From the Guidelines
I recommend proceeding with Aimovig (erenumab) 70 mg/mL subcutaneous injection monthly as prescribed, while monitoring the blurry vision symptom. According to the study published in Nature Reviews Neurology in 2021 1, erenumab is a recommended treatment for migraine prevention, with a dosage of 70 or 140 mg subcutaneous once monthly. The study does not list blurry vision as a common side effect or contraindication for erenumab. The blurry vision the patient is experiencing may be related to their underlying migraine condition rather than the medication itself, as visual disturbances can be part of migraine symptoms.
Some key points to consider when administering Aimovig include:
- Rotating injection sites between the abdomen, thigh, or upper arm to minimize local reaction
- Allowing the auto-injector to warm to room temperature for 30 minutes before administration
- Monitoring for any changes in vision or other symptoms, and reporting them to the healthcare provider for proper evaluation
- Following the prescribed regimen of one injection monthly for 90 days with one refill, as this is a common initial therapy approach
It is essential to note that if vision problems worsen after injection or persist between doses, the patient should seek prompt medical attention, as this could indicate either an uncommon medication reaction or progression of their underlying condition requiring further assessment, as suggested by the study 1.
From the Research
Adverse Events Associated with Erenumab
- The most common adverse events reported with erenumab are constipation, skin reactions, fatigue, sleep disturbances, and nausea/emesis 2.
- These adverse events are generally mild, with most being grade 1 according to the common terminology criteria for adverse events (CTCAE) 2.
- Discontinuation of erenumab therapy due to adverse events is rare, occurring in only 5 out of 49 patients in one study 2.
Efficacy of Erenumab in Migraine Prophylaxis
- Erenumab has been shown to be effective in reducing the mean number of monthly migraine days in patients with episodic migraine, with a significant proportion of patients achieving a 50% or greater reduction in migraine days 3, 4.
- Erenumab has also been found to be effective in patients with chronic migraine, with significant reductions in monthly migraine days and acute migraine-specific medication days 5.
Safety and Tolerability of Erenumab
- Erenumab has a good safety and tolerability profile, with no severe adverse events or frequent adverse events leading to treatment discontinuation reported in clinical trials 6.
- The most common adverse events associated with erenumab are local skin reactions and constipation, which are generally mild and well-tolerated 6.
- Erenumab has been found to be safe and effective in patients with migraine with and without aura, with no increased risk of adverse events in patients with aura 5.
Patient-Specific Factors
- Females and patients with aura may be more prone to adverse events when taking erenumab, although the overall safety and tolerability profile remains good 2.
- Increasing the dosage of erenumab from 70 mg to 140 mg per month does not appear to increase the frequency of adverse events 2.