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Chronic pain management

NICE recommends 'life-changing' drug for the prevention of migraine

Fremanezumab, an anti-calcitonin gene-related peptide monoclonal antibody, works by targeting the process by which proteins cause blood vessels in the brain to swell.

Woman with migraine

Source: David J. Green / Alamy Stock Photo

Fremanezumab has been recommended for preventing chronic migraine in adults where at least three previous preventative treatments have failed

The National Institute for Health and Care Excellence (NICE) has recommended fremanezumab (Ajovy; Teva Pharmaceuticals) for the prevention of chronic migraine in adults.

Fremanezumab, an anti-calcitonin gene-related peptide (CGRP) monoclonal antibody, is the first in the new class of medicines to be recommended by NICE for preventing chronic migraine. 

The drug is given as a monthly self-administered injection and works by targeting the process by which proteins cause blood vessels in the brain to swell. In NICE’s final draft guidance, it is recommended for preventing chronic migraine in adults where at least three previous preventative treatments have failed. 

Current treatment options for preventing chronic or episodic migraine include beta-blockers, antidepressants and anticonvulsants. If chronic migraine does not respond to at least three preventative medicines, botulinum toxin type A or best supportive care, such as treatment for the migraine symptoms, will then be offered.

NICE’s recommendation, made in a final appraisal document on fremanezumab for preventing migraine, published on 12 March 2020, was based on clinical trial evidence that fremanezumab worked better than best supportive care in both episodic and chronic migraine, although it said it was “unclear” whether fremanezumab worked better than botulinum toxin type A.

However, for chronic migraine, NICE said that assuming fremanezumab did work better than botulinum toxin type A, the “most likely cost-effectiveness estimates” were within the range NICE normally considered an “acceptable use of NHS resources”.

“Chronic migraines are extremely debilitating and can significantly affect a person’s quality of life,” said Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE.

“We are pleased that the company has been able to work with us to address the concerns highlighted in the previous draft guidance so that we are now able to recommend fremanezumab as an option for people with chronic migraine when several other medications have failed.”

Gus Baldwin, chief executive of The Migraine Trust — a research and support charity for people affected by migraine in the UK, which submitted patient evidence to NICE — said he was “delighted” that people living with chronic migraine across England and Wales would be able to access the drug.

“We would like to thank NICE for listening to the voices of chronic migraine patients, who have been united in their call to be allowed access to this drug on the NHS. Many people we spoke to told us this drug had been ‘life-changing’ for them,” he said.

Janine Barnes, a neurology specialist pharmacist at the Dudley Group NHS Foundation Trust, said NICE’s decision was “particularly pleasing” following NICE’s initial decision in January 2019 to reject erenumab (Aimovig; Novartis), which is in the same class as fremanezumab, for the prevention of chronic migraine on the grounds that it was not cost effective. 

“Although it is unclear whether fremanezumab works better than botulinum toxin [type] A, which is also recommended for this patient cohort, it is important to increase our armoury of drugs available to treat people with this very debilitating condition,” she said.

NICE said it expected to publish its final guidance on fremanezumab for preventing migraine on 15 April 2020.

Fremanezumab was approved by the Scottish Medicines Consortium in January 2020 for both chronic and episodic patients who have failed three or more migraine preventives.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207821

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