Acute migraine? NICE recommends Pfizer's rimegepant as potential option

The National Institute for Health and Care Excellence (NICE) has released conclusive draft guidance, suggesting Pfizer's Vydura (rimegepant) as a choice for treating acute migraines in adults with or without aura.

However, there is a caveat. This recommendation applies exclusively to individuals with a prior history of migraines, meeting one of the following criteria:

• At least 2 triptans were tried and they did not work well enough or
• Triptans were contraindicated or not tolerated, and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.

This drug was developed by the US-based Biohaven Pharmaceuticals, acquired by Pfizer in 2022, in an $11.6 billion deal. Nurtec ODT is the commercial name for the drug in the US, while the European Union approved the drug under the name Vydura in April 2022.

NICE recommended rimegepant, an oral lyophilisate (dissolving wafer) and the first oral calcitonin gene-related peptide (CGRP) receptor antagonist for acute migraine treatment, to be taken at the onset of a migraine attack.

Migraine affects one in seven people in the UK, often with a debilitating impact, Pfizer UK said in a statement. The condition entails symptoms such as head pain, vomiting, nausea, altered vision, fatigue, and heightened sensitivity to light, sound, and odours.

“Migraine can have a debilitating impact on those living with it,” said Prof. Peter Goadsby, Director of NIHR Clinical Research Facility, adding that decision was a welcome step to help expand the options for patients who need the treatment.

An estimated 43 million workdays are lost annually in the UK due to migraine-related absenteeism. Furthermore, it is estimated that migraine may incur total healthcare and productivity costs ranging from £6 billion to £10 billion for the UK economy each year.

Earlier this year, NICE recommended rimegepant as an option for preventing episodic migraine in adults experiencing between four and fifteen migraine attacks per month, provided that at least three prior preventative treatments have proven ineffective.

"This decision is an important milestone and further expands the use of rimegepant for treatment of acute migraine in England," said Toby Cousens, Head of Hospital and Internal Medicine, Pfizer UK. "Pfizer is committed to supporting people living with migraine and we will continue to work with healthcare partners to improve care.”

In 2022, Pfizer invested £289 million in UK research and development and engaged in 126 collaborations with universities, pharmaceutical companies, industries, and others. The UK has licenses for over 150 Pfizer medicines and vaccines.

In June, Pfizer's late-stage trials of their experimental antibiotic combination showed promising results against drug-resistant bacteria. The study pitted Pfizer's aztreonam-avibactam (ATM-AVI) and metronidazole against older antibiotics for targeted infections. Pfizer determined that ATM-AVI is a safe and effective treatment for gram-negative bacterial infections.