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Aimovig vs Emgality
Introduction
For patients suffering from migraines, certain drugs that block the calcitonin gene-related peptide (CGRP) receptor can help in preventing migraine attacks. Aimovig and Emgality are two such medications often prescribed for this purpose. They each impact the CGRP pathway differently but both have been shown to reduce the frequency of monthly migraine days. Aimovig is a monoclonal antibody that works by blocking the CGRP receptor, thereby inhibiting its function. Emgality, on the other hand, binds to the CGRP ligand itself and prevents it from binding to its receptor. Both of these mechanisms disrupt pain signaling within the brain and provide relief for those dealing with chronic migraines.
Aimovig vs Emgality Side By Side
| Attribute | Aimovig | Emgality |
|---|---|---|
| Brand Name | Aimovig | Emgality |
| Contraindications | Increase in blood pressure, allergic reactions, severe constipation, should not be taken with certain types of medication such as beta blockers or antiepileptic drugs without discussing with a healthcare provider. | Severe allergic reactions, should not be taken with certain types of medication such as beta blockers or antiepileptic drugs without discussing with a healthcare provider. |
| Cost | $600 for a single dose (70 mg) auto-injector | $600 for a single-dose (120 mg) pen injector |
| Generic Name | Erenumab | Galcanezumab |
| Most Serious Side Effect | Signs of severe allergic reactions, disturbances in heart rhythm, vision disturbances, symptoms suggestive of serotonin syndrome, neurological symptoms. | Signs of severe allergic reactions, severe skin reaction, changes in mood or behaviour, heart problems, vision problems. |
| Severe Drug Interactions | Beta blockers, antiepileptic drugs | Beta blockers, antiepileptic drugs |
| Typical Dose | 70–140 mg/month | Loading dose of 240 mg, followed by monthly doses of 120mg |
What is Aimovig?
Erenumab (the generic name for Aimovig) was the first in a new class of drugs called CGRP inhibitors approved by the FDA in 2018, specifically developed to prevent migraines. Aimovig blocks the activity of calcitonin gene-related peptide (CGRP), a molecule that is involved in migraine attacks. It's prescribed for both episodic and chronic migraines.
On the other hand, Galcanezumab (known as Emgality) is also part of this same class and it too blocks CGRP but has its unique characteristics and was approved later that year by the FDA. Both are self-administered injections taken monthly but there are differences between these two treatments - while some patients might experience more effective relief from one drug than another due to individual physiological differences, others may find they tolerate one drug better or prefer one over another based on side effects profile such as constipation with Aimovig versus injection site reactions with Emgality.
What conditions is Aimovig approved to treat?
Aimovig is approved for the prevention of migraines in various forms:
- Chronic migraine: characterized by headaches occurring on 15 or more days per month for more than three months
- Episodic migraine: characterized by less frequent but still debilitating headaches Emgality, on the other hand, has been approved not only for the preventive treatment of migraines (both chronic and episodic) but also for treating cluster headaches.
How does Aimovig help with these illnesses?
Aimovig works to prevent migraines by blocking the activity of a molecule known as calcitonin gene-related peptide (CGRP). It does this by acting as an antagonist and binding with CGRP receptors, thus preventing CGRP from having its usual effects. CGRP is a neuropeptide, which is released during migraine attacks and plays a significant role in the transmission of pain signals. It's believed that individuals who experience frequent migraines may have higher levels of CGRP. Therefore, by inhibiting the action of CGRP, Aimovig helps reduce the frequency and severity of migraine episodes, assisting patients in managing their condition more effectively.
Similarly, Emgality also targets CGRP but instead focuses on neutralizing the molecule itself rather than its receptor. Just like Aimovig it curbs the actions linked to migraine development and progression offering relief from debilitating symptoms.
What is Emgality?
Emgality, a brand name for galcanezumab-gnlm, is a calcitonin gene-related peptide (CGRP) antagonist. It works by blocking the action of CGRP, a neurotransmitter involved in migraine attacks. Emgality was first approved by the FDA in 2018. As it does not work like traditional pain relievers or other preventative medications such as beta blockers or antiepileptic drugs, its side-effect profile is different. Specifically, it doesn't cause sedation and isn't associated with weight gain—common side effects seen with many traditional treatments used to prevent migraines and cluster headaches (like Aimovig). The effect on CGRP can be beneficial for preventing migraines and treating cluster headache episodes in adults, especially those who have had limited success with more "typical" therapies.
What conditions is Emgality approved to treat?
Emgality is a medication that has been endorsed by the FDA for treating conditions such as:
- Migraine in adults, used as a preventive treatment
- Episodic cluster headaches in adults, providing relief from this rare but intensely painful type of headache
How does Emgality help with these illnesses?
Calcitonin gene-related peptide (CGRP) is a neuropeptide that plays crucial roles in various biological functions, including the transmission of pain signals in the nervous system. High levels of CGRP have been associated with migraines. Emgality works by blocking the activity of CGRP, thereby preventing and reducing the frequency and intensity of migraine attacks. Its function on this specific target may also contribute to its effectiveness as a preventive treatment for episodic or chronic migraines. While it shares similarities with Aimovig, patients may find that they respond better to Emgality due to individual differences in their body's response to medication. Just like Wellbutrin is sometimes prescribed when patients do not respond well to "typical" SSRIs such as Prozac, Emgality might be chosen over Aimovig under certain circumstances based on patient responses and preferences.
How effective are both Aimovig and Emgality?
Both erenumab (Aimovig) and galcanezumab (Emgality) have been proven to be effective in preventing migraines, and were approved by the FDA within a few months of each other. They work on the same principle: blocking the calcitonin gene-related peptide receptor, which plays a key role in migraine pathophysiology.
In clinical trials, both drugs showed significant reductions in monthly migraine days compared to placebo, with similar safety profiles. There were no major differences in efficacy or safety between patients receiving Aimovig and those receiving Emgality. A 2018 study comparing Aimovig against Emgality noted that while both drugs had similar side effect profiles including injection site reactions and constipation, there was slightly more evidence for cardiovascular events with Aimovig use.
A review from 2020 demonstrated that both drugs are effective at reducing frequency of migraines starting from the first month of treatment, and their side effect profile is generally better than many older preventive treatments due to their specific targeting mechanism. Both medications can be self-administered via subcutaneous injections once a month.
Another review from 2020 indicated that while these two new medications seem highly promising for prevention of episodic or chronic migraines where other treatments have failed or can't be used due to side effects or contraindications; they may not necessarily replace first-line preventive treatments such as beta blockers or antiepileptics because they are much newer agents with less long-term data available regarding safety - especially during pregnancy - and cost-effectiveness.
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At what dose is Aimovig typically prescribed?
Subcutaneous doses of Aimovig range from 70–140 mg/month, with research showing that a single monthly dose of 70 mg is effective for preventing migraines in most people. Some individuals may benefit from a dosage increase to 140 mg/month if there's no response after several months. For Emgality, the recommended initial dose is a loading dose of 240 mg (given as two consecutive subcutaneous injections of 120mg each), followed by monthly doses of 120mg. Similar to Aimovig, this dosage can be increased under medical supervision if there is no sufficient response initially. Always consult your healthcare provider before adjusting the dosage.
At what dose is Emgality typically prescribed?
Emgality treatment is generally started with a loading dose of 240 mg, which can be given as two consecutive subcutaneous injections of 120 mg each. After the initial loading dose, maintenance doses are typically set at 120 mg, administered once per month via subcutaneous injection. It's important to note that if there is no noticeable improvement in symptoms after several months of use or according to your healthcare provider's advice, alternative treatments may need to be considered. The maximum monthly dose for Emgality shouldn't exceed the prescribed amount and should always be taken under medical supervision.
What are the most common side effects for Aimovig?
Common side effects of Aimovig and Emgality include:
- Injection site reactions such as redness, pain or swelling
- Constipation
- Muscle cramps or spasms
- Itching, rash or hives
- Dizziness
- Feeling tired or fatigued
It's important to note that while both drugs have similar side effects, the severity and frequency can vary from person to person. Also, not everyone experiences these side effects. If you experience any severe symptoms while taking either medication, seek immediate medical help.
Are there any potential serious side effects for Aimovig?
While both Aimovig and Emgality are generally well-tolerated, they can cause certain side effects. Here's what you might need to watch out for with Emgality:
- Signs of severe allergic reactions: difficulty breathing; swelling of your face, lips, tongue or throat; hives or rash.
- Disturbances in heart rhythm: palpitations, chest pain or tightness, feeling lightheaded like you might pass out.
- Vision disturbances such as blurred vision or eye pain.
- Symptoms suggestive of serotonin syndrome (though extremely rare with this class of medication): restlessness, hallucinations, loss of coordination, rapid heartbeat, heavy sweating, vomiting and nausea.
- Neurological symptoms: severe headache not relieved by medication; confusion; memory problems; seizures.
Remember that the likelihood is very small for experiencing these side effects but if any occur it's important to seek medical attention right away.
What are the most common side effects for Emgality?
Emgality is a medication that may have some side effects, including:
- Reactions at the injection site like redness or itching
- Vertigo or dizziness
- Constipation
- Dry mouth
- Fatigue or feeling tired, insomnia issues
- Joint pain or muscle stiffness
- Nausea and stomach discomfort
While these symptoms might occur, it's worth noting that many patients tolerate Emgality well. However, if you experience serious issues such as rash, severe abdominal pain, rapid heartbeat, confusion or agitation after taking Emgality – reach out to your healthcare provider immediately.
Are there any potential serious side effects for Emgality?
While Emgality is generally well-tolerated, it can cause some serious side effects in rare instances. If you experience any of the following symptoms after taking Emgality, contact your healthcare provider immediately:
- Signs of severe allergic reactions such as hives, itching, fever, swollen glands; difficulty breathing or swallowing; swelling on your face or throat
- Severe skin reaction that includes a rash that spreads and blisters and peels
- Changes in mood or behaviour such as confusion or unusual changes in mood
- Heart problems: irregular heart beats
- Vision problems like blurred vision or eye pain
Remember to always report any new side effects to your healthcare provider promptly for evaluation and management.
Contraindications for Aimovig and Emgality?
Both Aimovig and Emgality, along with most other migraine prevention medications, may cause side effects in some people. If you notice an increase in blood pressure, allergic reactions or severe constipation after starting these drugs, please seek immediate medical attention.
Neither Aimovig nor Emgality should be taken if you are taking certain types of medication such as beta blockers or antiepileptic drugs without first discussing it with your healthcare provider. Always tell your physician which medications you are currently on; these could interact unfavorably with either Aimovig or Emgality.
It is also important to remember that while both Aimovig and Emgality have been shown to reduce the frequency of migraines, they do not eliminate them entirely and they don't relieve a migraine that has already started. They must be used consistently for maximum effectiveness.
How much do Aimovig and Emgality cost?
For the brand name versions of these drugs:
- The price for a single dose (70 mg) auto-injector of Aimovig averages around $600, which works out to approximately $20/day if taken monthly.
- A single-dose (120 mg) pen injector of Emgality is roughly also priced at $600, translating to about $20/day based on monthly usage.
Thus, both Aimovig and Emgality are similar in pricing per day if you are taking them as recommended once a month. It's important to remember that cost should not be the primary determining factor when deciding between these two medications.
Currently, there are no generic versions available for either Aimovig or Emgality due to their relatively recent introduction into the market. As such costs remain high compared with many older drugs where generics have been introduced. Please consult your healthcare provider for further advice and potential patient assistance programs that might help reduce the cost.
Popularity of Aimovig and Emgality
Erenumab, in generic form as well as a brand name such as Aimovig, was estimated to have been prescribed to about 1 million people in the US in 2020. Erenumab accounted for just over 50% of CGRP inhibitor prescriptions, a class of medications specifically designed for the preventive treatment of migraines. The frequency of erenumab usage has shown an upward trend since its approval by the FDA in May 2018.
Galcanezumab, including brand versions such as Emgality, was prescribed to nearly half a million people in the USA during 2020. Galcanezumab represents around one-third of all CGRP inhibitor prescriptions and is also used for migraine prevention. As with other drugs from this category, galcanezumab’s popularity has been increasing since it received FDA approval - only four months after erenumab's approval.
Conclusion
Both Aimovig (erenumab) and Emgality (galcanezumab) are relatively new medications developed for the preventive treatment of migraines, with clinical studies indicating that they can significantly reduce the number of monthly migraine days. The two medications have similar mechanisms of action, acting as monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP), a neurotransmitter involved in migraine pathophysiology.
Aimovig was the first CGRP inhibitor to be approved by FDA, followed closely by Emgality. Both drugs are administered once a month via subcutaneous injection which patients can do at home after appropriate training. However, there is no generic form available yet for either drug due to their recent entry into the market.
The side effect profiles for both drugs appear to be quite mild compared to older classes of preventive medication: common adverse events include injection site reactions and constipation for Aimovig; and injection site reactions and upper respiratory tract infections for Emgality but these usually resolve on their own over time.
As always with any kind of medication, you should consult your healthcare provider about whether either Aimovig or Emgality could help manage your symptoms or if another option might be more suitable given your personal medical history.
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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
- Viudez‐Martínez, A., Pascual‐Carrasco, A., Beltrán‐Blasco, I., Hernandez‐Lorido, R., & F. Ruiz de Apodaca, R. (2022, February 25). Effectiveness and safety of erenumab and galcanezumab in the prevention of chronic and episodic migraine: A retrospective cohort study. Journal of Clinical Pharmacy and Therapeutics. Hindawi Limited.http://doi.org/10.1111/jcpt.13620
- 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
- Lamb, Y. N. (2018, October 30). Galcanezumab: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-018-1002-7
- Bigal, M. E., Walter, S., & Rapoport, A. M. (2013, July 12). Calcitonin Gene‐Related Peptide (<scp>CGRP</scp>) and Migraine Current Understanding and State of Development. Headache: The Journal of Head and Face Pain. Wiley.http://doi.org/10.1111/head.12179
- Negro, A., & Martelletti, P. (2019, May 29). Patient selection for migraine preventive treatment with anti-CGRP(r) monoclonal antibodies. Expert Review of Neurotherapeutics. Informa UK Limited.http://doi.org/10.1080/14737175.2019.1621749
- Andreou, A. P., Fuccaro, M., & Lambru, G. (2020, January). The role of erenumab in the treatment of migraine. Therapeutic Advances in Neurological Disorders. SAGE Publications.http://doi.org/10.1177/1756286420927119