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New migraine class fails on cost

Posted 11 November 2019

As Lilly negotiates with the Department of Health to list its CGRP migraine preventative drug Emgality on the PBS and Teva awaits the PBAC outcome on its contender Ajovy, a new US report suggests new migraine attack drugs may be less cost-effective than genericised triptans.

US cost-effectiveness watchdog the Institute for Clinical and Economic Review (ICER) released a draft report on Thursday comparing new therapies coming through to older migraine therapies, with the outcome not good for sponsors.

Eli Lilly, Allergan and Biohaven all have new therapies targeting migraine attacks after Novartis, Lilly and Teva gained global approvals for the CGRP class of new migraine preventatives, which have to date battled to impress the PBAC.

The newcomers include Lilly's Reyvow, Allergan's ubrogepant and Biohaven's rimegepant, which the ICER draft report found with "moderate certainty" provided a "small or substantial" health benefit for patients who cannot take or haven't responded to triptans.

For those who do respond to triptans, the ICER found ubrogepant and rimegepant as "comparable or inferior" to triptans and Lilly's Reyvow as likely to perform worse.

Eli Lilly won FDA approval for Reyvow in October, with hopes it would arrive in Australia mid-2020.

The ICER noted pricing of the new therapies would "determine whether they are cost-effective at commonly used thresholds in patients who cannot take triptan medications", suggesting companies will not be able to command a premium price for the drugs.

Using expected US pricing for the new meds, ICER concluded triptans would "provide a greater benefit at a lower total cost", particularly for those who respond and can tolerate them.

Allergan's ubrogepant is set for an FDA decision in December and could also arrive in Australia in 2020. 

However, with the CGRP class having failed to impress at PBAC and being pushed under the existing Botox cap for migraine prevention, companies may wait to see how uptake goes in other markets before risking bringing the new therapies to Australia.

The heavily genericised triptans made less than $5 million in R/PBS benefits in the year to September for migraine.

Megan Brodie

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