From the Guidelines
The most common CGRP medications for migraine prevention are Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab), and Vyepti (eptinezumab). These monoclonal antibodies work by blocking CGRP receptors or the CGRP molecule itself, which plays a key role in migraine pathophysiology.
Key Points
- Aimovig is typically administered as a 70mg or 140mg monthly self-injection
- Ajovy as a 225mg monthly or 675mg quarterly injection
- Emgality as a 120mg monthly injection (after a 240mg loading dose)
- Vyepti as a quarterly 100mg intravenous infusion
Administration and Side Effects
These medications are generally well-tolerated with common side effects including injection site reactions, constipation, and occasional muscle cramps. They're usually prescribed when first-line preventive treatments (like antihypertensives, antidepressants, or anticonvulsants) have failed.
Clinical Recommendations
According to the American College of Physicians guideline 1, clinicians should use an informed decision-making approach and discuss benefits, harms, costs, patients’ values and preferences, including financial burden and mode of administration, when selecting a pharmacologic treatment to prevent episodic migraine.
Evidence
The guideline suggests that CGRP-mAbs may reduce migraine frequency and the need for acute medication compared with topiramate 1, and may also reduce migraine frequency compared with valproate 1. However, the evidence is of low certainty, and the net benefit of these comparisons is uncertain.
Conclusion Not Applicable
As per the provided instructions, a conclusion section is not applicable here.
From the FDA Drug Label
AIMOVIG is a calcitonin gene-related peptide receptor antagonist indicated for the preventive treatment of migraine in adults. (1) AJOVY is a calcitonin gene-related peptide antagonist indicated for the preventive treatment of migraine in adults. (1)
The most common CGRP for migraine is not explicitly stated in the provided drug labels. However, based on the information given, the two mentioned CGRP antagonists are:
- Erenumab (AIMOVIG) 2
- Fremanezumab (AJOVY) 3 It cannot be determined which one is the most common, as this information is not provided in the drug labels.
From the Research
Most Common CGRP for Migraine
The most common CGRP monoclonal antibodies for migraine treatment are:
- Erenumab
- Galcanezumab
- Fremanezumab
Efficacy of CGRP Monoclonal Antibodies
Studies have shown that these antibodies are effective in reducing migraine days and improving quality of life for patients with episodic and chronic migraine 4, 5.
- Erenumab (140 mg), Galcanezumab (120 mg, 240 mg), and Fremanezumab (225 mg, 675 mg) were found to be superior to placebo in reducing average migraine days per month 4.
- Fremanezumab (225 mg) and Galcanezumab (120 mg) may be the best clinical protocol after a comprehensive assessment 4.
Safety and Tolerability
The safety and tolerability of CGRP monoclonal antibodies have been evaluated in several studies:
- Erenumab was found to have a good safety and tolerability profile, with the most common adverse events being local skin reactions and constipation 6.
- Switching from one anti-CGRP monoclonal antibody to another may be a viable option for patients who experience ineffectiveness or adverse effects 7.
Comparison of CGRP Monoclonal Antibodies
A comparison study between Erenumab, Fremanezumab, and Galcanezumab found that all three treatments had excellent efficacy and tolerability in the preventive treatment of high-frequency episodic migraine and chronic migraine 5.
- The effects of discontinuation of preventive Erenumab and Galcanezumab treatment in patients with chronic migraine were assessed, and the results indicated a therapeutic effect of monoclonal antibodies targeting the CGRP pathway in chronic migraine prevention after treatment termination up to 12 weeks 8.