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NICE recommends first oral drug for preventing both chronic and episodic migraines

NICE recommends first oral drug for preventing both chronic and episodic migraines

The first oral drug for preventing migraines where other treatments have failed should be available on the NHS, NICE has recommended in final draft guidance.

Up to 170,000 people could be eligible for atogepant – also known as Aquipta – under the recommendations which cover both chronic and episodic migraines.

It is expected that use of the drug, which works by blocking the calcitonin gene-related peptide receptor (CGRP), will be initially managed in secondary care, under a commercial agreement agreed with NICE.

But in the evidence provided to the appraisal process, drug manufacturer AbbVie noted there was potential for it to be monitored in primary care, and for follow-up appointments to be done by GPs.

Patient and professional organisations also told the committee that the availability of atogepant through GPs would improve access to treatment and reduce NHS costs.

The committee said that while atogepant would initially be prescribed and monitored in secondary care, ‘there would be interest in being able to use it in primary care’.

Under the recommendations, atogepant will be an option for preventing chronic and episodic migraines in adults who have had at least four migraine days per month.

To be eligible for the drug, patients must also have tried at least three previous preventive treatments.

Atogepant may be useful for those who cannot tolerate current fourth-line injectable treatments or who have contraindications to them, the guidance said.

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The drug should be stopped after 12 weeks if the frequency of migraine attacks does not stop by at least 50% for episodic migraine and at least 30% for chronic migraine, NICE said.

It is also considered to be one of a range of suitable treatments and, after discussing the advantages and disadvantages of all the options, the least expensive should be used, NICE added.

NICE director of medicines evaluation Helen Knight said: ‘Today’s final draft guidance demonstrates our commitment to focusing on what matters most and getting the best care to people while ensuring value for the taxpayer.

‘Currently, the most effective options for people with chronic migraines who have already tried three preventative treatments are drugs that need to be injected.

‘The committee heard from patient experts that some people cannot have injectable treatments, for example because they have an allergy or phobia of needles. So, some people with chronic migraines would welcome an oral treatment. Atogepant also offers more choice for people with episodic migraine.’

Health minister Andrew Stephenson said: ‘Migraines affect millions of people in this country and this new treatment will help prevent recurring migraine attacks when other medicines have failed.

‘It will allow more people whose daily life is affected by this painful, debilitating condition to manage their migraines more effectively and to live their lives to the fullest.’

If there are no appeals, the final guidance is due to be published next month. 

Last year, NICE approved rimegepant as the first treatment for acute migraine, in draft guidance published in September.


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