The National Institute for Health and Care Excellence (NICE) has given draft approval to the migraine prophylaxis infusion eptinezumab (Vyepti; Lundbeck), as a treatment option for people who have at least four migraine days per month and have had no relief from three oral preventive drugs.
Eptinezumab, a calcitonin gene-related peptide (CGRP) inhibitor, is administered as an intravenous infusion every 12 weeks. Other drugs in the same class are administered at home by subcutaneous injection, usually every four weeks. The CGRP inhibitors erenumab, fremanezumab and galcanezumab have already been approved by NICE for prevention of severe migraine.
Despite the need for clinic administration, the draft guidance says that eptinezumab is likely to cost the same, or less, than the other CGRP inhibitors. NICE adds that it expects eptinezumab will be used only for people with severe migraine attacks, who struggle with subcutaneous self-injection (e.g. because of needle phobia), and that an estimated 164,000 people in the UK may benefit from the drug.
The draft guidance adds that eptinezumab is likely to work as well as erenumab, fremanezumab and galcanezumab and that prescribers should choose the cheapest of the treatments deemed suitable, after discussion with the patient.
Rob Music, chief executive of the Migraine Trust, welcomed the news: “We think this is really positive news. This is a really exciting time in terms of migraine treatments.”
He pointed out that migraine-specific treatments had been a long time coming, despite how widespread and disabling the condition is. “[Eptinezumab] should provide another option for people who are eligible.”
However, he said the “real focus” would now be on ensuring that people had access to approved drugs that they were eligible for. “For people who’ve had them, it’s transformed their lives. But despite the fact we’ve got these approved drugs, we know people are struggling to access them.”
CGRP inhibitors work by targeting the process by which proteins cause blood vessels in the brain to swell. Under the NICE draft approval, eptinezumab should be stopped after 12 weeks if there has not been a 50% reduction in migraine frequency, or a 30% reduction for people with chronic migraine (15 headache days per month or more, with at least 8 of those days having features of migraine).
The price of eptinezumab is £1,350 for a 100mg per mL vial. However, the draft guidance states that the NHS has reached an undisclosed discount agreement with manufacturer Lundbeck.