From the Guidelines
The injectable calcitonin gene-related peptide (CGRP) inhibitors used to prevent migraines include erenumab (Aimovig), galcanezumab (Emgality), fremanezumab (Ajovy), and eptinezumab, which have been shown to be effective in reducing migraine frequency, severity, and duration in patients with both episodic and chronic migraines 1. These medications work by blocking the CGRP pathway, which plays a crucial role in migraine pathophysiology. Erenumab targets the CGRP receptor itself, while galcanezumab and fremanezumab bind to the CGRP peptide. They are typically administered as monthly subcutaneous injections, with Ajovy also offering a quarterly dosing option. Some key points to consider when using these medications include:
- Eptinezumab is also available as an intravenous infusion every 3 months 1
- The CGRP inhibitors generally have favorable side effect profiles compared to traditional preventive options, with injection site reactions being the most common adverse effect
- These medications represent a significant advancement in preventive migraine treatment as they were specifically designed to target the migraine pathway, unlike older preventive medications that were originally developed for other conditions
- The American College of Physicians has recommended the use of CGRP inhibitors, including erenumab, fremanezumab, and galcanezumab, for the prevention of episodic and chronic migraines 1
From the FDA Drug Label
AJOVY is a calcitonin gene-related peptide antagonist indicated for the preventive treatment of migraine in adults. (1) AJOVY® (fremanezumab-vfrm) injection, for subcutaneous use The name of the injectable calcitonin gene-related peptide (CGRP) inhibitor is fremanezumab, also known by its brand name AJOVY 2.
- It is used for the preventive treatment of migraine in adults.
- The drug is administered subcutaneously.
- Fremanezumab is available in two subcutaneous dosing options: 225 mg monthly, or 675 mg every 3 months (quarterly) 2 2.
From the Research
Injectable Migraine Drugs
The names of the injectable calcitonin gene-related peptide (CGRP) inhibitors used to prevent migraines are:
Characteristics and Efficacy
These monoclonal antibodies have shown significant efficacy in reducing the mean monthly number of migraine days and the use of migraine-specific medication, and in decreasing physical impairment and impact of migraine on everyday activities 3, 6, 4, 5.
Safety Profile
The safety profile of these drugs has been demonstrated to be favorable, with a lack of significant differences in the occurrence of adverse events compared to placebo-treated patients 3, 6, 4, 5.
Clinical Recommendations
The American Headache Society recommends that CGRP monoclonal antibodies, including erenumab, fremanezumab, and galcanezumab, be considered as a first-line approach for migraine prevention 7.