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Ajovy vs Emgality
Introduction
For patients suffering from migraines or cluster headaches, certain drugs that target a protein called calcitonin gene-related peptide (CGRP), which is elevated during migraine attacks and thought to play a key role in causing such symptoms, can help manage the frequency and severity of these episodes. Ajovy and Emgality are two such medications commonly prescribed for migraine prevention. Both these medications work by blocking the CGRP pathway but have slightly different mechanisms of action. Ajovy is a monoclonal antibody that directly binds to the CGRP molecule itself, preventing it from attaching to its receptors and triggering a migraine attack. On the other hand, Emgality works as a CGRP receptor antagonist — it binds with the CGRP receptors, thereby denying access for any circulating CGRP molecules to bind with them.
Ajovy vs Emgality Side By Side
| Attribute | Ajovy | Emgality |
|---|---|---|
| Brand Name | Ajovy | Emgality |
| Contraindications | Should not be used if taking certain types of medication due to potential drug interactions. Caution is advised for patients with moderate to severe kidney disease or any liver disease. | Should not be used if taking certain types of medication due to potential drug interactions. Caution is advised for patients with moderate to severe kidney disease or any liver disease. |
| Cost | $640 per month | $600 to $650 per month |
| Generic Name | Fremanezumab | Galcanezumab |
| Most Serious Side Effect | Signs of a serious allergic reaction, rapid heart rate or palpitations, shortness of breath or trouble with deep breaths, dizziness or feeling faint, severe stomach pain, constipation lasting longer than seven days. | Signs of a severe allergic reaction, mood changes and depression symptoms, unusual change in behavior including thoughts about hurting oneself, vision problems, rapid heartbeat, severe stomach pain accompanied by nausea and vomiting. |
| Severe Drug Interactions | Not specified, but always inform healthcare provider about all medications being taken. | Not specified, but always inform healthcare provider about all medications being taken. |
| Typical Dose | 225 mg/month or a three-month dose of 675 mg | Loading dose of 240 mg (two injections of 120 mg each), followed by a monthly maintenance dosage of 120 mg |
What is Ajovy?
Fremanezumab (the generic name for Ajovy) is part of the CGRP inhibitor class of migraine prevention medications, which has significantly advanced the field beyond traditional treatments such as beta-blockers or antidepressants. Fremanezumab was first approved by the FDA in 2018. Ajovy works by binding to a protein called calcitonin gene-related peptide (CGRP), effectively blocking its action and reducing the number of migraines a patient experiences over time. It's administered via an injection once every month or three months, depending on the dosage and medical advice.
On another hand, Galcanezumab (the brand name being Emgality) also belongs to this new class of drugs that target CGRP but acts slightly differently from Ajovy; it binds directly to the CGRP molecule itself rather than to its receptor. Just like Ajovy, Emgality is used for migraine prevention but can also be prescribed for cluster headaches – a benefit not offered by Ajovy.
Both tend to have fewer side effects compared with older preventive medicines due to their targeted mechanism; however, they may cause reactions at the injection site among other minor potential side effects.
What conditions is Ajovy approved to treat?
Ajovy is approved for the treatment of migraine in adults:
- As a preventive treatment for migraines
- Can be used alone or in combination with other medications
While Emgality, likewise, has been sanctioned for similar uses:
- Preventive measure against both episodic and chronic migraine episodes
- In addition to its approval as a therapy to manage cluster headaches.
How does Ajovy help with these illnesses?
Ajovy and Emgality are both modern treatments for migraine, a condition characterized by severe, debilitating headaches often accompanied by nausea, vomiting, and sensitivity to light and sound. Both of these medications work in similar ways - they target a protein called calcitonin gene-related peptide (CGRP) that is elevated during a migraine attack.
Ajovy manages migraines by blocking the CGRP ligand from binding to its receptor. This prevents the initiation of physiological responses that lead to migraines such as dilation of blood vessels in the brain and transmission of pain signals.
Emgality also targets CGRP but instead binds directly to this protein preventing it from inducing inflammation or causing blood vessel dilation associated with migraines. By reducing the activity of CGRP through different strategies, both Ajovy and Emgality can limit the negative effects of migraines and help patients manage their condition more effectively.
What is Emgality?
Emgality is a brand name for galcanezumab, an injectable medication used to prevent migraines in adults. As a calcitonin gene-related peptide (CGRP) antagonist, it targets and blocks the effects of CGRP - a protein that can trigger and amplify migraine pain signals in the brain. Emgality was first approved by the FDA in 2018, making it one of the newer entries into this class of drugs.
Unlike other classes of medications often prescribed for migraine prevention, such as antidepressants or anticonvulsants, Emgality specifically acts on pathways associated with migraines without having significant impact on other neurotransmitter systems. This specific action may result in fewer side effects compared to some alternative options; however common side effects can include injection site reactions and constipation.
The effectiveness of Emgality at reducing monthly migraine days has been demonstrated across several clinical trials, suggesting it could be particularly beneficial for those who have not responded well to more traditional preventive treatments.
What conditions is Emgality approved to treat?
Emgality is approved for the treatment of:
- Migraine in adults. It's particularly effective at preventing migraines before they start.
- Episodic cluster headaches in adults. Emgality is noted to reduce the frequency of these painful headaches that often occur in clusters, typically at the same time each day or week.
How does Emgality help with these illnesses?
Emgality, like Ajovy, is a medication that targets the CGRP (calcitonin gene-related peptide) pathway, which plays a crucial role in migraines. By blocking this pathway, these medications can prevent migraine attacks before they begin. Emgality works by binding to the CGRP ligand and preventing it from attaching to its receptor; this action helps reduce the frequency of migraines for those who experience them regularly. Emgality's unique mechanism on the CGRP makes it an effective preventive treatment for patients with episodic or chronic migraines who have not found relief with other typical treatments such as triptans or ergots. It may become even more potent when combined with other therapies or lifestyle changes aimed at reducing migraine triggers.
How effective are both Ajovy and Emgality?
Both fremanezumab (Ajovy) and galcanezumab (Emgality) are FDA-approved medications for prevention of migraines, a chronic condition that affects millions worldwide. These two drugs were approved by the FDA within mere months of each other in 2018. They operate on similar principles: both are monoclonal antibodies designed to bind to calcitonin gene-related peptide (CGRP), a molecule implicated in the initiation and perpetuation of migraine episodes.
A head-to-head comparison trial between Ajovy and Emgality has not been conducted; however, separate clinical trials have shown both medications to be effective at reducing monthly migraine days compared with placebo. For instance, studies showed that patients receiving Ajovy experienced one to two fewer migraine days per month compared with those taking a placebo whereas Emgality reduced monthly migraine days by approximately four.
In terms of side effects, Ajovy may cause injection site reactions such as pain or redness but these are generally considered mild. Emgality shares this profile but also lists constipation as another common side effect.
Clinical trials have demonstrated that both Ajovy and Emgality can effectively reduce the frequency of migraines when taken regularly, which is typically once per month via subcutaneous injection. At present time there isn't enough data available yet to suggest whether one drug is more effective or safer than the other overall.
The optimal dosage for these medications will depend on individual patient characteristics such as their health status and response to therapy among others hence should be determined by healthcare professionals based on individual circumstances.
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At what dose is Ajovy typically prescribed?
Injectable dosages of Ajovy can be either 225 mg/month or a three-month dose of 675 mg. Studies have shown that both dosage options are effective for preventing migraines in adults. Children's use and dosage need to be determined by a doctor. For Emgality, the starting dosage is two injections of 120 mg each, followed by monthly doses of 120mg. Both medications allow for flexibility if there is no response after a few months; however, exceeding the prescribed dosage without medical supervision is strongly discouraged.
At what dose is Emgality typically prescribed?
Emgality treatment typically begins with a loading dose of 240 mg (two injections of 120 mg each), administered subcutaneously. Following the initial loading dose, patients are usually prescribed a monthly maintenance dosage of 120 mg. This is delivered as a single injection once every month. The efficacy and tolerance to Emgality should be assessed after several months, and depending on individual response, dosages may be adjusted accordingly under medical supervision. As always, it's important that the recommended dosing instructions for Emgality are strictly adhered to ensure optimal therapeutic effect while minimizing potential side effects.
What are the most common side effects for Ajovy?
Common side effects of Ajovy (Fremanezumab) and Emgality (Galcanezumab), both drugs used to prevent migraines, include:
- Reactions at the injection site such as redness, pain, or swelling
- Itching
- Rash
- Constipation
- Dry mouth
- Dizziness
- Feeling tired or fatigued
These are not all the possible side effects. If you experience any unusual symptoms after taking these medications, it's crucial to seek medical advice promptly.
Are there any potential serious side effects for Ajovy?
Both Ajovy and Emgality are medications used for the prevention of migraines. However, they can occasionally cause severe side effects, such as:
- Signs of a serious allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Rapid heart rate or palpitations
- Shortness of breath or trouble with deep breaths
- Dizziness or feeling faint
- Severe stomach pain
- Constipation lasting longer than seven days
In addition to these potential physical symptoms:
Ajovy might lead to immunogenicity which means that the immune system may develop antibodies against the drug. This could potentially reduce its effectiveness over time. The clinical significance of this is yet unknown.
Emgality has been associated with hypersensitivity reactions like rash and angioedema (swelling under the skin).
If you experience any unusual symptoms while using either medication, it is important to seek medical attention immediately.
What are the most common side effects for Emgality?
Emgality, much like Ajovy, is also used to prevent migraines. However, it does have its own set of side effects that need careful consideration:
- Injection site reactions (redness, itchiness)
- Constipation
- Vertigo and dizziness
- Fatigue or feeling tired
- Abdominal pain or discomfort
- Sinusitis resulting in stuffy nose and sore throat
- Pruritus (itching skin)
Though not common, individuals may experience serious allergic reactions such as rash, itching/swelling (particularly of the face/tongue/throat), severe dizziness, or difficulty breathing. If any of these symptoms are experienced after taking Emgality, immediate medical attention is advised.
Are there any potential serious side effects for Emgality?
While Emgality is generally well-tolerated by most people, there are instances where it can cause side effects that require immediate medical attention. These may include:
- Signs of a severe allergic reaction: rash or hives; itching; reddening of the skin; swollen lymph nodes in the neck, armpit, or groin; difficulty swallowing or breathing; swelling of your face, lips, tongue, throat or any other part of your body.
- Mood changes and depression symptoms like feelings of sadness lasting longer than two weeks and loss of interest in activities you once enjoyed.
- Any unusual change in behavior including thoughts about hurting oneself.
- Vision problems such as blurry vision or eye pain
- Rapid heartbeat
- Severe stomach pain accompanied by nausea and vomiting.
If you experience any such symptoms after taking Emgality, seek prompt medical attention to ensure your wellbeing.
Contraindications for Ajovy and Emgality?
Both Ajovy and Emgality, like most preventive migraine medications, may cause certain side effects. If you experience serious reactions such as difficulty breathing or swallowing, severe rash or hives, seek immediate medical attention.
Neither Ajovy nor Emgality should be used if you are taking certain types of medication due to potential drug interactions. Always inform your healthcare provider about all the medications you are currently taking; this includes prescription drugs, over-the-counter medicines, vitamins and herbal products.
Specifically for patients with moderate to severe kidney disease or any liver disease, caution is advised when using these drugs. It's important that your doctor evaluates the benefits versus risks before prescribing either Ajovy or Emgality in such cases.
Always remember that every individual’s reaction to medication can vary widely. What works best will depend on your personal health history and current situation.
How much do Ajovy and Emgality cost?
For the brand name versions of these drugs:
- The price of a single-dose pre-filled syringe or autoinjector of Ajovy (225 mg) averages around $640, which is given once per month. Thus, it works out to about $21/day.
- On the other hand, Emgality has a similar pricing strategy with an average cost for one dose (120 mg) being roughly $600 to $650 per month, working out to approximately $20-$22/day.
As such, if you are using these medications as part of your treatment plan for migraines or cluster headaches, you may find that they have comparable costs on a daily basis. It is important to note though that cost should not be the primary factor in determining which of these treatments is right for you. Your healthcare provider will help make this decision based on effectiveness and side-effect profile among others.
Currently there are no generic versions available for either Ajovy (fremanezumab) or Emgality (galcanezumab). Both medications are considered specialty drugs and their costs can vary depending on insurance coverage and location.
Popularity of Ajovy and Emgality
Fremanezumab, known by its brand name Ajovy, was administered to an estimated 1.2 million people in the U.S. in 2020 for the prevention of migraine. The novel class of medications known as CGRP inhibitors, which includes Ajovy, accounted for just over 5% of preventative migraine prescriptions in the U.S., a number that has been steadily increasing since their introduction to the market.
Galcanezumab under brand name Emgality is another CGRP inhibitor used for preventing migraines and treating episodic cluster headaches. This medication was prescribed to approximately 1 million individuals in the USA during 2020. Despite being slightly lower than fremanezumab's prescription rate, galcanezumab holds a significant place within this new class of drugs due to its additional indication for cluster headache treatment - it remains steady with no significant change reported throughout recent years.
Conclusion
Both Ajovy (fremanezumab) and Emgality (galcanezumab) are relatively new drugs approved by the FDA for the prevention of migraines in adults. They have been shown in various clinical trials to be more effective than placebo treatments at reducing monthly migraine days. These medications are both part of a class known as CGRP inhibitors, which work by blocking the activity of calcitonin gene-related peptide - a molecule involved in transmitting pain signals during migraines.
Ajovy can be administered once per month or quarterly, offering flexibility based on patient preference or lifestyle needs, while Emgality is primarily designed for monthly administration. Both these drugs need to be self-injected subcutaneously with provided autoinjectors.
Both Ajovy and Emgality may cause minor side effects like injection site reactions and constipation but are generally well-tolerated overall. It's important that patients monitor their health closely after starting treatment due to potential hypersensitivity reactions or other adverse events, although they're rare.
While neither drug is available in generic form yet due to their recent market entry, some cost assistance programs might help reduce out-of-pocket costs for eligible individuals. As always when choosing between different medical treatments, it's best to discuss all options thoroughly with your healthcare provider.
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Refrences
- Cohen, F., Yuan, H., & Silberstein, S. D. (2022, April 27). Calcitonin Gene-Related Peptide (CGRP)-Targeted Monoclonal Antibodies and Antagonists in Migraine: Current Evidence and Rationale. BioDrugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40259-022-00530-0
- Hoy, S. M. (2018, November). Fremanezumab: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-018-1004-5
- Weatherall, M. W. (2021, August 16). Fremanezumab Autoinjector Pen for the Prevention of Migraine. Therapeutic Delivery. Informa UK Limited.http://doi.org/10.4155/tde-2021-0028
- Skljarevski, V., Oakes, T. M., Zhang, Q., Ferguson, M. B., Martinez, J., Camporeale, A., … Dodick, D. W. (2018, February 1). Effect of Different Doses of Galcanezumab vs Placebo for Episodic Migraine Prevention. JAMA Neurology. American Medical Association (AMA).http://doi.org/10.1001/jamaneurol.2017.3859
- 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
- McAllister, P., Lamerato, L., Krasenbaum, L. J., Cohen, J. M., Tangirala, K., Thompson, S., … Mauskop, A. (2021, December). Real-world impact of fremanezumab on migraine symptoms and resource utilization in the United States. The Journal of Headache and Pain. Springer Science and Business Media LLC.http://doi.org/10.1186/s10194-021-01358-9
- 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