In a randomised clinical trial, patients treated with fremanezumab (Ajovy, Teva Pharmaceuticals) had significantly fewer headache and acute-medication use days per month, and significantly fewer monthly migraine days compared with those who received the placebo.
The trials also showed that fremanezumab worked better than the best supportive care (usually comprising acute treatments for migraine symptoms) for preventing chronic or episodic migraine in people who have already tried three preventive treatments. However, it is unclear if fremanezumab works better than Botulinum toxin type A, which is also recommended by NICE for preventing chronic migraine in these patients.
Fremanezumab is part of a wave of novel drugs which target calcitonin gene-related peptide (CGRP). CGRP found by researchers at King’s College London to be increased in patients with migraine and identified as a therapeutic target to reduce the pain and associated symptoms of migraine.
This is an enormous and welcome breakthrough for patients with migraine. At last a migraine-specific treatment to prevent attacks available on the NHS, says lead researcher Peter Goadsby, NIHR-Wellcome Trust Clinical Research Facility, Slam Biomedical research Centre and Professor of Neurology at Institute of Psychiatry, Psychology & Neuroscience, King's College London.
Fremanezumab works by blocking the effects of CGRP, which is key to the migraine attack. It is given as a monthly self-administered injection.
It is estimated that there are 190,000 migraine attacks experienced every day in England with women more likely to experience one than men (5-25% versus 2-10% respectively). A minority of these will be eligible for treatment with fremanezumab.
The aim of treatment is to reduce the frequency, severity or duration of migraine and improve quality of life. Current treatment options for preventing migraine include botulinum toxin type A and drugs that are used for treating other conditions, such as beta-blockers, antidepressants and epilepsy medications. The patient experts explained that these treatments can have significant side-effects and can be ineffective for some people.
If no appeals are received during the draft consultation, final guidance is expected to be published in April 2020.