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Appeal success on NICE guidance on erenumab for preventing migraine



NICE is likely to recommend erenumab for preventing migraine later this month (January 2021) after earlier drafts of the guidance were appealed.

In final draft guidance, the committee ruled that the treatment would be cost effective in patients who had tried three or more other treatments including those who had failed to benefit from or couldn’t have botox injections.

Patients will be eligible for the treatment (also known as Aimovig) if they have at least four migraine days each month, NICE said.

In 2019, the British Association for the Study of Headache and Association of British Neurologists appealed a previous ruling not recommending the drug be made available.

New evidence was put before the committee comparing the drug with best supportive care in patients for whom other treatments had not worked.

NICE said they had also reached agreement over an ‘improved commercial arrangement’ from manufacturers Novartis to supply the drug, which has a list price of £5,000 per patient per year.

Under current recommendations patients with chronic (more than 15 episodes a month) or episodic migraine can be offered prevention with beta- blockers, antidepressants and antiepileptic drugs.

If chronic migraine does not respond to at least three preventive drug treatments, botulinum toxin type A is an option, although there are lengthy waiting lists and it is not available everywhere, the final draft guidance said.

Experts submitted evidence to NICE said other preventive treatments were often poorly tolerated.

A study published in the New England Journal of Medicine in 2017 found half of the episodic migraine patients given erenumab, experienced significantly fewer days with migraine symptoms.

The final guidance on erenumab, which is given every four weeks as a self-administered injection, is expected at the end of January.