AbbVie's migraine drug cleared for migraine attacks on NHS

AbbVie's Aquipta can now be commissioned by the NHS in England and Wales as an acute treatment for migraine, adding to its existing use for prevention in people suffering multiple attacks per month.

Reimbursement authority NICE has published final draft guidance making Aquipta (atogepant) available for the acute treatment of migraine in people who have unsuccessfully tried at least two triptan medicines, or in whom triptans are contraindicated or not tolerated, and who also cannot get relief from standard painkillers like paracetamol.

The green light comes just a few weeks after the MHRA approved the acute use of Aquipta, and two years after it was recommended by NICE for use as migraine prophylaxis.

The recommendation is based on results from ECLIPSE, a phase 3 study in which 24.3% of patients treated with atogepant were free of pain two hours after dosing, following the first migraine attack, compared with 13.1% for placebo.

The recommendation has been welcomed by The Migraine Trust, whose chief executive, Rob Music, described Aquipta as a much-needed alternative for people who have not had success with or aren't able to tolerate other medications.

He added, however, that prescribing of the drug will be subject to local commissioning through Integrated Care Boards (ICBs), and the Trust is aware of difficulties that people experience in accessing medicines.

"Access to appropriate care for people with migraine can be seriously inconsistent, creating a postcode lottery," said Music. "Many people with migraine tell us they have struggled to access treatments or had to wait a long time before they could see a specialist. We now need to ensure access to this treatment for acute use is swift and consistently applied in both primary and secondary care, so that migraine patients can access [it] as easily as possible."

Aquipta is an oral CGRP inhibitor, a class that has revolutionised the prevention and treatment of migraine in recent years, and is marketed in the US and some other markets as Qulipta. AbbVie claims it is the number one oral CGRP brand for prevention, ahead of its main rival Nurtec ODT (rimegepant) from Pfizer.

Along with stable-mate CGRP inhibitor Ubrelvy (ubrogepant) – labelled for acute treatment and the first drug in the class to reach the market – it has reached blockbuster status, with Qulipta/Aquipta bringing in global sales of $1.03 billion last year while Ubrelvy added $1.27 billion.

AbbVie is also testing both Aquipta and Ubrelvy for menstrual migraine prevention – a distinct, hard-to-treat subtype affecting nearly 15% of women with migraine – with data from phase 3 trials due in the second half of this year. If all goes well, those readouts will be followed by a regulatory filing in Europe before year-end and in the US in early 2027.