Pfizer’s Nurtec approved in Korea, intensifying CGRP migraine treatment competition

The Korean approval of Pfizer’s Nurtec, an oral calcitonin gene-related peptide (CGRP) targeting drug for both acute and preventive treatment, is expected to further intensify competition in the domestic migraine treatment market.

According to the Ministry of Food and Drug Safety, Pfizer Korea's oral CGRP receptor antagonist, Nurtec Oral Disintegrating Tablets 75 mg (ingredient: rimegepant sulfate hydrate), was approved as a new drug on March 24.

The approved indications are the acute treatment of migraine with or without prodromal symptoms in adults and the prevention of episodic migraine in adults. It is the first migraine-specific drug in Korea that can be used for both acute and preventive treatment.

Existing migraine treatments such as triptans, ergotamines, and NSAIDs help relieve symptoms in the acute phase but have limited preventive effects. Some patients experience insufficient efficacy or short duration of relief.

CGRP-targeted therapies have addressed these limitations by targeting the key mechanism of migraine—CGRP—to reduce attack frequency and intensity. These drugs have shown clinical utility even in patients unresponsive to existing treatments.

So far, CGRP monoclonal antibodies (mAbs) like Emgality (galcanezumab, Lilly Korea), Ajovy (fremanezumab, Handok Teva), and the CGRP receptor antagonist Aquipta (atogepant, AbbVie Korea) have been introduced in Korea.

Among them, Aquipta entered the market relatively late, launching in Korea last year. As the only oral CGRP-targeting therapy in the country—unlike the injectable Emgality and Ajovy—Aquipta has established its place in the market. With Nurtec's future launch, the two oral drugs are expected to compete directly.

“Aquipta is a daily medication, while Nurtec is taken once every two days,” said Kim Byung-kun, a professor of neurology at Nowon Eulji Medical Center. “Nurtec is designed so that an extra pill can be taken for acute pain.”

“Aquipta is also undergoing an indication expansion for acute treatment. If approved, the two drugs will be in direct competition,” he added. “However, as doctors and patients have no clinical experience with Nurtec yet, we will need to monitor its use closely.”

In the Korean medical field, Nurtec is expected to be launched in the second half of this year. Beyond simply increasing the number of treatment options, the availability of another oral drug may attract more patients to clinics and expand the overall migraine treatment market.

Chu Min-kyung, a professor of neurology at Severance Hospital, commented on the growing variety of migraine treatments, saying, “It’s significant to have a new option. While CGRP monoclonal antibodies must be administered in hospitals, oral medications can be prescribed directly, making it easier to manage patients with intractable headaches in outpatient clinics.”

On patient preference for administration methods, she said, “Initially, patients tend to prefer oral medications, but some find it inconvenient to take pills over time. Some patients prefer injectables, while others prefer oral drugs. Needs vary from person to person.”

Regarding the use of Aquipta and Nurtec, she noted, “There is currently no data on whether Nurtec is effective for patients who do not respond to or experience side effects from Aquipta. Internationally, both drugs are considered similarly effective.”

Experts also believe that reimbursement will significantly influence prescribing patterns. “While many patients have private health insurance, which supports the partial success of oral drugs, it is important to gain reimbursement within the national healthcare system,” Chu said. “Europe began reimbursing oral CGRP drugs last October, starting with Spain. Korea should look to examples like the U.K. and other European nations.”

Beyond Nurtec, more migraine treatment options are expected to emerge in Korea. Lundbeck Korea aims to launch its CGRP monoclonal antibody eptinezumab (marketed as Vyepti internationally) in the first half of 2027.

Vyepti differs from Emgality and Ajovy, which are administered monthly, by offering intravenous administration once every three months. Lundbeck has also conducted a global Phase 3 clinical trial in Korea to evaluate the efficacy and safety of eptinezumab in migraine prevention and in patients with both migraine and medication-overuse headache.

“Eptinezumab is known to be highly effective with few side effects,” said Chu. “While other CGRP monoclonal antibodies may lose effectiveness over time, Vyepti has shown lower rates of diminishing efficacy, raising expectations among physicians.”