Thousands of people in England who get migraines could benefit from a drug that has been approved on the NHS.
The National Institute for Health and Care Excellence (Nice), the drugs regulator, said it was recommending rimegepant for preventing migraines in the approximately 145,000 adults where at least three previous preventive treatments had failed.
The drug, also called Vydura and made by Pfizer, is taken as a wafer which dissolves under the tongue. It is the first time Nice has recommended an oral treatment for preventing migraines.
“Each year the lives of millions of people in England are blighted by migraine attacks,” said Helen Knight, the director of medicines evaluation at Nice. “They can be extremely debilitating and can significantly affect a person’s quality of life.
“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.”
Nice has given the green light for use of rimegepant to prevent episodic migraines, which is where a person has fewer than 15 migraine days each month. The draft guidance recommends rimegepant for adults who have at least four migraine attacks a month but fewer than 15.
About 5.6 million people in England are thought to have episodic migraines. It is estimated about 190,000 migraine attacks are experienced every day.
Rimegepant works by blocking a protein around the brain called calcitonin gene-related peptide (CGRP) from binding on to its targets in the brain. CGRP causes intense inflammation and is responsible for the severe pain associated with migraine attacks.
Treatment options for preventing migraines include drugs used for other conditions such as beta-blockers, antidepressants and epilepsy medications. These can have significant side-effects and may be ineffective for some people.
Alternatives offered after these have been tried include the Nice-recommended erenumab, fremanezumab or galcanezumab. All are given as injections.
Nice also published draft guidance for consultation on Wednesday that did not recommend rimegepant for treating acute migraine. Charities welcomed the arrival of another treatment to prevent migraines but expressed disappointment it had not also been approved for acute cases.
The chief executive of the Migraine Trust, Rob Music, said: “Too many people with migraine end up with medication overuse headache as a result of their migraine treatment, which has a serious impact on their lives. This is an impact which is preventable if migraine is treated effectively.
“Gepants, the new class of migraine medication which Rimegepant is part of, can help prevent this happening. While we welcome that it has been approved for the preventive treatment of migraine, we are very disappointed by the decision not to approve it for the acute treatment of migraine.”
• This article was amended on 1 June 2023. An earlier version incorrectly said that Rimegepant worked by stopping the release of a protein around the brain called calcitonin gene-related peptide (CGRP). It instead blocks CGRP from binding on to its targets in the brain.
