reason for physician consultation diminishes opportunities for prescription medication use. Many migraine patients will never present to a physician with this problem and many more will manage OTC for a considerable time before presentation. Disorder awareness campaigns in healthcare and broader settings would help validate migraine as a disorder worthy of a prescription and increase knowledge of available treatments. An increase in presentation to physician should impact the size of the migraine prescription market - page 6
- Long-term prophylactic management of migraine offers significant commercial opportunity. Such an indication has generally been seen as an add-on, without due consideration given to an assessment of the unique needs of this area. Unsurprisingly current prophylactic treatments fall below patients' and physicians' expectations. The pharmaceutical industry would benefit from developing a clear understanding of these needs and how they differ from acute migraine management, as this would provide a basis for clearer product positioning based on the suitable attributes - page 7
- As with many disorders, novel formulations and delivery systems can provide a product with a differentiator to maintain/improve its status in the market. In addition to this, such devices for migraine can help build key attributes to meet the needs in specific migraine segments. Rapid onset would be a priority in acute, whereas simplicity would be a driver for prophylaxis. Pharmaceutical companies need to clearly define their target segment(s) and ensure devices are relevant to this. Delivery systems in migraine may be seen to lag behind those in other areas. Many companies could benefit from assessing their existing delivery technologies in other therapeutic areas, such as diabetes (needle-free injections, inhaled insulins), HRT (sustained-release patch technology) and others - page 10
- TABLE OF CONTENTS - page 14
- CHAPTER 2 INTRODUCTION AND SCOPE - page 21
- Disease overview - page 21
- Etiology - page 21
- Diagnosis and classification of migraine - page 22
- Migraine diagnosis - page 22
- Classification of migraine type - page 24
- Epidemiology of migraine - page 27
- US - page 28
- Japan - page 29
- France - page 29
- Germany - page 29
- Italy - page 30
- Spain - page 30
- UK - page 30
- CHAPTER 3 TREATMENT - page 32
- Introduction - page 32
- Treatment guidelines - page 33
- Unmet needs - page 36
- Pharmacotherapy - page 39
- Classification of acute migraine drugs - page 39
- Triptans - page 40
- Ergotamines - page 54
- Others - page 56
- OTC products - page 59
- CHAPTER 4 PIPELINE ANALYSIS - page 62
- Introduction - page 62
- Clinical trial guidelines for migraine - page 63
- Acute therapy - page 63
- Prophylactic therapy - page 64
- Pipeline drugs for migraine - page 65
- Anticonvulsants - page 65
- Others - page 69
- CHAPTER 5 STRATEGIC ISSUES - page 81
- OTC drugs - page 81
- Patient and physician education - page 83
- Acute therapy: combination drugs - page 85
- Anti-emetic and analgesic combinations - page 85
- Triptan combination drugs - page 86
- Prophylactic therapy - page 88
- Anticonvulsants - page 88
- Triptans - page 90
- Formulations and drug delivery systems - page 91
- Oral - page 92
- Nasal - page 93
- Suppositories - page 95
- Other formulations and delivery systems - page 96
- Cost and reimbursement - page 98
- Conclusions - page 100
- Epidemiology - page 102
- Clinical trial data - page 104
- Bibliography - page 108
- List of contributing experts - page 111
- List of tables - page 111
- List of Tables
- Table 1: Prevalence of migraine in the seven major markets, 2003 - page 28
- Table 2: Imitrex: key facts - page 41
- Table 3: Zomig: key facts - page 43
- Table 4: Maxalt: key facts - page 45
- Table 5: Amerge: key facts - page 47
- Table 6: Axert: key facts - page 49
- Table 7: Frova: key facts - page 51
- Table 8: Relpax: key facts - page 52
- Table 9: Pipeline drugs for migraine - page 63
- List of Figures
- Figure 1: International Headache Society Classification of Migraine - page 25
- Figure 2: Treatment tree to summarize current migraine therapies - page 32
- Figure 3: Summary of strategic issues facing the industry for migraine treatment, 2003 - page 81
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