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Appraisal consultation document

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1 Recommendations

1.1 Rimegepant is not recommended, within its marketing authorisation, for acute treatment of migraine with or without aura in adults.

1.2 These recommendations are not intended to affect treatment with rimegepant that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

The company proposed rimegepant for acute treatment after 2 or more triptans have not worked, or if people cannot have triptans. This is narrower than the marketing authorisation. After triptans there are no other treatment options available.

Clinical trial evidence for acute migraine shows that rimegepant is more likely to reduce pain at 2 hours than placebo.

The most likely cost-effectiveness estimates are above what NICE considers to be an acceptable use of NHS resources. So, rimegepant is not recommended. But because there is an unmet need for people who cannot have triptans, more evidence is needed to see if rimegepant could be cost effective in this group.