Sales of migraine drug treatments in six major markets are set to grow an average of 5.8% a year, rising from around $3 billion in 2013 to over £5 billion in 2023, say new forecasts.

This growth – in the US, France, Germany, Italy, Spain, the UK and Japan – will occur mainly in the second half of the 2013-23 forecast period and will be driven largely by the launch of two nontriptan acute therapies – Allergan’s orally-inhaled dihydroergotamine product Semprana (dihydroergotamine), launching in the US in 2016, and CoLucid’s 5HT1F receptor agonist lasmiditan, launching in the major markets beginning in 2018.

Together, these two therapies will earn nearly $1.5 billion in major-market sales in 2023 and will serve a subset of patients seeking nontriptan therapies due to non-response or to cardiovascular risks, says the research, from Decision Resources.

It also expects the launch of five triptan reformulations to offset generic erosion of the triptan class during the forecast period. These emerging non-tablet products – Teva’s Zecuity (sumatriptan transdermal patch), Avanir Pharmaceuticals/OptiNose’s AVP-825 (sumatriptan intranasal powder), Applied Pharma Research/tesa Labtec’s zolmitriptan oral dispersible film (ODF), IntelGenX/RedHill Biopharma’s Rizaport (rizatriptan ODF) and Suda’s SUD-001 (sumatriptan oral spray) – will together earn more than $800 million in major-market sales in 2023 and will help offset a decline in sales as the remaining branded triptans become generically available through 2017, it says.

Allergan’s Botox (onabotulinumtoxinA) continues to drive growth in the prophylactic market. Physicians are becoming increasingly comfortable with prescribing it for chronic migraine, especially given its very favourable tolerability profile and few undesirable side effects compared to other prophylactic options. Increasing use of Botox will be a key driver of over 6% annual growth in migraine prophylactic sales to 2023, it forecasts.

But there is still unmet need for prophylactic migraine therapies. The drug development pipeline is dominated by acute treatments, leaving sizeable opportunity for developers to address the need for more efficacious prophylactic drugs with reduced side effects.

“Given the large acutely-treated migraine patient population, high-priced acute therapies targeting niche groups can still garner considerable market share while capturing only a small percentage of the patient share,” says Decision Resources group analyst Angela Sparrow.

‘Despite the unmet need for new prophylactic migraine therapies, no such treatments are likely to launch in the near term. However, one emerging class of prophylactic treatments that is garnering excitement from interviewed experts is the calcitonin gene-related peptide-targeted therapies; though still early in development, these therapies represent a truly novel approach to migraine prophylaxis,” adds Dr Sparrow.