NICE (UK) positive for Aquipta (atogepant) for treating migraine – AbbVie
NICE (UK): Atogepant can be used as an option for the acute treatment of migraine with or without aura in adults, only if, for previous migraines: i) at least 2 triptans were tried and they did not work well enough, or ii) triptans were contraindicated or not tolerated, and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough. Use the least expensive option of the suitable treatments (including atogepant and rimegepant), having discussed the advantages and disadvantages of the available treatments with the person with the condition. Take account of administration costs, dosages, price per dose and commercial arrangements.
Why these recommendations were made: Rimegepant is the usual acute treatment for migraine after at least 2 triptans have not worked well enough, or if people cannot have triptans, and NSAIDs and paracetamol do not work well enough. Clinical trial evidence shows that atogepant is more effective than placebo. It has not been directly compared in a clinical trial with rimegepant. Evidence from an indirect comparison suggests that the levels of pain reduction at 2 hours are similar with atogepant and rimegepant. But these results are uncertain. This means that it is unclear from these results alone whether atogepant works the same as, or better or less well than, rimegepant. But, because the way the medicines work and are administered are similar, it is likely that their clinical effectiveness is similar. Clinical expert feedback supports this and states that they would be used at the same place in the treatment pathway. A cost comparison suggests that the costs for atogepant are similar to or lower than those for rimegepant. So, atogepant can be used.
