What are the long-term side effects of Aimovig (Erenumab)?

Long-Term Side Effects of Aimovig (Erenumab)

Aimovig (erenumab) has a generally favorable long-term safety profile with constipation, injection site reactions, and potential hypertension being the most significant long-term concerns. 1

Common Long-Term Side Effects

Based on the FDA drug label and clinical evidence, the most common long-term side effects of Aimovig include:

• Constipation with potential serious complications: This is one of the most significant long-term concerns. In some cases, patients have required hospitalization or surgery for severe constipation. 1

• Injection site reactions: Pain, redness, or swelling at the injection site may persist with continued use. 1

• Hypertension: New-onset or worsening of pre-existing high blood pressure can occur with continued Aimovig use. 1

Serious Long-Term Side Effects

Hypersensitivity Reactions

• Can occur within hours to more than one week after administration
• May include swelling of the face, mouth, tongue, or throat and breathing difficulties
• Requires immediate discontinuation if serious reactions occur 1

Constipation with Serious Complications

• Can lead to hospitalization or surgery in severe cases
• Warning signs include severe or constant abdominal pain, vomiting, abdominal swelling, or bloating 1
• Requires close monitoring, especially with prolonged use

Hypertension

• Regular blood pressure monitoring is recommended during long-term treatment
• Contact healthcare provider if blood pressure increases 1

Real-World Long-Term Experience

In real-world clinical settings, additional observations have been made regarding long-term use:

• Treatment wearing-off: Some patients report diminishing effects approximately one week before their next scheduled dose during long-term treatment 2

• Discontinuation rates: In a real-world tertiary headache clinic study, 27.7% of patients discontinued erenumab after extended use, primarily due to:

  • Ineffectiveness (39.3%)
  • Adverse effects (42.9%) 2

Long-Term Efficacy Considerations

The STRIVE study demonstrated sustained efficacy over 52 weeks with similar safety profiles between dose groups:

• Mean changes in monthly migraine days at week 52 were -4.2 days (70 mg) and -4.6 days (140 mg) from baseline
• Approximately 61-65% of patients achieved ≥50% reduction in monthly migraine days at week 52
• Among patients who showed ≥50% reduction during the first phase of treatment, 86% maintained this response during long-term treatment 3

Special Considerations for Long-Term Use

Pregnancy and Breastfeeding

• Not recommended during pregnancy or breastfeeding
• A pregnancy registry exists to monitor outcomes in women exposed to Aimovig during pregnancy 1

Storage for Long-Term Use

• Store in refrigerator (36°F to 46°F)
• Can be kept at room temperature for up to 7 days
• Must be discarded if left at room temperature for more than 7 days 1

Monitoring Recommendations for Long-Term Use

For patients on long-term Aimovig therapy, regular monitoring should include:

• Blood pressure checks
• Assessment for constipation symptoms
• Evaluation of injection site reactions
• Overall efficacy assessment to determine continued benefit

Practical Considerations

When considering long-term treatment with Aimovig:

• The medication is administered subcutaneously once monthly
• Available in 70 mg and 140 mg doses
• Some patients may benefit from the higher 140 mg dose for sustained efficacy 1

Remember that individual responses to long-term treatment may vary, and the benefit-risk profile should be periodically reassessed during continued therapy.