NICE backs AbbVie’s oral therapy for migraine prevention

AbbVie’s Aquipta has become the first once-daily oral therapy for both chronic and episodic migraine prevention to be recommended by NICE for NHS patients in England and Wales.

Final draft guidance says that CGRP antagonist Aquipta (atogepant) can be used for migraine prevention in adults who have at least four migraine days per month, but only if at least three other preventative treatments have not worked.

The decision ends a disparity in access to Aquipta in the UK, as Scotland gave a green light to the drug in this indication last October, and makes the drug an option for around 170,000 patients across the UK.

The drug provides an alternative to CGRP antagonists delivered by injection or infusion, like Novartis’ Aimovig (erenumab), Teva’s Ajovy (fremanezumab), Eli Lilly’s Emgality (galcanezumab), and Lundbeck’s Vyepti (eptinezumab), which are also backed for use in migraine prevention.

Botox (botulinum toxin type A) is also used by the NHS for the treatment of chronic migraine in adults, defined as having at least 15 headache days a month.

Helen Knight, director of medicines evaluation at NICE, said the agency’s appraisal committee “heard from patient experts that some people cannot have injectable treatments; for example, because they have an allergy or phobia of needles.”

She added: “Some people with chronic migraines would welcome an oral treatment [while] atogepant also offers more choice for people with episodic migraine.”

Another oral CGRP antagonist – Pfizer’s Vydura (rimegepant) – was recommended by NICE last year for preventing episodic migraine in adults who have at least four and fewer than 15 migraine attacks per month, again only if at least three preventative treatments have not worked, as well as for acute treatment of migraine attacks.

The Migraine Trust said that the new drugs are important new options for people who have not had success with other preventive medications, as well as those who are affected by ‘rebound’ headaches caused by painkiller overuse.

“It is positive to see even more therapies emerging for people with migraine, as many still rely on treatments developed for other conditions,” said the charity’s chief executive, Rob Music. “We now need to ensure access to the newer treatments is swift, so that migraine patients can benefit from them.”

Aquipta, known as Qulipta in the US and Canada, is the first daily oral treatment for both chronic and episodic migraines and, according to GlobalData, could achieve worldwide revenues of almost $1.4 billion in 2029.

Photo by Nik Shuliahin via Unsplash