New oral treatment to prevent migraines recommended by NICE
A new kind of oral treatment should be made available to NHS patients who experience regular migraines, according to guidance from the National Institute for Health and Care Excellence (NICE).
The final draft NICE guidance, issued on 11 April, recommended atogepant (Aquipta) as a treatment option for the estimated 170,000 adults in England who have at least four migraine days per month.
“Some people with chronic migraines would welcome an oral treatment”
Helen Knight
Atogepant is the first oral option in the class of calcitonin gene-related peptide (CGRP) receptor antagonists, noted NICE.
The guidance recommended the new drug be considered as a preventative treatment option for adults with episodic migraine, who suffer between four and 15 headache days per month.
It also recommended it for those with chronic migraine, who suffer 15 or more headache days per month with at least eight having features of migraine.
The draft guidance recommended atogepant be used as a fourth-line treatment, considered only after three other treatments have failed to effectively prevent migraines.
Treatment should be stopped after 12 weeks if atogepant does not cut migraine frequency by at least 50% in patients with episodic migraine and by 30% in those with chronic migraine, the guidance said.
Other oral treatments are already available for prevention of migraine in adults with episodic migraine. However, atogepant is the first oral preventative treatment to be available for chronic migraine patients.
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 [NICE] committee heard from patient experts that some people cannot have injectable treatments, for example because they have an allergy or phobia of needles,” she said.
“So, some people with chronic migraines would welcome an oral treatment. Atogepant also offers more choice for people with episodic migraine,” Ms Knight added.
The final guidance on the use of atogepant for the prevention of migraine is due to be published on 15 May 2024.
