Scotland backs Aimovig for migraine after NICE says no

People suffering from severe migraines in Scotland will be able to get treatment with Amgen and Novartis’ Aimovig if they fail other therapies, according to the country’s cost-effectiveness agency for medicines.

The Scottish Medicines Consortium (SMC) has given its backing to routine use of the calcitonin gene-related peptide (CGRP) inhibitor throughout NHS Scotland for people who have at least four migraine days per month, and for whom at least three prior preventive treatments have failed.

The verdict comes a few weeks after Aimovig (erenumab) was turned down for the same indication in draft guidance from the National Institute for Health and Care Excellence (NICE) in England, once again threatening a disparity in access to a new medicine in different areas of the UK.

The NICE appraisal of Aimovig is still ongoing, however, with final guidance expected to be published in the second quarter.

“The high frequency and severity of migraine symptoms can be extremely debilitating and may have a substantial impact on day-to-day and work related activities,” said the SMC in its advice on the drug.

“In studies in patients with episodic and chronic migraine, erenumab significantly reduced the number of migraine days per month compared with placebo,” it added.

Aimovig became the first drug in a new class of antibody-based CGRP inhibitors to be approved in Europe when it got the okay from the European Medicines Agency (EMA) last year, and is designed as a once-monthly, self-injected preventive treatment for migraines.

In a statement, Novartis – which has just become embroiled in a legal dispute with Amgen over rights to Aimovig after being accused of a breach of contract – said that less than half of migraine patients are satisfied with their current treatment options and many have been waiting years for new treatment options.

However, the company’s UK, Ireland and Nordics managing director, Haseeb Ahmad, said that it is “disappointing that the restriction means it will not be NHS funded for episodic migraine, which can be equally as devastating.”

Nevertheless, the green light in Scotland for Aimovig has been hailed by the Migraine Trust as the first preventive medication specifically developed to treat the condition and an important milestone for migraine treatment in the UK.

“Despite being an extremely painful and debilitating condition that is highly prevalent, people with migraine have so far only been able to take preventive treatments that were designed for other conditions,” said the charity’s chief executive Gus Baldwin.

“It’s a sad reality that migraine is ruining far too many lives across the UK and this announcement will provide new hope for patients everywhere,” he added.

Novartis also says that as migraine predominantly affects people of working age, it costs the UK economy £8.8 billion per year in lost productivity alone. Aimovig costs around £5,000 per year, although Novartis has offered the NHS a confidential discount.