BMJ TAG: making meaningful contributions to patient care In the last year, the BMJ Technology Assessment Group (BMJ-TAG) has played a key role in evaluating the safety and effectiveness of drugs for public use through the NHS, contributing to the development of high profile NICE guidance.
In July 2023, rimegepant was recommended for use in the UK’s NHS by the National Institute for Health and Care Excellence (NICE) as a preventive option for adults with episodic migraine and in October 2023, it was recommended as a treatment option for acute migraine in adults. Rimegepant is an oral treatment in the form of a wafer that dissolves on or under the tongue. It was the first oral preventive option to be recommended as the fourth line by NICE, offering an alternative to existing treatments that require injections for up to 145,000 people in England. In the acute setting, rimegepant is the first treatment to be recommended by NICE and may be available to up to 13,000 patients in England, offering an alternative to treatments that were originally designed for use in other conditions. Later, in May 2024, atogepant was the latest preventive migraine treatment to be recommended by NICE. In the form of an oral tablet, atogepant is the second oral treatment to be recommended in the fourth-line setting for the prevention of episodic migraines (following rimegepant), but the first oral treatment at this line of therapy for the prevention of chronic migraines, providing more choice for those with episodic migraine and an oral alternative to existing preventive treatments for chronic migraine which require injections. The new guidance may provide an additional treatment option for up to 170,000 people in England.
Rimegepant and atogepant represent significant advancements in migraine care. According to patient and healthcare experts involved in the NICE appraisals, migraines can severely impact daily life and current treatments often fall short. These new oral medications offer a much-needed improvement in treatment options for adults with migraines. In November 2023, foslevodopa-foscarpidoba became the first treatment for Parkinson’s disease to be approved by NICE for use in the NHS. It is administered as a continuous subcutaneous infusion (24 hours a day), with release controlled by a small automatic pump with an option for manual boost if needed. Unlike traditional oral treatments, it provides a steady supply of medication, preventing the harmful spikes and drops in dopamine levels that cause movement problems. Limiting movement problems can significantly improve Parkinson’s Disease patients’ quality of life. Foslevodopa- foscarpidoba provided a notable improvement in quality of life over Levodopa-Carbidopa Intestinal Gel (LCIG). LCIG has a similar concept for regulating levodopa administrations/dopamine levels but involves invasive surgery, which was both costly and negatively impacted patients’ quality of life. An NHS England News item from February 2024 outlines how the patient community welcomes the new treatment and estimates that nearly 1000 patients will benefit from it. 32
A migraine attack can be incredibly debilitating. Symptoms can include intense head pain, loss of or changes to the senses and lack of ability to carry out day-to-day life. It is positive to see even more therapies emerging for people with migraine, as many still rely on treatments developed for other conditions. We now need to ensure access to the newer treatments is swift so that migraine patients can benefit from them. Rob Music, Chief Executive, The Migraine Trust
“For someone who has lived with severe migraine for over 40 years and for whom no treatment has ever worked, the innovation of atogepant has brought me hope and life-changing relief.” Deborah, migraine patient
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