26th September 2019

NICE rejects Aimovig as a migraine treatment in NHS England

The Migraine Trust is concerned about health inequalities and a postcode lottery for people with migraine in the UK

The Migraine Trust response

The Migraine Trust has expressed concern about health inequalities and a postcode lottery for people with migraine in the UK. This follows the rejection of Aimovig (erenumab) for routine NHS use in England by the National Institute for Health and Care Excellence (NICE).

Aimovig, which is manufactured by Novartis, is one of a new generation of migraine treatments, the first preventive medication that is dedicated to treating the condition. It was accepted for restricted use within NHS Scotland for the treatment of adults with chronic migraine by the Scottish Medicines Consortium (SMC) in April.

Commenting on the NICE announcement, Gus Baldwin, Chief Executive of The Migraine Trust, said:

“We will look closely at what NICE has said. NICE has an extremely difficult job but this still feels like a very bad day for chronic migraine patients.

“My main worry is that I’m yet to find a neurologist who doesn’t want to have the option of being able to prescribe these new types of preventive drugs when they and their patient think it is likely to be in the patient’s best interest. Crucially, these new drugs do not have the nasty side-effects of other preventives already available.

“I am also concerned that this decision is going to deepen health inequalities amongst people living with migraine. Those who can afford to pay will continue to receive drugs like these while those who can’t will be denied the option.

“Finally, I am concerned by the postcode lottery that is gradually developing around effective migraine treatments. Scottish chronic migraine patients can be prescribed this new drug through the Scottish NHS while today’s announcement means that patients in England and Wales will not be able to access them. Far too many people with chronic migraine are having their lives ruined by this horrible brain disease and access to the most effective treatments should not be decided by where you live in the UK.

“We are expecting a number of new – potentially very exciting – migraine drugs to start to come onto the market over the next few years. We are keen to work in partnership with NICE and the rest of the migraine community so that we can make the best case possible for the cost-effectiveness of new drugs that improve the lives of people with migraine.”

British Association for the Study of Headache (BASH) response

The British Association for the Study of Headache (BASH) notes with extreme disappointment the decision of NICE not to approve the use of Aimovig for the treatment of migraine in the NHS in England.

NICE recognise that migraine significantly affects health-related quality of life and that well-tolerated treatments are needed. It further acknowledges that for people whose migraine has not responded to at least 3 oral preventive treatments, the clinical trial evidence shows that Aimovig 140 mg works better than best supportive care for preventing chronic or episodic migraine, and also improved other outcomes, including the severity of migraine pain.

Aimovig has been approved for use in Scotland by the SMC for patients with chronic migraine.

The determination indicates that on some analyses, the cost of Aimovig for patients with chronic migraine was within the range considered a cost-effective use of NHS resources. It refuses approval on the basis of a “high degree of uncertainty” of the effectiveness of the drug, specifically when compared with the effects of onabotulinum toxin A (Botox), which is approved for use for patients with chronic migraine in the UK.

Dr Mark Weatherall, Chair of BASH Council, comments:

“This drug is not a panacea, but it is an important advance in the scientific treatment of migraine, which effects huge improvements in the lives of many of those who take it. It is completely unacceptable that patients in England and Wales who suffer with such a debilitating neurological disorder should be denied access to effective treatment. It is difficult to understand why a treatment that has been approved for use in Scotland has been denied to patients elsewhere in the UK. We will do everything we can to turn this decision around in the interests of our patients and their families.”

What this means for people with migraine

I am currently receiving Aimovig (erenumab) in England, will that continue?

Patients receiving it via the NHS ‘free of charge’ scheme in England will continue to receive it for up to three years, dependent on their individual clinician’s decision.

Does this affect the availability of Aimovig in Scotland?

No, it has no impact on the availability of it in Scotland.

Does this affect patients in Northern Ireland and Wales?

While this decision is for NHS England, the All Wales Medicines Strategy Group (AWMSG) has today confirmed that it will apply to Wales too.

In circumstances where NICE does not recommend a particular drug, the Health and Social Care Board in Northern Ireland does not routinely commission that therapy for use in Northern Ireland. They have said that there are arrangements by which such treatments can be accessed for individual patients via an individual funding request (IFR) “where the case for clinical exceptionality can be established”. This would be via your neurologist.

Can patients outside of Scotland be referred to Scotland for treatment?

You would need to be registered as a patient in Scotland to have treatment there.

Can I buy Aimovig privately?

Yes, it will still be available privately. A private prescription can be obtained from a specialist.

Why did NICE make this decision?

NICE has explained its decision which is published here.

Will there be an appeal?

The British Association for the Study of Headache (BASH) and the Association of British Neurologists (ABN) launched an appeal with NICE.

On 4 February 2020 NICE announced its appeal decision that it would look again at its decision to reject Aimovig. The NICE appeal panel decided that the appraisal committee unreasonably failed to consider all of the evidence about the cost-effectiveness of erenumab for patients who have failed to respond to botulinum toxin (Botox).

This latest announcement by NICE does not mean that its original decision to reject erenumab has been overturned. It means that the decision now returns to the appraisal committee to consider whether erenumab is a cost-effective treatment for chronic migraine patients who have tried Botox but found it didn’t work for them. We are awaiting word from NICE about how long this new step will take and what it will involve.

What is The Migraine Trust going to do now?

We are taking part in upcoming NICE and SMC technology appraisals for new CGRP medication. We have launched a patient survey to support this and strengthen the overall patient voice in the process.

If you have or are taking CGRP medication to treat migraine, we would welcome you sharing your experience with us in the survey. This will ensure that your voice is heard in the process.

You can find out more about it and take it here.

How do I complain to NICE?

The contact details for NICE are here.

Is there other CGRP antibody preventive medication available?

There are other CGRP antibody preventive medications available privately but the only medication that is available on the NHS is Aimovig in Scotland.