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Aimovig vs Ajovy
Introduction
For patients suffering from chronic or episodic migraines, certain drugs that target and block the activity of calcitonin gene-related peptide (CGRP), a molecule involved in triggering migraine attacks, can offer significant relief. Aimovig and Ajovy are two such medicines prescribed for preventing migraines. They each impact CGRP but in slightly different ways; still, both have shown to reduce the frequency of monthly migraine days in patients.
Aimovig is a CGRP receptor antagonist; it works by blocking the receptors where CGRP would generally bind. On the other hand, Ajovy is a monoclonal antibody that targets and binds to the CGRP molecules themselves rather than their receptors—effectively neutralizing them before they can trigger a migraine attack.
Aimovig vs Ajovy Side By Side
| Attribute | Aimovig | Ajovy |
|---|---|---|
| Brand Name | Aimovig | Ajovy |
| Contraindications | Allergic to Aimovig or severe allergic reactions to similar drugs | Allergic to Ajovy or severe allergic reactions to similar drugs |
| Cost | $690 for a single-use pre-filled syringe or auto-injector pen (70 mg) | $640 for one pre-filled syringe (225 mg) |
| Generic Name | Erenumab | Fremanezumab |
| Most Serious Side Effect | Allergic reactions such as hives, difficulty breathing or swallowing, swelling of the face or throat; Heart palpitations; Muscle stiffness or spasms; Unusual tiredness or weakness | Symptoms of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat; Rapid weight gain; Severe headache or pounding in your neck or ears; Fever, chills, sore throat; Numbness or tingling (especially in your feet and hands) |
| Severe Drug Interactions | Not specifically mentioned, but always inform your physician about all medications you are taking to avoid potential interactions | Not specifically mentioned, but always inform your physician about all medications you are taking to avoid potential interactions |
| Typical Dose | 70-140 mg/month | 225 mg/month or 675 mg every three months |
What is Aimovig?
Erenumab (the generic name for Aimovig) was the first drug of the CGRP inhibitor class designed specifically to prevent migraines, marking a significant development from other classes of migraine treatments. Erenumab received FDA approval in 2018. Aimovig works by blocking the activity of calcitonin gene-related peptide (CGRP), a molecule that is involved in migraine attacks, effectively reducing its influence on pain signals transmission.
On the other hand, Fremanezumab (the generic name for Ajovy) is another medication from the same class but it differs slightly in its mechanism and dosage frequency. Both drugs are prescribed for preventing migraines in adults but their effects may vary between individuals.
Aimovig has a selective influence on CGRP receptors with minor impact elsewhere which results in fewer side effects than older medications known to have broader impacts throughout the body. Comparatively, Ajovy binds directly to CGRP ligand restricting its ability to bind anywhere else thus also demonstrating lower side effect profile compared with traditional migraine medicines.
What conditions is Aimovig approved to treat?
Aimovig is approved for the prevention of migraines in adults:
- Chronic migraine, characterized by headaches on 15 or more days per month
- Episodic migraine, with fewer headache days per month
On the other hand, Ajovy has gained FDA approval for:
- Prevention of both chronic and episodic migraines in adults.
How does Aimovig help with these illnesses?
Aimovig helps manage migraines by blocking the calcitonin gene-related peptide receptor (CGRP-R), which is implicated in migraine pathophysiology. It does this by acting as a monoclonal antibody specifically designed to bind and inhibit the CGRP-R, thus preventing activation of this pathway that leads to migraine pain. CGRP itself is a neuropeptide that plays an important role in transmitting pain signals within the brain and has been found at high levels during acute migraines. Therefore, by inhibiting its action, Aimovig can limit the frequency, duration, and severity of migraines helping patients manage their condition more effectively.
Ajovy also targets the CGRP pathway but does so slightly differently from Aimovig. Instead of binding directly to the receptor like Aimovig does, Ajovy binds to CGRP itself thereby preventing it from activating its receptor. By stopping this neuropeptide from initiating its effect on receptors involved in pain transmission pathways particularly during migraine attacks; Ajovy offers another therapeutic option for individuals suffering from chronic or episodic migraines.
What is Ajovy?
Ajovy, or fremanezumab, is a calcitonin gene-related peptide (CGRP) antagonist that works by blocking the action of CGRP, a molecule involved in migraine attacks. By preventing CGRP from binding to its receptor, Ajovy can help reduce the frequency of migraines. It was approved by the FDA in 2018 and is administered as an injection once per month or once every three months.
As a non-SSRI drug, it does not inhibit serotonin reuptake which means side effects such as sedation or sexual dysfunction commonly associated with SSRIs are unlikely to occur with Ajovy. Instead, common side effects include injection site reactions like redness and itching. Just like Aimovig, another CGRP antagonist medication for migraines, Ajovy's efficacy has been tested through clinical trials showing fewer monthly migraine days compared to placebo groups.
Therefore patients who experience frequent migraine episodes may find benefit from this class of medications including Ajovy if they do not respond well to traditional migraine treatments.
What conditions is Ajovy approved to treat?
Ajovy, known generically as fremanezumab, is recognized by the U.S. Food and Drug Administration (FDA) for its effectiveness in treating:
- Chronic migraines: Ajovy can greatly decrease the frequency of chronic migraines that occur 15 or more days per month.
- Episodic migraines: For people who experience migraine attacks fewer than 15 days a month, Ajovy can reduce their occurrence and severity.
How does Ajovy help with these illnesses?
Calcitonin gene-related peptide (CGRP) is a protein that plays a significant role in the transmission of pain and the dilation of blood vessels. Elevated levels of CGRP have been implicated in migraine, making it an appealing target for medications designed to prevent these debilitating headaches. Ajovy works by selectively binding to CGRP ligands, thereby blocking their interaction with the receptor and preventing activation of this pathway. This results in reduced frequency and severity of migraines for many patients. Unlike Aimovig which blocks only one type of CGRP receptor, Ajovy has broader activity as it can bind both alpha- and beta-CGRP receptors, potentially providing more comprehensive migraine relief for certain individuals who may not respond fully to Aimovig's selective action.
How effective are both Aimovig and Ajovy?
Both erenumab (Aimovig) and fremanezumab (Ajovy) have been approved by the FDA within recent years to prevent migraine. They are both monoclonal antibodies that target a pathway involved in migraines, but they act on different parts of this pathway. Erenumab blocks the calcitonin gene-related peptide receptor (CGRP-R), while fremanezumab binds to the CGRP ligand itself.
The effectiveness of erenumab and fremanezumab has been studied in multiple double-blind clinical trials. A 2017 study found that patients receiving erenumab had significantly fewer monthly migraine days compared to placebo, with a similar safety profile[1]. Similarly, a 2018 trial showed that fremanezumab reduced headache frequency among chronic migraine sufferers more effectively than placebo over a 12-week period[2].
In terms of side effects, both drugs appear well-tolerated. Common side effects for both include injection site reactions and constipation. However, because these medications are relatively new, long-term data regarding their safety profiles is still being collected.
Despite their similarities in efficacy and tolerability, differences between Aimovig and Ajovy may influence which drug is chosen for specific patients. For example, Ajovy can be administered either monthly or quarterly depending on patient preference whereas Aimovig is only available as a once-monthly injection.
Erenumab was one of the first CGRP antagonists developed for preventing migraines; it carries significant weight in its history due to its groundbreaking mechanism of action as well as promising results from numerous studies demonstrating its benefits compared to placebos when treating episodic or chronic migraines[3].
Fremanezumab also shows promise with strong evidence supporting its effectiveness against episodic and chronic migraines [4]. It's important to note that every individual responds differently to medication; therefore what works best will vary from person-to-person based upon an array of factors including how well each medicine works for them individually along with any potential adverse reactions encountered during treatment.
References: 1 - https://www.nejm.org/doi/full/10.1056/NEJMoa1705848 2 - https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31153-9/fulltext 3 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483085/ 4 - https://pubmed.ncbi.nlm.nih.gov/30167637/.
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At what dose is Aimovig typically prescribed?
Subcutaneous dosages of Aimovig range from 70-140 mg/month, but studies have indicated that 70 mg/month is adequate for preventing migraines in most people. However, the dose may be increased to 140 mg once a month if the response at a lower dose is considered insufficient. On the other hand, Ajovy can be administered either as an injection of 225 mg per month or three injections (675mg total) every three months depending on patient preference and response to treatment. In any case, exceeding these recommended doses should not be attempted without medical consultation.
At what dose is Ajovy typically prescribed?
Ajovy treatment is typically initiated at a dosage of 225 mg/month or 675 mg every three months. The dose can be administered as one injection (if using the monthly dose) or in three separate injections if opting for the quarterly regimen. The decision on dosing frequency should be made jointly by you and your healthcare provider, based on factors such as your individual medical history, lifestyle preferences, and response to therapy. It's essential to remember that Ajovy injections should always be spaced accordingly whether it’s taken monthly or quarterly. If there is no response to treatment after a few months, consult with your doctor about adjusting the dosage or possibly switching medications.
What are the most common side effects for Aimovig?
Common side effects of Aimovig include:
- Injection site reactions such as pain, redness or swelling
- Constipation and cramps
- Muscle spasms or stiffness
On the other hand, Ajovy may cause these common side effects:
- Injection site reactions such as pain, redness or swelling
- Rash at the injection site
- Slight itching
These are not comprehensive lists of all possible side effects. If you experience any severe symptoms after taking either medication, it is important to seek immediate medical attention.
Are there any potential serious side effects for Aimovig?
While Aimovig and Ajovy are both prescribed to prevent migraines, their side effects can differ. For Aimovig, some possible but rare adverse effects may include:
- Allergic reactions such as hives, difficulty breathing or swallowing, swelling of the face or throat
- Heart palpitations: rapid heart rate that you feel in your chest
- Muscle stiffness or spasms
- Unusual tiredness or weakness
For Ajovy users, potential severe reactions include:
- Hypersensitivity: rash; itching/swelling (especially of the face/tongue/throat); severe dizziness; trouble breathing.
- Severe constipation: Painful bowel movements; blood in stools.
Always remember to contact a healthcare professional immediately if any unusual symptoms present themselves while taking either medication.
What are the most common side effects for Ajovy?
Ajovy, as with many medications, can cause a range of side effects. Some people may experience:
- Injection site reactions such as redness or itching
- Headache
- Joint pain
- Rash
- Immediate allergic reaction symptoms like difficulty breathing and swelling of your face, lips, tongue or throat.
Though less common than these are severe side effects like rapid heartbeat and confusion. It's important to note that the severity and type of side effects vary from person to person. Always consult with your healthcare provider about potential risks before starting any new medication regimen.
Are there any potential serious side effects for Ajovy?
While Ajovy is generally safe and well-tolerated, there can be significant side effects in some cases. Be alert for potential signs of serious adverse reactions, such as:
- Symptoms of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Rapid weight gain
- Severe headache or pounding in your neck or ears
- Fever, chills, sore throat
- Numbness or tingling (especially in your feet and hands)
If you experience any severe symptoms after taking Ajovy like those listed above - stop using it immediately and seek medical attention. It's crucial to discuss these symptoms with a healthcare provider to decide upon the best course of action.
Contraindications for Aimovig and Ajovy?
Both Aimovig and Ajovy, like most other migraine prevention medications, may cause certain side effects. If you notice any severe reactions such as rash, itching/swelling (especially of the face/tongue/throat), severe dizziness or difficulty breathing after taking these drugs, please seek immediate medical attention.
Neither Aimovig nor Ajovy should be taken if you are allergic to them or have a history of severe allergic reaction to similar drugs. Always inform your physician about all the medications you are currently taking; there might be potential interactions between these anti-migraine treatments and other medicines that need consideration before starting therapy.
It's also important to note that both these treatments require regular injections – they aren't daily oral pills. The frequency differs: Aimovig is usually injected once a month while Ajovy can be injected monthly or three-monthly based on physician advice. Both injections can be self-administered but require training in correct injection technique to prevent complications.
How much do Aimovig and Ajovy cost?
For the brand name versions of these drugs:
- The price for a single-use pre-filled syringe or auto-injector pen of Aimovig (70 mg) averages around $690, which works out to approximately $23/day.
- The price of one pre-filled syringe of Ajovy (225 mg) is about $640, working out to roughly $21/day.
Thus, if you are on the higher dosage range for Aimovig (i.e., 140 mg/month), then brand-name Ajovy may be less expensive on a per-month treatment basis. However, it's important that cost should not be your primary consideration in determining which of these migraine-preventing treatments is right for you.
As far as we know, there are no generic versions available yet for either Aimovig or Ajovy. Therefore, costs remain relatively high compared to many other medications. Be sure to discuss with your doctor and pharmacist whether one drug might have benefits over the other in terms of efficacy and side effects for your specific needs; also consider any coverage offered by your insurance plan when assessing overall affordability.
Popularity of Aimovig and Ajovy
Erenumab, which is sold under the brand name Aimovig, and fremanezumab-vfrm, sold as Ajovy, are both relatively new medications designed to prevent migraines.
Aimovig was prescribed to around 290,000 people in the United States in 2020. It works by blocking a specific protein that transmits pain signals during migraines. The prevalence of Aimovig has been steadily increasing since its approval by the FDA in May 2018.
Ajovy was prescribed to approximately 150,000 individuals in the USA during the same year. Unlike Aimovig which is administered monthly, Ajovy can be taken either monthly or quarterly making it more convenient for some patients depending on their preference or lifestyle needs. Since being approved by FDA in September of 2018 - several months after Aimovig- Ajovy's usage has also seen an upward trend.
Conclusion
Both Aimovig (erenumab) and Ajovy (fremanezumab) are relatively new treatments for the prevention of migraine headaches. They represent an entirely new class of drugs called CGRP inhibitors, which work through a unique mechanism by blocking the activity of calcitonin gene-related peptide, a molecule that is elevated during migraines. Both medications have been shown in clinical trials to reduce the number of monthly headache days experienced by chronic migraine sufferers.
Although they share similar mechanisms, their dosing schedules differ; Aimovig is administered once per month while Ajovy can be given either monthly or as a higher dose every three months based on patient preference and response.
Neither drug is available in generic form yet due to their recent introduction to market, potentially leading to high out-of-pocket costs for patients without insurance coverage. Both drugs may require some time before effects are noticeable as it takes time to achieve therapeutic levels in the body.
Side effect profiles between these two therapies appear similar with most common side effects being injection site reactions such as pain or redness at injection site, constipation with Aimovig use and possible hypersensitivity reactions such as rash or itching with both drugs. For both medications, if any unusual physical symptoms occur after starting treatment, immediate medical attention should be sought.
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Refrences
- Raffaelli, B., Neeb, L., & Reuter, U. (2019, October 3). Monoclonal antibodies for the prevention of migraine. Expert Opinion on Biological Therapy. Informa UK Limited.http://doi.org/10.1080/14712598.2019.1671350
- Markham, A. (2018, July). Erenumab: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-018-0944-0
- Markham, A. (2018, July). Erenumab: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-018-0944-0
- Jiang, Y., & Huang, Z.-L. (2022, June 17). Recent advances in targeting calcitonin gene-related peptide for the treatment of menstrual migraine. Medicine. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/md.0000000000029361
- Lionetto, L., Curto, M., Cisale, G. Y., Capi, M., Cipolla, F., Guglielmetti, M., & Martelletti, P. (2019, June 26). Fremanezumab for the preventive treatment of migraine in adults. Expert Review of Clinical Pharmacology. Informa UK Limited.http://doi.org/10.1080/17512433.2019.1635452
- Barbanti, P., Egeo, G., Aurilia, C., d’Onofrio, F., Albanese, M., Cetta, I., … for the FRIEND-Study Group. (2022, April 9). Fremanezumab in the prevention of high-frequency episodic and chronic migraine: a 12-week, multicenter, real-life, cohort study (the FRIEND study). The Journal of Headache and Pain. Springer Science and Business Media LLC.http://doi.org/10.1186/s10194-022-01396-x
- Bigal, M. E., & Walter, S. (2014, March 18). Monoclonal Antibodies for Migraine: Preventing Calcitonin Gene-Related Peptide Activity. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40263-014-0156-4