Atogepant recommended by NICE for migraine prevention in adults after 3 failed therapies

In a significant development for migraine sufferers, the National Institute for Health and Care Excellence (NICE) has recommended Atogepant as a preventive treatment for people experiencing four migraine days (minimum) in a month, but only after 3 other preventive medications have failed.

Migraines, often lasting between 4 to 72 hours, cause debilitating throbbing pain, severely impacting both mental well-being and physical activities. Those who experience frequent migraines are typically offered oral preventive medicines. If these treatments are ineffective or intolerable, patients can turn to injectable anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies. For episodic migraines, rimegepant oral is available, while botulinum toxin type A intramuscular injection is effective for chronic migraine prevention.

Despite these treatments, there remains a significant unmet need, particularly for those unable to use injectable medicines due to allergies or needle phobia. Atogepant oral medication, offers a new solution, especially for chronic migraine sufferers without other oral options. Its shorter half-life compared to injectable treatments is advantageous for patients who may need to cease treatment quickly, such as those with high vascular risk or planning to conceive.

The NICE recommendation is supported by data from two clinical trials which included Atogepant for migraine:

• ELEVATE, focusing on adults with episodic migraines after the failure of 2 to 4 preventive medications, and,
• PROGRESS, which involved adults with chronic migraines unresponsive to up to four previous treatments.

Additional supportive data came from the CGP-MD-01 and ADVANCE trials, which further highlighted Atogepant's efficacy in reducing monthly migraine days over the use of a placebo. The trials demonstrated significant reductions in monthly migraine days for both episodic and chronic migraine sufferers using Atogepant therapy. Economically, Atogepant was found to be cost-effective compared to existing treatments, particularly in chronic migraine cases.

Atogepant should be discontinued after 12 weeks if it fails to reduce migraine frequency by at least 50% for episodic migraines and 30% for chronic migraines, aligning with clinical trial protocols and current practices, as suggested.