Vyepti: a new drug for preventing migraines

A new drug for migraine

In April 2023, a new preventative treatment option became available on NHS England for adults living with chronic migraine, following approval from the Instituto Nacional para la Excelencia en Salud y Atención (NICE) in March¹.

The new drug, known both as eptinezumab and by brand name Vyepti, is believed it to be as effective as the other current injectable treatments. However, because it's injected by hospital staff rather than seif-administered, Vyepti could be helpful for those who find it difficult or impossible to self-inject at home. This drug is unlikely to benefit people who can't regularly visit hospital - as well as those hoping for a non-injectable treatment to appear on the market.

Migraine episodes can involve throbbing headaches, nausea, and vomiting. Dealing with this condition long-term has a profound impact on someone's quality of life - their relationships, careers, and general wellbeing can all be affected.

Rob Music is chief executive at The Migraine Trust. He says that another treatment option is great news, as long as those who are eligible can access it:

"The class of drugs that Vyepti belongs to can be life-changing - allowing many to do things that migraine had prevented them from doing, from being able to work full-time to being able to enjoy travelling."

Music adds "

As we start 2023, we hope that integrated care systems will do more to ensure that there is greater access to this potentially life changing treatment.”

Why do we need Vyepti?

There are other chronic migraine drugs on the market. However, many oral preventative treatments are largely ineffective and poorly tolerated¹. In the NHS, it's standard practise for people to try at least three oral preventative treatments before being considered for more specialist injectable drugs, including erenumab, fremanezumab, and galcanezumab.

While these injectable drugs have a much higher success rate in reducing and managing migraine, there are two drawbacks that could prevent some people from accessing their benefits:

• They are all self-administered by injection - this excludes people who can't self-inject due to physical disability or psychological barriers such as needle phobias.

• Access can vary depending on where someone lives - not everyone has a suitable home set-up to store and carry out this treatment.

Vyepti provides an alternative option because it's administered as an infusion by a professional in hospital, every 12 weeks.

What does Vyepti do?

Vyepti works in much the same way as the current injectable drugs. It prevents future migraines by blocking a protein called calcitonin gene-related peptide (CGRP) which is thought to play a part in triggering migraine episodes. The new treatment works immediately to prevent migraine episodes - but it doesn't treat episodes that are already happening.

While there are no clinical trials that directly compare the effectiveness of Vyepti against the other injectables, an indirect comparison suggests that it works as well as these treatments¹.

For treatment to be considered successful, you should expect:

• At least a 50% reduction in episodes if you have episodic migraine - fewer than 15 migraine days a month.

• At least a 30% reduction if you have chronic migraine - 15 or more migraine days a month.

Who is Vyepti for?

NICE estimates that this drug could benefit around 164,000 people in the UK². You may be one of these people, if you meet the following eligibility criteria:

• You're an adult.

• You experience four or more migraine days a month.

• You have already been treated unsuccessfully with three or more preventive treatments.

How is Vyepti given?

Unlike the other treatments on the market, Vyepti is administered as an infusion into your veins. This means that it's delivered directly into your blood stream and can start working straight away. You may notice your migraine episodes have gone from the first day of treatment.

The infusion is done by a health professional in hospital every 12 weeks. This makes Vyepti a promising alternative for people who are unable to use the at-home self-injecting drugs.

Is Vyepti safe?

Scientists describe Vyepti as a relatively safe drug. While there are possible side effects, these aren't too common and are usually mild - although more serious side effects can occur³.

Mild side effects

• The common cold.

• Upper respiratory tract infections (URTIs).

• Sinusitis

These side effects may disappear on their own within a few days or weeks. However, you need to talk to your doctor or pharmacist if they don't go away or become more severe.

Serious side effects

Serious side effects aren't common and are usually an allergic reaction to one of the ingredients in Vyepti. Severe allergic reaction symptoms include:

• Erupción cutánea.

• Sentirse o estar enfermo.

• Dificultad para respirar.

• Chest pain or tightness.

• Anafilaxia - the most dangerous and sudden type of allergic reaction.

If you experience any of these symptoms, you need to seek urgent medical attention.

Embarazo y lactancia

The treatment has undergone many clinical trials and has been found to be safe for most people, including those with diabetes tipo 2 y la obesidad³. This said, its effects on pregnant and breastfeeding women aren't yet known, because these groups aren't able to participate in trials.

1. NICE: Eptinezumab for preventing migraine.

2. NICE: LinkedIn post.

3. Datta et al: A review of eptinezumab use in migraine.