London, 10 January 2019. The National Institute for Health and Care Excellence (NICE) is assessing guidance on health technologies, clinical practice and prevention for the UK Department of Health. The guidelines are based primarily on the analysis of effectiveness and cost-effectiveness. NICE assesses whether new treatments provide added value compared to other treatments that do not come into play when the new form of therapy is used.

In a draft assessment of erenumab for migraine prevention, NICE states that erenumab (Aimovig) is not cost-effective. The guideline analyzed erenumab for the prevention of chronic and episodic migraine in adults who experience four or more migraine episodes per month or more and for whom at least three other preventive treatments were not effective.

NICE believes that the available studies demonstrate that erenumab is a clinically effective treatment. However, the committee concluded that the available studies did not reflect the range of patients treated in the healthcare system. In addition, the studies would not provide the necessary comparative data for previous medications. For this reason, more stringent standards would be applied to the assessment of cost-effectiveness than usual if there were uncertainties regarding the evidence of effectiveness.

Given the severe disability caused by migraine, the Director of NICE said it was disappointing that NICE was unable to make a positive recommendation for erenumab because of this fact.

There is insufficient evidence that erenumab is more effective than botulinum toxin type A for the treatment of chronic migraine. For both chronic and episodic migraine, there is no evidence that erenumab is sustainably effective for patients for whom three previous treatments with other active ingredients were not effective.

NICE wants to work with the manufacturer to give them the opportunity to address the issues raised in this interim recommendation.

It is estimated that 190,000 migraine attacks are suffered every day in England and women are affected more often than men (5-25% versus 2-10%).

Typically, three different classes of drugs are tried without success before further specialized treatment is considered. For patients with chronic migraine who have failed at least three previous treatment attempts, NICE has recommended botulinum toxin type A as a treatment option.

An overview of erenumab can be found here:

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