A treatment for acute migraine has been recommended for use by clinicians in the NHS in England for the first time, according to the National Institute for Health and Care Excellence (NICE).
NICE has today published final draft guidance recommending rimegepant (Vydura) as a cost-effective option for the acute treatment of migraine in adults.
“This is the first and only NICE-recommended medicine that can help alleviate the misery of acute migraines”
The institute noted that, as a result of its latest recommendation, the drug was very likely to be soon available to around 13,000 patients in England.
It follows a similar decision last week by the Scottish Medicines Consortium (SMC) to approve rimegepant for use within the NHS in Scotland for the acute treatment of migraine.
Meanwhile, NICE had previously recommended treatments, including rimegepant, in May for the prevention of migraine in adults.
Today’s final draft guidance recommends rimegepant for adults who have tried at least two triptans – a group of medicines used to treat migraine or headache – but they did not work well enough.
Rimegepant is also recommended for those unable to take triptans or they were not tolerated, and nonsteroidal anti-inflammatory drugs and paracetamol were tried but did not work well enough.
According to NICE, the clinical trial evidence showed that Rimegepant, which is manufactured by Pfizer, was more likely to reduce pain at two hours than a placebo.
Rimegepant is taken as a wafer which dissolves under the tongue. It works by stopping the release of a protein around the brain called calcitonin gene-related peptide that is believed to be responsible for the severe pain associated with migraine attacks.
Currently, when triptans are ineffective, not tolerated, or contraindicated, there is no further standard treatment and people are advised to see a migraine specialist.
However, NICE noted that there were a limited number of headache centres in the UK and there were long waiting lists for them.
Helen Knight, director of medicines evaluation at NICE, said: “This is the first and only NICE-recommended medicine that can help alleviate the misery of acute migraines, and may be considered a step-change in treatment.
“Migraine is a condition described in comments to NICE from carers and people with migraine as an invisible disability that affects all aspects of life including work, education, finances, mental health, social activities, and family.
“Today’s final draft guidance addresses the high unmet need for treatment options for acute migraine, once again demonstrating our ability to ensure clinically and cost-effective medicines are available to those who need them as quickly as possible,” she added.
NICE said it expected to publish its final recommendations on rimegepant for treating acute migraine in October.
“Migraine is an incredibly misunderstood condition that can have a significant impact on all areas of life”
Rimegepant is indicated for the acute treatment of migraine with or without aura in adults. It costs £12.90 per 75mg tablet. The recommended dose is 75mg as needed, not more than once daily.
Rob Music, chief executive of the Migraine Trust, said: “This decision provides people with migraine valuable options to help reduce the pain and length of a migraine attack. It brings new hope.
“It will especially benefit those who have not found a treatment that works and those who get debilitating side effects such as medicine overuse headache from existing treatments.
“It will also benefit those with cardiovascular disease who cannot take existing treatments,” noted Mr Music.
He added: “Migraine is an incredibly misunderstood condition that can have a significant impact on all areas of life, including ability to work, maintain relationships and mental health.”