The assessment looks at erenumab, fremanezumab, and galcanezumab, the first monoclonal antibodies targeting the CGRP pathway for migraine prevention. It notes that for some patients, existing preventive therapies have not provided enough relief or have otherwise not been tolerable. The CGRP inhibitors could therefore be a treatment option for patients for whom other therapies have failed. It found that currently:
• The evidence on CGRP inhibitors is limited to those for whom up to three prior preventive therapies have failed. • CGRP inhibitors are projected to have positive impact on migraine days and associated QALYs for episodic and chronic migraine patients. • For patients with chronic migraine for whom other preventive treatments have failed, CGRP inhibitors may meet the upper bound of common willingness-to-pay (WTP) thresholds. • In patients with episodic migraine and patients with chronic migraine who have other treatment options available to them, it is likely that CGRP inhibitors will exceed commonly-cited WTP thresholds.
A BMJ editorial notes that erenumab was approved by US FDA in May and a marketing application is under review by the European Medicines Agency. Galcanezumb and fremanezumab are under FDA review; eptinezumab’s licensing application has yet to be submitted to the FDA. It suggests that by unquestioningly accepting the high prices and the industry arguments to justify them, patients are being priced out of treatment. Furthermore, poorly treated migraine is associated with high costs to society, and limiting access may prove short sighted. It calls for the price of these agents to fall, both to reflect their modest efficacy, and to allow more equitable access to a treatment option that might succeed where others have failed.