Transitioning from Emgality to Aimovig: Dosage Recommendations
When transitioning from Emgality (galcanezumab) to Aimovig (erenumab), start Aimovig 140 mg monthly immediately after the last Emgality dose without any washout period.
Dosing Recommendations
Emgality to Aimovig Transition Protocol:
Complete current Emgality treatment cycle
- Emgality standard dosing: 120 mg monthly (240 mg loading dose initially)
Initiate Aimovig without washout period
- Recommended starting dose: 140 mg subcutaneously once monthly
- No loading dose is required for Aimovig
Administration timing:
- Administer first Aimovig dose at the time the next Emgality dose would have been due
- Both medications target the CGRP pathway but through different mechanisms (Emgality binds to CGRP ligand; Aimovig blocks CGRP receptor)
Evidence-Based Rationale
The 140 mg dose of Aimovig is recommended over the 70 mg dose because:
- Evidence indicates numerically better efficacy with 140 mg across a broad spectrum of migraine outcomes 1
- Patients transitioning from one CGRP therapy to another typically have difficult-to-treat migraine and prior treatment failures, which may benefit from the higher dose 1
- The 140 mg dose shows greater effectiveness in preventing progression to chronic migraine 1
Clinical Considerations
Patient Monitoring
- Evaluate treatment response within 2-3 months after transition 2
- Key outcome measures: attack frequency, attack severity, and migraine-related disability 2
- Monitor for potential development or worsening of hypertension, particularly with erenumab 2
Practical Administration Differences
- Injection depth: Aimovig needle has a 7 mm insertion depth vs. 5 mm for Emgality 3
- Activation force: Aimovig requires 14 N activation force vs. 8 N for Emgality 3
- Injection speed: Aimovig has slower injection speed (0.24 mL/s at room temperature) compared to Emgality (0.40 mL/s) 3
Safety Considerations
- Both medications have similar safety profiles with injection site reactions being the most common adverse events 4
- Rare systemic allergic reactions have been reported with Emgality, particularly in patients with autoimmune disorders 5
- Aimovig has been associated with hypertension in post-marketing studies 2
Special Populations
Patients with Treatment-Resistant Migraine
- Both medications have demonstrated effectiveness in patients with multiple prior preventive treatment failures 6
- Erenumab 140 mg has shown particular benefit in difficult-to-treat cases 1
Conclusion
The transition from Emgality to Aimovig should be seamless with no washout period required. Starting with the 140 mg dose of Aimovig provides the best chance of maintaining or improving migraine control, particularly for patients with difficult-to-treat migraine who are switching between CGRP therapies.