TA871 · HST

Eptinezumab for preventing migraine

Recommended with restrictionsJanuary 2023

Only if adults have 4 or more migraine days a month, at least 3 preventive drug treatments have failed, and the company provides it according to the commercial arrangement. Stop after 12 weeks if episodic migraine frequency does not reduce by at least 50%, or chronic migraine frequency does not reduce by at least 30%.

Source documents

Intervention

eptinezumab (VYEPTI)
CGRP inhibitor · calcitonin gene-related peptide inhibitor · intravenous infusion

Conditions

chronic migraineneurology_psychiatry · chronic
episodic migraineneurology_psychiatry · chronic

Comparators

NameType Established Committee preferred
erenumabactive drugYes
fremanezumabactive drugYes
galcanezumabactive drugYes

Clinical trials

TrialDesignPhasePivotal
Network meta-analysis of RCTs comparing eptinezumab with erenumab, fremanezumab and galcanezumabnetwork meta-analysis

Methodological decisions (1)

equivalence assumption

Cost comparison recommended based on assumption of similar clinical effectiveness between eptinezumab and other CGRP inhibitors (erenumab, fremanezumab, galcanezumab)

Committee: The committee agreed that there was sufficient evidence of similar clinical efficacy for eptinezumab compared with erenumab, fremanezumab and galcanezumab based on network meta-analysis and clinical opinion

ICER impact: negligible

Evidence gaps

no direct comparisonNo clinical trials directly comparing eptinezumab with erenumab, fremanezumab or galcanezumab; indirect comparison via network meta-analysis was used instead

Commercial arrangement

simple discount pas · confidential · critical for recommendation

Special considerations

Equality issues raised

Cross-references

comparator guidance — References to previous NICE technology appraisal guidance on erenumab, fremanezumab and galcanezumab for preventing chronic or episodic migraines