NICE rejects Novartis' Aimovig migraine injection for NHS use

It’s disappointing news for Novartis as NICE revealed that it had decided not to recommend Aimovig (erenumab) for routine NHS use for the prevention of chronic and episodic migraine in patients across England and Wales.

Specifically, the issued draft guidance concerned adult patients who experience four or more migraines each month, and for whom three previous preventative treatments have failed.

While the organisation agreed that erenumab is clinically effective, it found issue with the fact that it felt the submitted trial data was not directly relevant to the NHS, failing to reflect the patients the service sees in clinical practice or include all relevant comparators and outcomes. These issues served to drive up the cost-effectiveness estimates for the drug outside what NICE considers to be an efficient and sensible use of NHS resources.

“Migraine is a debilitating condition that significantly affects quality of life and the committee heard from patient experts that well-tolerated treatment options are needed. It’s therefore disappointing that we’ve not been able to make a positive recommendation for erenumab,” said Meindert Boysen, Director of the Centre for Health Technology Evaluation at NICE.

“Erenumab is a promising new preventive treatment for migraine that has been shown to be clinically effective compared with best supportive care. However, there was not enough evidence to suggest that it is more effective than botulinum toxin type A for people with chronic migraine, which NICE already recommends. And for both the chronic and episodic migraine populations there was no evidence to show that erenumab is effective in the long-term in people for whom three previous preventive treatments had failed.

“We will work with the company to ensure that they are given every opportunity to address the issues highlighted in these provisional recommendations,” he added.

The self-administered injection is the first treatment to target the process which leads to migraine symptoms in which proteins cause the swelling of blood vessels. It has a list price of $5,000 per year.

Matt Fellows