Vydura is NHS’ first oral CGRP for migraine prevention

Pfizer’s Vydura has become the first oral CGRP antagonist recommended for routine use by the NHS to prevent episodic migraine attacks, after being rejected earlier this year as an acute treatment.

The National Institute for Health and Care Excellence (NICE) has recommended Vydura (rimegepant) as a prophylactic option for people who have at least four and fewer than 15 migraine attacks per month on average – but only as a fourth-line option.

That means patients will have to have tried three other oral preventive treatments, which could include topiramate, propranolol, and amitriptyline, which is narrower than its approved indication in the UK. The drug will also have to be discontinued if the frequency of migraine attacks isn’t halved within 12 weeks.

Vydura adds to the stable of CGRP-targeting drugs available to NHS patients in England and Wales, with three injectables – Novartis’ Aimovig (erenumab), Teva’s Ajovy (fremanezumab), and Eli Lilly’s Emgality (galcanezumab) – also reserved for fourth-line use.

The drug was turned down by NICE in February as an acute treatment for migraine in draft guidance, although it won’t make a final decision on that use until later this year.

The decision was criticised by The Migraine Trust, which has argued that oral CGRPs could help patients manage their condition without the risk of medication overuse headache – a recognised problem with older drugs like triptans, non-steroidal anti-inflammatory drugs (NSAIDs), and other painkillers.

In Scotland, meanwhile, the situation is currently a mirror image, as the Scottish Medicines Consortium (SMC) approved used of Vydura for acute migraine treatment earlier this month, but turned it down for episodic migraine prevention.

AbbVie’s oral CGRP inhibitor Qulipta (atogepant) is also under review by NICE for migraine prevention, with a decision due in mid-August.

“On top of debilitating physical symptoms, migraine can place significant pressure on the professional and personal lives of those living with it, including being forced to take time off work,” said Toby Cousens, head of hospital and internal medicine at Pfizer UK.

“Today’s decision is a positive step forward to help meet the care needs of eligible patients in England and Wales,” he added.

“We are committed to improving the lives of those living with the burden of migraine and will continue to work with NICE and other health bodies in the UK to help further enhance access and care.”

According to the company, an estimated 43 million workdays are lost each year in the UK to migraine-related absenteeism. Other estimates suggest migraine may cost the UK economy between £6 billion and £10 billion per year in total healthcare and productivity costs.

Photo by Akshar Dave on Unsplash.