NICE recommends further migraine prevention option

Galcanezumab (Emgality) is the second calcitonin gene-related peptide (CGRP) inhibitor to be approved for routine NHS prescribing in patients with chronic migraine.

Elevated blood concentrations of CGRP have been associated with migraine attacks. | GETTY IMAGES
Elevated blood concentrations of CGRP have been associated with migraine attacks. | GETTY IMAGES

Prescribers can consider galcanezumab as an option to prevent migraine in adults who have at least 4 days with migraine each month and in whom at least 3 previous preventive treatments have failed.

Unlike fremanezumab (Ajovy), NICE has ruled that galcanezumab can be used within the NHS to prevent both chronic and episodic migraine.

For migraine that has not responded to at least 3 preventive treatments, NICE concluded from the clinical trial evidence that galcanezumab works better than best supportive care in both episodic and chronic migraine. It may also work better than botulinum toxin type A.

Galcanezumab should be stopped after 12 weeks of treatment if episodic migraine does not reduce in frequency by at least 50% or chronic migraine does not reduce by at least 30%.

The decision by NICE assumes the manufacturer of galcanezumab continues to provide the antibody according to the commercial arrangement.

Like other CGRP inhibitors, galcanezumab targets the process by which proteins cause blood vessels in the brain to swell. It is administered monthly by subcutaneous self-injection.

A third CGRP inhibitor, erenumab (Aimovig), was rejected by NICE last year. 

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