Rimegepant (also called Vydura and made by Pfizer) is recommended as an option for preventing episodic migraine in adults where at least 3 previous preventive treatments have failed, opening the way for up to 145,000 people to choose it on the NHS in England.
The final draft guidance recommends rimegepant for adults who have at least 4 migraine attacks per month but less than 15.
The clinical trial evidence shows that rimegepant works better than a dummy treatment for reducing the number of episodic migraines in people who have already tried 3 preventive treatments.
Over 5.6m people in England are thought to have episodic migraines in England and it is estimated that 190,000 migraine attacks are experienced every day in England.
Rimegepant is taken as a wafer which dissolves under the tongue. It works by stopping the release of a protein around the brain that is responsible for the severe pain associated with migraine attacks.
Helen Knight, director of medicines evaluation at NICE, said: “Each year the lives of millions of people in England are blighted by migraine attacks. They can be extremely debilitating and can significantly affect a person’s quality of life. In comments received during consultation on the previous draft guidance, patients and carers described migraine as an invisible disability that affects all aspects of life including family, social activities, mental health, finances, education and.
“Rimegepant is the first oral treatment for migraine to be recommended by NICE and for many thousands of people it is likely to be a welcome and more convenient addition to existing options for a condition that is often overlooked and undertreated.
“Today’s draft guidance demonstrates our commitment to focusing on what matters most and getting the best care to people while ensuring value for the taxpayer.”
Current treatment options for preventing migraine include drugs that are used for treating other conditions, such as beta-blockers, antidepressants and epilepsy medications. These treatments can have significant side-effects and can be ineffective for some people. Treatments offered after these have been tried include NICE-recommended erenumab, fremanezumab or galcanezumab, all of which are given as injections.
The draft guidance says if rimegepant is considered to be 1 of a range of suitable treatments, after discussing the advantages and disadvantages of all the options, the least expensive should be used.
NICE expects to publish final guidance on rimegepant for preventing episodic migraines next month.