How Are CGRP Drugs Similar and Different?
Migraine treatment options continue to expand. There are many different drug choices for the treatment and prevention of migraine. There are now six CGRP (calcitonin-gene-related peptide) drugs available.1-6 They are:
CGRP blockers are drugs used for migraine prevention and two are approved as acute treatment. They offer hope to millions who live with the debilitating effects of migraine. These products, which target the CGRP process, work in different ways.1-6
Similarities and Differences of CGRP Drugs
| Aimovig | Ajovy | Emgality | Nurtec ODT | Ubrelvy | Vyepti | |
|---|---|---|---|---|---|---|
| Marketed by | Amgen & Novartis Pharmaceuticals | Teva Pharmaceuticals | Eli Lilly and Company | Biohaven Pharmaceuticals | Allergan | H. Lundbeck A/S |
| FDA Approval | 2018 | 2018 | 2018 | 2020 | 2019 | 2020 |
| Target | Blocks CGRP receptor | Attaches to CGRP peptide | Attaches to CGRP peptide | Blocks CGRP receptor | Blocks CGRP receptor | Attaches to CGRP peptide |
| Preventive or Acute Treatment | Preventive | Preventive | Preventive | Acute | Acute | Preventive |
| Route of administration | Auto injector | Auto injector & Prefilled syringe | Auto injector & Prefilled syringe | Quick dissolving tablets | Tablets taken by mouth | IV infusion |
| Assistance programs | With commercial insurance, those eligible for the savings program may get the drug free or at a reduced copay amount | With commercial insurance, those eligible for the savings program may get the drug at a reduced copay amount | With commercial insurance, those eligible for the savings program may get the drug free or at a reduced copay amount | With commercial insurance, those eligible for the savings program may get the drug free or at a reduced copay amount | With commercial insurance, those eligible for the savings program may get the drug at a reduced copay amount |
How do CGRPs prevent migraine?
CGRP is a protein that acts like a neurotransmitter. This is a chemical messenger that sends information throughout the brain and body. The role of CGRP in migraine was identified many years ago, the path to develop drugs which effectively target CGRP has been difficult.
CGRP's role with migraine attacks
CGRP and CGRP receptors are found in large numbers in the trigeminal system, the sensory nerves that supply the head and neck. The CGRP protein in the brain attaches to CGRP receptors and activates them.6 CGRP also plays a role in the dilation of veins (vasodilation) and in the sensory nervous system. This process appears to play a role in causing migraine. CGRP levels increase during a migraine attack. People who have chronic migraine generally have ongoing elevated CGRP levels.
CGRP inhibitors: the lock and key analogy
These drugs are monoclonal antibodies that target the CGRP pathway. Monoclonal antibodies have been used to treat a number of different chronic health conditions. They work on the immune system by binding to proteins, peptides (part of a protein), or receptors.1-6
The lock-and-key analogy helps explain how these drugs disrupt the CGRP process. The CGRP peptide acts as the key and the receptor acts as the lock.
Aimovig, Nurtec ODT and Ubrelvy block the lock, which allows less of the CGRP protein to bind to the receptors, preventing activation.1,4-5
Ajovy, Emgality, and Vyepti attach to the key, they bind to it, preventing it from activating CGRP receptors by distorting the CGRP protein so that less of it can connect to the receptors.2-3,6
How are CGRPs taken?
The first three CGRP blockers to market, Aimovig, Ajovy, and Emgality are given subcutaneously, by injection under the skin. These CGRP blockers can be self-administered, given by a caregiver, or a healthcare professional.1-3 Nurtec ODT and Ubrelvy are tablets taken by mouth.4-5 Vyepti is administered by IV infusion in a health care setting.6
CGRP cost savings and assistance programs
CGRP blockers can be expensive. The manufacturers may offer financial assistance and support programs for each of these drugs. Check online or with your physician. Commercial insurance coverage may vary depending on individual plans.1-6
Are CGRPs right for you?
Clinical trial data show similar results in terms of efficacy, tolerability, and safety. Each of these CGRP blockers has demonstrated effectiveness in reducing the number and/or severity of migraine days in adults with chronic or episodic migraine.1-3
These CGRP pathway medications are designed to help prevent or treat migraine. They may work for some people and not for others. Talk to your doctor about whether a CGRP blocker is right for you. Be sure to discuss all medications you use to treat migraine and any other medical conditions.
Editorial Note: This page was last updated in May 2020
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