1 Recommendations

1.1 Eptinezumab is recommended as an option for preventing migraine in adults, only if:

  • they have 4 or more migraine days a month

  • at least 3 preventive drug treatments have failed and

  • the company provides it according to the commercial arrangement.

1.2 Stop eptinezumab after 12 weeks of treatment if:

  • in episodic migraine (fewer than 15 headache days a month), the frequency does not reduce by at least 50%

  • in chronic migraine (15 headache days a month or more with at least 8 of those having features of migraine), the frequency does not reduce by at least 30%.

1.3 If people with the condition and their clinicians consider eptinezumab to be 1 of a range of suitable treatments (including erenumab, fremanezumab and galcanezumab), discuss the advantages and disadvantages of the available treatments. After that discussion, if more than 1 treatment is suitable, choose the least expensive. Take account of administration costs, dosage, price per dose and commercial arrangements.

1.4 These recommendations are not intended to affect treatment with eptinezumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why these recommendations were made

Treatments for preventing chronic or episodic migraines include erenumab, fremanezumab and galcanezumab when they have not responded to at least 3 oral preventive drug treatments. These treatments are already recommended in NICE's technology appraisal guidance on erenumab, fremanezumab and galcanezumab. They are all administered as injections under the skin. Eptinezumab is another treatment option that works in a similar way but is administered as an infusion into a vein.

There are no clinical trials directly comparing eptinezumab with erenumab, fremanezumab or galcanezumab. An indirect comparison suggests that eptinezumab works as well as these treatments.

A cost comparison suggests that eptinezumab has similar costs and overall health benefits to erenumab, fremanezumab and galcanezumab. So, eptinezumab is recommended for preventing migraine if it is used in the same population as these treatments.