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CGRP drug type comparisons

How Are CGRP Drugs Similar and Different?

With all the recent news in migraine treatment, it might be difficult to keep up! 2018 has been an exciting year for those waiting for something new to prevent migriane, and that patience has paid off–there are now three CGRP blockers available for the prevention of migraine:

  • Aimovig™ (erenumab-aooe), approved by the FDA on May 17th
  • Ajovy™ (fremanezumab-vfrm), approved on September 14th
  • Emgality™ (galcanezumab-gnlm), approved on September 27th

CGRP blockers are the latest development in migraine prevention, offering new hope to the millions who live with the debilitating effects of migraine. While all of these new products target the CGRP process, there are some differences between these products.

Chart of Similarities and differences of CGRP drugs

(Information in chart last updated on 10/18/18.)

How do the drugs prevent migraine?

CGRP (calcitonin-gene-related peptide) is a protein that acts like a neurotransmitter (a chemical messenger) throughout the brain and body. The role of CGRP in migraine has been know since the mid-1980s, but it has been difficult to develop drugs targeting CGRP.

CGRP and CGRP receptors are found in large numbers in the trigeminal system, the sensory nerves that supply the head and neck. As well, CGRP is known to be involved in the dilation of veins (vasodilation) and in the sensory nervous system, both of which are impacted by migraine. Researchers have discovered that the level of CGRP is increased during a migraine attack. In people with chronic migraine, CGRP seems to be chronically elevated.

All three medications are monoclonal antibodies targeting the CGRP pathway. To date, monoclonal antibodies have been used to treat a number of different chronic health conditions. Monoclonal antibodies work both indirectly, by activating our own immune system, and directly by binding to proteins or parts of a protein (peptide) or receptors.

To understand how the new medications disrupt the CGRP process, consider the lock-and-key analogy, with the CGRP peptide acting as the key and the receptor acting as the lock.

  • Aimovig blocks the lock, which allows less of the CGRP protein to bind to the receptors.1
  • Ajovy and Emgality attach to the key, distorting the CGRP protein so that less of it can connect to the receptors.2,3

How are the drugs taken?

All three CGRP blockers are administered subcutaneously, an injection given under the skin. Aimovig is available in a self-administered autoinjector, while Ajovy comes in a prefilled syringe. Emgality is available in both a self-administered autoinjector and a prefilled syringe. These CGRP blockers may be administered by the patient, a caregiver, or a healthcare professional.1-3

What are the dosing options?

Aimovig dosing

Aimovig is given monthly. The recommended starting dosage is 70 mg once monthly, although some patients may benefit from a dosage of 140 mg once monthly.1

Ajovy dosing

Ajovy offers two different dosing options: 225 mg given monthly or 675 mg given every 3 months (quarterly).2

Emgality dosing

With Emgality, the first dose is a “loading dose” of 240 mg (given as two injections). Afterwards, the dose is 120 mg given once a month.3

As with any medication, the best dosage for you should be determined with your doctor.

Pricing and assistance programs

All three CGRP blockers are similarly priced, although coverage may vary depending on an individual’s insurance plan or other support programs.

Aimovig cost and assistance programs

Aimovig (marketed by the partnership of Amgen and Novartis) is priced at $6,900 per year, which works out to $575 a month. Aimovig offers two months of free samples and Amgen has a program that can provide up to a year’s supply of the drug for some people who may have difficulties getting insurance coverage.

Ajovy cost and assistance programs

Ajovy (manufactured by Teva) is similarly priced at $575 a month or $6,900 a year, although the quarterly dosing offers another option: three injections for $1,725.4 While the details on Ajovy’s assistance program are not yet known, Teva has stated they will have an assistance program that can bring the out-of-pocket expenses to $0 for certain patients.4

Emgality cost and assistance programs

The list price of Emgality (manufactured by Lilly) is also $575 monthly, or $6,900 annually.5 Lilly is offering a year’s worth of Emgality treatment to those with commercial insurance as part of their patient assistance program. Offering the product free for a year also gives the company time to work with insurance companies on coverage.5

Will it work for me?

Since there were no clinical trials comparing these three different anti-CGRPs drugs to each other, there is no way to know which might be more effective. For now, the clinical trial data shows very 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

Despite the devastating impact of migraine for people with the condition, only about 10 percent of people with migraine are currently taking a preventive treatment.

While these new anti-CGRP medications may help prevent migraine for some people, others may not experience a benefit. Like all medications, they may work for some and not for others. While the CGRP pathway is a novel and exciting new development, it may not be the answer for all who have migraine. Each individual should discuss with their doctor whether a CGRP blocker is right for them, as well as if there are other medications that may help with the relief of other migraine symptoms.

  1. Aimovig prescribing information. Available at https://pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/aimovig/aimovig_pi_hcp_english.ashx. Accessed 10/4/18.
  2. Ajovy prescribing information. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/761089s000lbl.pdf. Accessed 10/4/18.
  3. Emgality label. Available at http://pi.lilly.com/us/emgality-us-ppi.pdf. Accessed 10/4/18.
  4. Beasley D. U.S. regulator approves Teva migraine drug, shares rise. Available at https://www.reuters.com/article/us-teva-migraine-fda/u-s-regulator-approves-teva-migraine-drug-shares-rise-idUSKCN1LU2TU. Accessed 10/4/18.
  5. Lilly's Emgality™ (galcanezumab-gnlm) Receives U.S. FDA Approval for the Preventive Treatment of Migraine in Adults. PR Newswire. Available at https://www.prnewswire.com/news-releases/lillys-emgality-galcanezumab-gnlm-receives-us-fda-approval-for-the-preventive-treatment-of-migraine-in-adults-300720720.html. Accessed 10/4/18.

Comments

  • ninafranco
    4 months ago

    I am on Medicare and my Insurence said the copay would be 150 a month. I applied to Amgen and now they send the Aimovig’s free of any cost.

  • pblask
    6 months ago

    I started out on Aimovig for around 3 months and was doing good, reduced migraines by about a third. Then my insurance decided that Aimovig was too expensive (really?, they cost the same. Kickback anyone?), and forced me to change to Ajovy. I have to say that I have not seen a difference between the two, but I have only been on the Ajovy around the same amount of time. I really didn’t know about the
    “lock and key” difference between the two, so that is interesting to know! One other thing, my husband, who has never been officially diagnosed with migraines, or been through the medication rigamarole like topamax, rescue meds like I’m on, or been debilitated by migraines as I have, was put on Ajovy by his internal medicine doctor. His migraines have been cut in nearly half, by his 3rd monthly dose. He was using Butalbital daily, sometimes more than once a day. Our insurance started to cut the quantity, so his doctor suggested the Ajovy. I’m also in a 6 month study with Ajovy, which has proved very interesting, I can see what other users have experienced as well.

  • Irene Muratore
    7 months ago

    I have suffered with migraines for over 60 years. I have been taking aimovig since October and it is a miracle!! I take the double dose. Every month it gets better. I have not had a hospital visit since I started and only now get occasional night headaches. I treat with a sumatriptan and I’m good to go. Amgen will help with the cost, if you qualify and Blue Medicare will also hep with the cost. Aimovig has completely changed my life and so worth the cost!

  • Map50
    7 months ago

    I was wondering I’m on amatriptaline as a preventative after taking Topamax and venlafaxine with no success, can you ask for these injections now? I’m in the UK

  • TBI and still going
    9 months ago

    I have had chronic migraines for about 40 years! Basically my entire life. 8 years ago I was in a serious car accident and the TBI lead to daily and more severe migraines, seizures, and a balance disorder. Amiovig has been the only med that has worked In My entire lifetime. Some one said that it lasts 3 weeks and then they said they feel the migraines coming on and I was the same way so my neurologist upped my dose to two shots. I will begin with two next month!thanks to whoever developed this class of meds! They have been a game changer for me! I never had a level 10 migraine brought down to the point I could get out of bed and stop vomiting within a few hours of taking the injection. Amazing drug that finally helps! I hope it lasts because I have had meds work and then 6-9 months later or sooner they stop and migraines return! Time will tell! I hope others get relief as well!

  • bobbyc
    10 months ago

    I’m taking Aimovig (started in December) and it did reduce my migraines from 7 days a week to 3-4 days. It does ease the strength of the migraines from a 9.5 to 9.0, with some getting to an 8.0 ( rare but I will take it.). The only complaint is that Aimovig only lasts about 3 weeks. That final week before I take the next shot tends to be a “booger bear”.

    My neurologist got me 4 injectables and has applied with Humana Medicare Advantage for a full year. Aimovig is the first drug that has helped in many years. I’ve tried Botox twice (2005) and (2018) with zero results whatsoever.

    I am doing this on my tablet so I do apologise for odd or misspelled words.

  • TBI and still going
    9 months ago

    Try two injections. I could tell after three weeks it was wearing off as well. Next does I will try two doses! Botox never worked for me either!

  • vostie
    10 months ago

    Why are all of these companies discriminating against those of us on Medicare? We are not eligible for any discounts at all…

  • TBI and still going
    9 months ago

    Which did u try? I am on Amiovig and they sent me free meds until my insurance said it was approved. Then they told me to sign up for the Amiovig access card and my $50 copay that I paid twice is only $5 now! I would have paid $50 since it works so well but I like $5 much better. Contact the companies they all seem to want to help us all.

  • MarlaB
    9 months ago

    I’m on Medicare with Aetna Rx insurance. My doctor applied and they approved. Very quickly. It still costs $200 per month for 70mg. But once insurance deductibles met its cheaper. I’d inquire at different companies.

  • TBI and still going
    9 months ago

    Apply for the Amiovig access card my $50 copay went to $5 and that’s for 140mg or two shots!

  • BLTSandwich
    11 months ago

    Hi, Maureen – now that you’re three months further along, can you give an update? I’m about the same age and have the same kinds of migraines, so I’m interested on your results. Thanks!

  • Lifetimegirl2000
    11 months ago

    I have a question about CGRP. Does this mean individuals who lack or make too much of this protein inherited this and make it a genetic disease or disorder? Are we born with it? Look forward to the answer.

  • emilydownward author
    11 months ago

    Hi Lifetimegirl2000 — So far, no genetic mutation (inherited or acquired) has been identified as being connected with elevated levels of CGRP. Researchers have found that the levels of CGRP go up during a migraine and go down afterwards. The findings that people with chronic migraine have chronically elevated levels of CGRP could be a result of having more frequent migraines. Research is ongoing, and to date, they still don’t know what causes migraines. CGRP is another clue and provides a target for treatment, but scientists continue to search for the causes.

  • TBI and still going
    9 months ago

    My grandma, mom and sister all have migraines. I know one hasn’t been discovered but ours run in families! My son has had a few killer migraines! Thankfully far between. I pray everyday that both my kids and my sisters don’t develop migraines! I wouldn’t wish them on anyone!

  • Krista
    11 months ago

    The Aimovig 140 mg is $1150 a month. I was told incorrectly that it would be the same price as 70 MG, but they charge my insurance $1150.

  • TBI and still going
    9 months ago

    My copay was $50 and when I applied for the Amiovig access card is was only $5! My dr. Told me to apply! It takes a minute and u print out the card and give it to ur pharmacist. It’s on this post. I suggest everyone try applying. I drug that works is awesome! But a drug that works and is cheap is even better!

  • carsons23
    1 year ago

    Wondering if that’s can help me. I have chronic aura symptoms; numbness tingling in extremities, face and pain in face, cotton head and brain fog. Usually without the painful headache. I’m starting to understand that aura is it just a precursor but an actual migraine symptom.

  • TBI and still going
    9 months ago

    It’s worth a shot! Helps me tremendously.

  • mboykin
    1 year ago

    I am currently on my 4th treatment of Aimovig. The first 3 were 70mg ( one shot) I didn’t have any change. This past treatment was 2 shots (140mg). I suffer from 24/7 Migraine pain with no pain free days. The past 2 days I have noticed a difference in my pain level so I pray it’s starting to kick in.

  • TBI and still going
    9 months ago

    I am with u since my TBI my chronic migraines became daily! This Amiovig has been a game changer! My neurologist just upped my 60 mg to 140mg. I could tell when it was wearing off by week three! This month is my first two shot month so I am hoping it works even better for both of us!

  • MarlaB
    9 months ago

    I started 70 mg aimovig in November. In February I noticed a huge improvement. It says takes a couple months to kick in. Still get some headaches but far fewer and very few really bad ones. For the first time in years I didn’t use all 9 abortive pills and I’m starting to get over the daily anxiety that I’ll wake up with a headache every day. I can also keep up my exercise routine again.

  • TBI and still going
    9 months ago

    Congrats! It’s been a game changer for me as well! I just hope it lasts! I am enjoying this time of relief! Never had a med work at the level this one has in 40 years of migraines!

  • Woody
    1 year ago

    It is excellent to hear that CGRP blockers available for the prevention of migraine:

  • MaureenE
    1 year ago

    I have had 2 monthly doses of Aimovig. I live in Atlanta, GA, and have had migraines related to barometric pressure changes all of my adult life. Also had estrogen-dropoff and full-moon triggered migraines as well.

    I’m 54 and perimenopausal, so estrogen-related are not as frequent.

    With ZERO changes to other meds, diet, lifestyle, etc, Aimovig has reduced my chronic (50+% of the month, some multi-day migraines) to *only* migraines during a full moon. Even the migraines that I do have are significantly reduced in severity.

    Honestly, I pray this is NOT a coincidence. I’m hopeful that continuing Aimovig will provide the same level of reduction in migraines.

    Try it if you can work with your doctor, as I was cautiously optimistic and have been AMAZED at the effectiveness in such a short time.

    Note: 5 years of Botox with minimum effectiveness…it did help with tension in my neck and shoulders and reduced those related migraines. I tried Topomax and felt like my IQ had been reduced about 50pts, and couldn’t work as an IT geek when on it. I was relying on MaxAlt and Lortab 5mg to treat and reduce pain levels.

  • TBI and still going
    9 months ago

    It’s been the first med to help me in 40 years of migraines! I too hope it continues! Botox never worked for me and my last dose gave me a ten day level 10 in bed migraine! I had to call my neurologist and we did 3 cycle breaker meds and then he was sending me to the ER but the last med finally worked!

  • TBI and still going
    9 months ago

    Also I am peri menopausal as well and barometric changes kill me! About a month age we had a 70 degree temperature change in a few days and it killed my head! We just had another one not as extreme but my head let’s me know when a winter storm is coming! I love having triggers of hormones and weather that I can’t control! Alcohol and exercise are also triggers So at least I can control them!

  • TBI and still going
    9 months ago

    Also topomax sucked for me and my lawyer said it’s a terrible medicine and should be taken off the market! Many migraineurs call it dope a max because it effects there minds in terrible ways! For me I had numb feet and hands and everything tasted like metal! Number one side effect weight loss! I said yeah because everything tastes like shit!

  • BLTSandwich
    11 months ago

    Hi, Maureen – now that you’re 3 months out, can you give an update? I have a similar migraine history and curious about your results so far. Thanks!

  • mammapeaches (Susan McManus)
    1 year ago

    Emily,

    Thank you for the wonderful information!

    One question, do you know if any of the research shows that these meds can help sinus related migraines? By biggest trigger is the barometric pressure.

  • emilydownward author
    1 year ago

    Hi mammapeaches,
    The research studies didn’t specifically go into triggers. Each of the CGRP blockers mentioned above were studied in patients with episodic migraine as well as patients with chronic migraine. I’d suggest talking to your doctor about whether these are a good treatment option in your case. I hope you find relief!
    Best, Emily

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