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 and Emgality are available in a self-administered autoinjector, while Ajovy comes in 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, which is given as two consecutive 70 mg injections.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.

View References
  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

View Comments (8)
  • Lifetimegirl2000
    1 week 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.

  • Krista
    2 weeks 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.

  • carsons23
    3 months 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.

  • mboykin
    3 months 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.

  • Woody
    3 months ago

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

  • MaureenE
    3 months 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.

  • mammapeaches (Susan McManus)
    3 months 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
    3 months 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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