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Dr Gérald Kierzek (Medical Director of Doctissimo)
Medical validation:
November 28, 2023
A new drug, formulated with rimegepant, would provide relief to migraine patients, but it remains not reimbursed. An update on this therapeutic avenue, with Dr Gérald Kierzek, medical director of Doctissimo.
Migraine affects nearly 10 million French people. A real public health problem which has benefited from a new treatment for several weeks. But this expensive drug is still not reimbursed.
An indication for curative and preventive purposes
Since October 10, a new treatment, presented in the form of an oral lyophilisate, has been available in pharmacies. This is Vydura, a medicine based on rimegepant.
According to the European Medicines Agency, Vydura is a medicine used to treat migraine with or without aura (unusual visual or other sensory experiences) in adults. It is also used to prevent migraine in adults who have four or more migraine attacks per month.
The medicine blocks the pain
A chemical messenger called calcitonin gene-related peptide (CGRP) contributes to the development of migraine. The active substance in Vydura, rimegepant, binds to the CGRP receptor (target). By attaching to this receptor, the drug prevents CGRP from binding to it, which helps treat migraines and also prevents the onset of attacks.
For Dr. Gérald Kierzek, this drug is very promising.
“It acts on the causal mechanism of migraine; it will therefore block certain chemical mediators and block pain pathways. It is therefore a very interesting therapeutic avenue, particularly for patients resistant to other treatments such as triptans.“, he says.
Efficacy evaluated on the reduction of the duration and frequency of attacks
Vydura was more effective than placebo (a dummy treatment) in treating migraine in three studies involving a total of about 3,500 adults. On average, during the three studies, 20% of treated patients no longer had a headache after two hours, compared to 12% on average for those taking a placebo. Vydura has also been shown to be effective in treating other migraine symptoms such as photophobia (abnormal sensitivity of the eyes to light), phonophobia (abnormal sensitivity to sounds), or nausea (feeling unwell): on average, about 36 % of patients on Vydura no longer had any of the above symptoms two hours after treatment, compared to around 27% of patients on placebo.
Another study involving 747 chronic migraine patients showed that Vydura is effective in reducing the number of days with migraines. Patients took Vydura or a placebo every other day for up to 12 weeks. Treated patients experienced an average of 4.3 fewer days of migraines during the final four weeks of the study, compared to 3.5 fewer days for patients on placebo.
Treatment awaiting reimbursement
Currently, the treatment is not yet reimbursed: Health Insurance considers that additional proof of its effectiveness is necessary. It is therefore, for the moment, delivered on medical prescription at a price of around €25 per unit (the tablet).
At present, taking this medication depends on the patient’s wallet, Dr Wilfrid Casseron, a neurologist in Aix-en-Provence, admitted to us last September. “Among my patients, there are patients who can afford this medication, which costs between 240 and 270 euros per month. It is an injectable pen, like insulin. I prescribe it to them, they take their treatment independently at home and everything goes well. But there are also patients for whom it is impossible to pay such a sum every month and who only have to grit their teeth in the face of pain and that is completely unfair.”
Just like several associations, this expert denounced an injustice: “It is not normal to create two-tier medicine and a selection of access to treatments through money. In addition, France is one of the last countries not to have implemented reimbursement for these treatments: Spain, Switzerland and Germany have done so..