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New HTA Decisions in England
March 2021
Drug name
AIMOVIG® (erenumab)
Decision date
Therapeutic area
Neurological conditions
Therapeutic sub area
Recommended with restrictions
Erenumab is recommended as an option for preventing migraine in adults.
Decision Detail
It is recommended only if: • they have 4 or more migraine days a month; • at least 3 preventive drug treatments have failed; • the 140 mg dose of erenumab is used and; • the company provides it according to the commercial arrangement (there is a simple discount patient access scheme for erenumab). Stop erenumab after 12 weeks of treatment if: • in episodic migraine (less than 15 headache days a month) the frequency does not reduce by at least 50%; • in chronic migraine (15 headache days a month or more with at least 8 of those having features of migraine) the frequency does not reduce by at least 30%.
Four randomised controlled trials provided the clinical evidence for erenumab; study 295 in chronic migraine, and STRIVE, ARISE and LIBERTY in episodic migraine. For people whose migraine has not responded to at least 3 preventive treatments, erenumab 140 mg works better than best supportive care for preventing chronic or episodic migraine. There is no direct evidence comparing erenumab with botulinum toxin type A in chronic migraine, but an indirect comparison suggests that erenumab has some benefit. It is plausible that erenumab may work better than botulinum toxin type A. The cost-effectiveness estimates are within what NICE usually considers an acceptable use of NHS resources. So erenumab is recommended for preventing migraine in adults who have at least 4 migraine days per month.