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Chronic pain management

Novel drug for chronic migraine approved in Scotland

The first monoclonal antibody therapy for the prevention of chronic migraine has been approved for use by the Scottish Medicines Consortium.

Erenumab (Aimovig; Novartis) will be available through NHS Scotland for people living with chronic migraine, defined as a migraine that occurs on more than 15 days per month, for whom at least three prior treatments have failed.

Erenumab works by targeting the process by which proteins cause blood vessels in the brain to swell, leading to the symptoms associated with migraines. In clinical trials of the drug, patients with chronic migraine experienced an average reduction of 2.5 migraine days per month compared with placebo.

Commenting on the approval, Alok Tyagi, consultant neurologist at the Queen Elizabeth University Hospital in Glasgow, said: “Aimovig has been shown to reduce the average number of monthly migraine days in both episodic and chronic migraine patients, including those who have tried and not had success with existing treatment options.

“Today’s announcement represents a significant milestone for people living with this debilitating condition and marks a new era of migraine management in Scotland.”

The European Medicines Agency’s Committee for Medicinal Products for Human Use recommended granting a marketing authorisation for erenumab in June 2018.

In draft guidance published in January 2019, the National Institute for Health and Care Excellence (NICE) rejected erenumab on the basis that the cost-effectiveness estimates for the drug were higher than what is usually considered acceptable in the case of substantial uncertainty. 

However, following a high volume of comments received by NICE on its draft guidance, the appraisal of erenumab for preventing migraine is ongoing, with final guidance expected to be published in summer 2019. 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206402

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