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New HTA Decisions in England
March 2021
Drug name
AIMOVIG® (erenumab)
Company
Novartis
Decision date
11/12/2020
Therapeutic area
Neurological conditions
Therapeutic sub area
Headaches
Decision
Recommended with restrictions
Indication
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%.
Summary
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.