13 September 2023 , 23:01
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The first oral drug to tackle the cause of migraines is being rolled out as a treatment on the NHS.
The regulator said its approval of Rimegepant - taken as a wafer on the tongue - marks a “step-change in treatment” for the “invisible disability that affects all aspects of life”. Draft guidance by the National Institute for Health and Care Excellence (NICE) means the drug made by Pfizer will initially be offered to 13,000 patients hospitalised due to acute migraines in England.
Helen Knight, NICE medicines director, said: “This is the first and only NICE-recommended medicine that can help alleviate the misery of acute migraines, and may be considered a step-change in treatment. Migraine is a condition described in comments to NICE from carers and people with migraine as an invisible disability that affects all aspects of life including work, education, finances, mental health, social activities, and family.
“Today’s final draft guidance addresses the high unmet need for treatment options for acute migraine, once again demonstrating our ability to ensure clinically and cost-effective medicines are available to those who need them as quickly as possible.”
Pill is taken as a wafer on the tongue (Getty Images)Around 10 million people in the UK suffer some form of migraines. Rimegepant is the first ever dedicated oral treatment on the NHS and works by stopping the release of a protein around the brain called calcitonin gene-related peptide (CGRP) which causes intense inflammation in the coverings of the brain.
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Until now migraine sufferers were offered drugs for other linked conditions - such as beta-blockers, antidepressants and epilepsy medications - or injections. Rimegepant had earlier this year been approved as a preventative measure for 150,000 patients with “episodic migraines” - at least four severe headaches a month - where three previous treatments have failed.
Prof Peter Goadsby, top neurologist at King's College London, said: “Migraine can have a debilitating impact on those living with it. Today’s decision, to offer a treatment which can be used at the onset of a migraine is a welcome step to help expand the options available to eligible patients.” It is estimated that up to 43 million workdays are lost each year in the UK to migraine-related absenteeism.
Migraines are estimated to cost the UK economy between £6 billion and £10 billion a year in healthcare and productivity costs. They affect three-times as many women as men, likely due to the differences in sex hormones. Migraine affects one in ten children.
Treatment options such as beta-blockers, antidepressants and epilepsy medications can have significant side-effects and can be ineffective for some people. Toby Cousens, head of internal medicine at Pfizer UK said: “Migraine can significantly interrupt people’s day to day lives, both personally and professionally, and we know women are disproportionately impacted by this condition. This decision is an important milestone.”
Rimegepant will be available to adults who have tried at least two triptans - medication usually given to tackle headaches or migraines - but found they did not work well enough. It can also be administered to those who are not able to take triptans or have an intolerance, or patients who have tried nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol.
It will also be used to relieve symptoms of a migraine, which can include pain, nausea and sensitivity to light, but also painless symptoms such as temporary visual disturbances known as "aura", which Nice said "is not well managed with existing treatments". NICE will publish its final recommendations on rimegepant in October.