As you might have heard, the migraine medication Vydura (rimegepant ) will be soon be available on the NHS. This is exciting news, as it’s the first new migraine tablet since the triptans came out 30 years ago. A lot is still unknown but I’ll try to answer some questions here.
How does it work?
Vydura interferes with the CGRP receptor, just like the CGRP antibodies that were approved a few years ago. The difference is that Vydura isn’t an antibody, but a small molecule so that it can be taken as a tablet and leaves the body much quicker.
How do you use it?
You can take Vydura as a pain killer, it will then take around two hours to have effect but the effect will then last 24 hours. This is slower than most other pain killers and triptans, and not more effective, which is one of the reasons the NHS will not fund it as a pain killer. You can still get it privately, at a cost of around £20 per tablet.
Instead, the NHS has recommended it as a preventative, taking Vydura every second day. The studies included patients with between 4 and 15 headache days a month and showed a reduction of 4 days.
Is it safe?
From what we know so far, Vydura is very safe It can even be taken by persons with stroke and ischaemic heart disease. This is a group that can’t take triptans, and because of that there’s been some criticism that NHS will not fund Vydura as a pain killer
Who can get it?
The criteria is similar to botox and the CGRP antibodies: you should first have tried three oral preventatives and don’t have medication overuse headache. The difference is that Vydura is not approved for chronic migraine (>15 days/month), but only for episodic migraine (between 4 and 15 headache days a month). Compared to other advanced treatment, botox is only approved for chronic migraine, and the CGRP antibodies for the whole group.
This restriction puts Headache Services all over England in a tight spot. Because of limited capacity most of our patients have chronic migraine, and patients with episodic migraine are much more likely to only see their GP.
One way around this would be to let GP prescribe it, or at least continue the prescriptions after a headache specialist has recommended it. This would probably be safe, but is not how it’s usually done with new medication, and the cost could be significant.
What happens now?
The Dorset ICB Formulary group will make a local decision about Vydura. We will almost certainly improve it within a couple of months, but it’s still unclear whether it will be a specialist drug or accessible to GPs, and if there will be additional restrictions in who can have it.
A patient that’s interested in trying it, can already now make sure that they keep a headache diaries, have tried three standard preventatives and avoid medication overuse. I’ll keep this page updated.
If Vydura is recommended as a preventative then what is the reasoning behind not approving it for chronic headaches? Very good information here and a nice picture of the molecule too!
Thanks!
That’s how the studies were designed, probably both easier to recruit and show effect in this group. Time will tell if it works for chronic migraine as well, but there’s no reason why it shouldn’t.
Just approving it for episodic migraine could have the interesting consequence that these patients get more attention and more easily get referred to a headache specialist.