What is the recommended dose of Ajovy (fremanezumab) for migraine prevention?

Recommended Dosage of Ajovy (Fremanezumab) for Migraine Prevention

The recommended dosage of Ajovy (fremanezumab) for migraine prevention is 225 mg administered subcutaneously once monthly, or 675 mg administered subcutaneously once quarterly (every 3 months). 1

Dosing Options

• Ajovy offers two flexible dosing regimens for migraine prevention:

  • 225 mg administered subcutaneously once monthly 1
  • 675 mg administered subcutaneously once quarterly (every 3 months) 1

• The 675 mg quarterly dose is administered as three consecutive injections of 225 mg each 1

Administration Details

• Ajovy is administered via subcutaneous injection only 1

• Injection sites include:

  • Abdomen
  • Thigh
  • Upper arm 1

• For multiple injections (when administering the quarterly dose), the same body site may be used, but not the exact location of the previous injection 1

• Ajovy is available in two formulations:

  • 225 mg/1.5 mL single-dose prefilled autoinjector
  • 225 mg/1.5 mL single-dose prefilled syringe 1

• The autoinjector and prefilled syringe have been shown to be bioequivalent with similar safety and tolerability profiles 2

Efficacy and Clinical Positioning

• Ajovy (fremanezumab) is classified as a third-line medication for migraine prevention in clinical guidelines 3

• Clinical trials have demonstrated significant reductions in:

  • Monthly headache days
  • Monthly migraine days
  • Days requiring acute medication use 4, 5

• In phase 3 trials, fremanezumab showed the following efficacy:

  • 38% of patients on quarterly dosing achieved at least 50% reduction in headache days
  • 41% of patients on monthly dosing achieved at least 50% reduction in headache days 4

Special Considerations

• Ajovy is contraindicated in patients with serious hypersensitivity to fremanezumab-vfrm or any excipients 1

• Not recommended in patients with:

  • History of stroke
  • Subarachnoid hemorrhage
  • Coronary heart disease
  • Inflammatory bowel disease
  • Chronic obstructive pulmonary disease
  • Impaired wound healing 3

• Hypersensitivity reactions may occur, including rash, pruritus, drug hypersensitivity, and urticaria 1

• Cases of anaphylaxis and angioedema have been reported in postmarketing surveillance 1

• The most common adverse reaction is injection site reactions (43% with monthly dosing, 45% with quarterly dosing) 1

Treatment Evaluation

• Response to Ajovy treatment should be evaluated within 2-3 months after initiation 3

• Key outcome measures for effectiveness include:

  • Attack frequency (headache or migraine days per month)
  • Attack severity
  • Migraine-related disability 3

• Headache calendars are useful for tracking these measures and monitoring medication use 3