Daily migraine pill gets green light on NHS for 170,000 Brits – are you eligible?
A MIGRAINE pill taken once daily has been given the green light on the NHS.
Some 170,000 Brits will benefit from the drug after the NHS spending watchdog recommended it for England for the first time.
A migraine charity has called for “swift” access to the drug to ensure patients with the debilitating condition “can benefit from them as quickly as possible”.
Atogepant – sold under the brand name Aquipta – is a type of CGRP receptor antagonist (gepant), a new class of drugs for migraines.
It works by blocking the receptor of a protein found in the sensory nerves of the head and neck, known as calcitonin gene-related peptide (CGRP).
CGRP makes blood vessels dilate, which can lead to inflammation and migraine.
In clinical trials, a statistically significant reduction in migraine days – between three and four days per month – across 12 weeks was shown when Aquipta was compared with a placebo.
Between 55 and 61 per cent of patients achieved at least a 50 per cent reduction in average monthly migraine days depending on their medicine dose.
Aquipta has been recommended under new final draft guidance from the National Institute for Health and Care Excellence (Nice).
If there are no appeals against its final draft guidance, Nice is expected to publish its final guidance on the drug next month.
According to The Migraine Trust, about 10 million adults in the UK are living with the condition.
Are you eligible?
Aquipta will be an option for people who have at least four migraine days a month, and who have tried at least three other treatments to no avail.
There are four injectable versions of CGRPs.
Helen Knight, director of medicines evaluation at Nice, said: “Currently, the most effective options for people with chronic migraines who have already tried three preventative treatments are drugs that need to be injected.
“The committee heard from patient experts that some people cannot have injectable treatments, for example because they have an allergy or phobia of needles.”
Ms Knight said patients with chronic migraines – that happen on more than 15 days of the month – “would welcome an oral treatment”.
She added that Aquipta also “offers more choice” for people who suffer episodic migraines, which happen on fewer than 15 days of the month.
The Migraine Trust chief executive, Rob Music, said: “A migraine attack can be incredibly debilitating.
“Symptoms can include intense head pain, loss of or changes to the senses, and lack of ability to carry out day-to-day life.
“It is positive to see even more therapies emerging for people with migraine as many still rely on treatments developed for other conditions.
“We now need to ensure access is swift so that migraine patients can benefit from them as quickly as possible.”
Health minister Andrew Stephenson said: “Migraines affect millions of people in this country and this new treatment will help prevent recurring migraine attacks when other medicines have failed.
“It will allow more people whose daily life is affected by this painful, debilitating condition to manage their migraines more effectively and to live their lives to the fullest.”
Nice’s guidance for England comes after Aquipta was recommended for use in Scotland by the Scottish Medicines Consortium (SMC) in October last year.
Rachael Millward, medical director at AbbVie UK, which makes the drug said: “AbbVie has an extensive history in migraine research and is committed to addressing the unmet needs of people living with this debilitating condition.”
Nice recommends that Aquipta should be stopped after 12 weeks if chronic migraines do not reduce by at least 30 per cent and episodic migraine by at least 50 per cent.
How is migraine treated?
Often the only way to get rid of a migraine is to take painkillers and sleep it off.
Sufferers normally rest up in a dark room until it has passed – which can be up to 72 hours.
There are many options for migraine that can be tried – some help at the point of migraine and others are preventative.
And there are new treatments coming onto the market that are not just repurposed drugs for other conditions.
Triptans
Triptans reduce the pain and sickness of a migraine attack at the time they are taken.
Naratriptan and frovatriptan usually take longer to reach their maximum effect but their effect lasts longer.
But if a patient’s attacks peak quite quickly, a triptan such as sumatriptan, zolmitriptan, eletriptan or rizatriptan may be more appropriate.
Two doses of any triptan are allowed in 24 hours and they should not be used more than 10 days in a month.
Analgesics
This is medication that treats the pain of a migraine attack at the time they are taken and includes paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Prophylactics
Prophylactics are preventative medicines for migraines taken every day.
Most preventive medications currently available are repurposed from other conditions.
They include:
- Angiotensin II blockers (for hypertension)
- Anti-convulsants (for epilepsy)
- Anti-serotonergic drugs (for depression)
- Beta-blockers (for hypertension)
- Calcium channel blockers
- Tricyclic antidepressants
- CGRP monoclonal antibodies (described below)
Botox injections
Botox (botulinum toxin type A) is a type of nerve toxin that paralyses muscles. It was discovered that those who had the cosmetic injections had fewer headaches.
Botox is approved for use on the NHS for the treatment of chronic migraine – at least 15 headache days a month – in adults who have tried other treatments.
Doctors think it works by blocking chemicals called neurotransmitters that carry pain signals from within your brain.
CGRP monoclonal antibodies
Calcitonin gene-related peptide antibodies (CGRP) monoclonal antibodies (mAbs) are a new type of treatment for migraine.
CGRP mAbs are the first preventive medicines specifically developed for the treatment of migraine.
Several are now available on the NHS. This includes erenumab (brand name Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality) and eptinezumab (Vyepti).
The drugs target CGRP, released by the nerves and blood vessels during a migraine attack. It is thought to cause pain.
The new drugs target CGRP to prevent migraine developing.
All of the medicines are taken by injection, either monthly or every few months.
Gepants
Gepants are like the tablet form of the injectable CGRPs antibodies described above.
There are currently three gepants – ubrogepant (not yet on the NHS), atogepant and rimegepant – and others in development. They are CGRP receptor antagonists.
Gepants bind to the CGRP receptors on nerves and block its effects. Gepants (unlike triptans) do not constrict or tighten the blood vessel. They prevent them from dilating.
This makes them safer for people with heart issues and they can be used in people with cardiovascular disease.
Early indications suggests that gepants may be the first acute treatment not associated with medication overuse headache. Due to this, they may also be used as a preventive treatment.
Greater Occipital Nerve (GON) block
There are injections which contain small doses of local anaesthetic and/or steroid which is injected around the greater occipital nerve – which travels up each side of the back of the head.
Evidence suggests a GON block can provide short-term benefit to some people with migraine, reducing how often migraines occur and their severity.
Around one in three people do not see any benefit from a GON block.
Lifestyle measures
If none of these treatments help a patient’s symptoms, or they’re getting worse, a referral to a specialist may be made.
A GP may also recommend making changes to lifestyle to help manage migraines, such as eating at regular times and drinking less caffeine.
These include:
- Eat meals at regular times
- Exercise
- Get plenty of sleep
- Manage stress
- Drink plenty of water and less alcohol and caffeine
- Limit trigger foods, such as spicy food
Sources: NHS and The Migraine Trust