A new treatment for migraine attacks that dissolves under the tongue will soon be available on the NHS, according to the latest guidance from the National Institute of Health and Care Excellence (NICE). The drug, called rimegepant, is expected to benefit thousands of people who suffer from sudden and severe head pain that can last for up to three days.
What is rimegepant and how does it work?
Rimegepant is a type of medicine known as a CGRP receptor antagonist. CGRP stands for calcitonin gene-related peptide, a protein that is released around the brain during a migraine attack and causes inflammation and pain. Rimegepant blocks the action of CGRP and stops the migraine from progressing.
Rimegepant comes in the form of a wafer that dissolves under the tongue and can be taken as soon as a migraine attack starts. It is not a preventative medicine, but rather a treatment for acute attacks. It is suitable for adults who cannot take or do not respond to other medicines, such as triptans, ibuprofen, or paracetamol.
Who can benefit from rimegepant?
NICE estimates that about 13,000 people in England could be eligible to take rimegepant for their migraine attacks. These are people who have migraines on between four and 15 days a month and have tried at least three other preventative drugs without success or with intolerable side effects.
Migraines are a common and disabling condition that affects about one in seven people in the UK, mostly women aged 35 to 45. Migraine attacks can cause a range of symptoms, such as nausea, vomiting, sensitivity to light and sound, and visual disturbances. Some people also experience aura, which are warning signs that a migraine is coming, such as flashing lights, blind spots, or tingling sensations.
Migraines can have a significant impact on a person’s quality of life, affecting their work, social, and family activities. According to the Migraine Trust, migraines cost the UK economy about £8.8 billion a year in lost productivity.
What are the advantages of rimegepant?
Rimegepant is the first oral treatment for migraine attacks to be recommended by NICE. It offers a new option for people who have not found relief from existing treatments or who have contraindications to them. For example, some people with heart disease cannot take triptans, which are the most commonly prescribed drugs for migraine attacks.
Rimegepant is also more convenient than some other treatments, as it does not require water or swallowing, which can be difficult during a migraine attack. It can be taken anywhere and anytime, without the need for injections or nasal sprays.
Rimegepant has been shown to be effective in reducing pain and other symptoms of migraine attacks in clinical trials. In one study, 19.6% of people who took rimegepant were pain-free within two hours, compared to 12.0% of those who took a placebo. In another study, 37.6% of people who took rimegepant were free from their most bothersome symptom (such as nausea, light sensitivity, or sound sensitivity) within two hours, compared to 25.2% of those who took a placebo.
Rimegepant has also been found to have a good safety profile, with few serious or severe adverse events reported. The most common side effects were nausea, dizziness, and fatigue, which were mild to moderate in intensity and resolved quickly.
What are the challenges and limitations of rimegepant?
Rimegepant is not a cure for migraines, nor does it prevent them from occurring. It is only a treatment for acute attacks, and it may not work for everyone. People who take rimegepant may still need to take other medicines to prevent or reduce the frequency of their migraines, such as beta-blockers, antidepressants, or epilepsy drugs.
Rimegepant is also not widely available yet, as it is still awaiting approval from the European Medicines Agency (EMA) and the Medicines and Healthcare products Regulatory Agency (MHRA). NICE has issued its final draft guidance based on the assumption that rimegepant will be approved and launched in the UK by the end of 2023. However, this may change depending on the regulatory process and the manufacturer’s plans.
Rimegepant is also not cheap, as it costs about £20 per wafer. NICE has deemed it to be cost-effective for the NHS, based on the manufacturer’s offer of a confidential discount and the assumption that rimegepant will be used only by people who meet the eligibility criteria. However, some experts and campaigners have argued that rimegepant should be made more widely available for people who suffer from migraines, especially those who have medication-overuse headache, a condition caused by taking too many painkillers.
What are the reactions and expectations from rimegepant?
Rimegepant has been welcomed by many health experts and migraine sufferers as a step change in the treatment of migraine attacks. Helen Knight, director of medicines evaluation at NICE, 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.”
Prof Peter Goadsby, from King’s College London, who was involved in the development of rimegepant, said: “Today’s decision offers an important advance in treatment options for those who do not respond or cannot tolerate current treatments.”
Barbara Tesio-Ryan, a librarian who has migraines about four times a month, said: “I’m really excited to try this drug – it could mean a huge change for my life.”
The Migraine Trust, a charity that supports people with migraines, said rimegepant brought new hope for many people who have been struggling with their condition for years. However, it also expressed its disappointment that rimegepant was not recommended for treating migraine attacks once they start, which would benefit more people.
Rob Music, chief executive of the Migraine Trust, said: “This would make a huge difference to people affected by medication-overuse headache, those who are unable to take other acute treatments and who have not responded well to the currently available acute treatments.”
