Emgality vs. Aimovig for Migraines

Migraines can be extremely debilitating, causing throbbing head pain, nausea, and sensitivity to light and sound. For those suffering from frequent migraine attacks, preventive medications can provide much-needed relief.

Two of the latest preventive treatment options are Emgality and Aimovig, belonging to a new class of CGRP inhibitors. These drugs block calcitonin gene-related peptide (CGRP), a molecule involved in migraine attacks.

In this article, we compare Emgality and Aimovig to help you and your doctor determine which migraine prevention treatment suits your needs better.

1. Mechanism of Action

Emgality and Aimovig work by blocking CGRP, which transmits migraine pain signals. However, the two drugs differ in how they interact with the CGRP pathway to achieve this effect.

Emgality

Emgality, with the generic name galcanezumab, operates as a CGRP antagonist. The drug exerts its therapeutic effect by directly binding to CGRP, a neuropeptide implicated in transmitting pain signals and dilating blood vessels during migraines.

Through this antagonistic action, Emgality inhibits the inflammatory response of blood vessels and disrupts the transmission of pain signals, ultimately preventing the onset of migraine headaches.

Aimovig

Aimovig, or erenumab, belongs to the class of monoclonal antibodies and operates as a CGRP receptor antagonist. Its mechanism of action involves targeting the CGRP receptor, specifically inhibiting the binding of CGRP to its receptor in blood vessels.

By disrupting this interaction, Aimovig effectively reduces the dilation of blood vessels and the release of pro-inflammatory substances, thereby preventing the initiation of migraine attacks.

2. Dosage and Administration

Following the proper dosage regimen is key to leveraging the preventive benefits of Emgality and Aimovig. Both drugs are injected subcutaneously, but their schedules differ based on the indication.

Emgality

Emgality is administered subcutaneously for the prevention of migraines in adults. The dosing regimen is tailored to the specific indication.

For migraine prophylaxis, Emgality begins with a loading dose consisting of two subcutaneous injections, each containing 120 mg of galcanezumab. Following the loading dose, patients transition to a monthly maintenance dose of 120 mg, administered subcutaneously. This carefully designed schedule aims to establish an effective preventive measure against migraine headaches.

In the case of cluster headaches, Emgality is utilized differently. At the onset of a cluster period, three subcutaneous injections are administered, each containing 100 mg of galcanezumab. Subsequently, patients receive a monthly maintenance dose of 100 mg until the end of the cluster period. This targeted approach aligns with the unique characteristics of cluster headaches.

Patients are instructed to self-administer Emgality, using prefilled syringes or injection pens. Proper storage is crucial, with refrigeration recommended, although brief room temperature storage (up to 7 days) is permissible. The medication should not be used if it appears cloudy or contains particles. Disposal guidelines emphasize the one-time use of prefilled syringes or injection pens, even if there is remaining medicine.

Aimovig

Aimovig is also administered subcutaneously for the preventive treatment of migraines in adults.

The usual adult dose for migraine prophylaxis with Aimovig is 70 mg subcutaneously once a month. Some patients may be prescribed a higher dose of 140 mg, administered as two subcutaneous injections of 70 mg each. The flexibility in dosing allows for individualized treatment based on patient response.

Aimovig administration involves subcutaneous injection under the skin, with patients potentially trained in self-administration. The prescribing healthcare provider determines the specific dosage, 70 mg or 140 mg. Patients using the 140 mg dose should administer two injections, using separate autoinjectors or syringes for each injection.

Storage precautions include refrigeration of Aimovig in its original carton, avoiding freezing and exposure to heat and light. Room temperature storage for up to 7 days is acceptable, and the medication should be allowed to reach room temperature for 30 minutes before injection. Aimovig, like Emgality, emphasizes the one-time use of prefilled syringes or autoinjectors with proper disposal measures in place.

3. Efficacy

In comparing the effectiveness of Emgality and Aimovig for migraine prevention, a real-world study analyzed the experiences of 77 patients (out of 95) using CGRP inhibitors.

Results indicated that both drugs reduced monthly migraine days (MMD) by ≥50% after 12 weeks, surpassing their clinical trial outcomes. In the real world, galcanezumab showed a better response (72.4% reduction in MMD) than erenumab (58.3%).

The conclusion suggested that both drugs are effective in real patients, but galcanezumab may be more effective than erenumab in reducing MMD by ≥50%. Further studies are recommended for confirmation.

In separate clinical trials, Aimovig demonstrated a larger reduction in monthly migraine days (-2.5 days) compared to Emgality (-2.1 days). A higher percentage of Aimovig patients (16.4%) experienced a 50% reduction in migraines compared to Emgality (13%). Emgality also treats episodic cluster headaches, distinguishing it from Aimovig.

Overall, real-world and clinical trial data suggest both drugs effectively reduce migraines, with galcanezumab potentially having an edge in real-world scenarios. Emgality's additional indication for episodic cluster headaches adds versatility.

4. Side Effects

While generally well-tolerated, both Emgality and Aimovig have potential side effects that patients should monitor. Reactions tend to be mild, like injection site irritation, but severe allergic responses are possible.

Emgality

Emgality may elicit certain side effects. Patients must be aware of potential adverse reactions and promptly report any concerns to their healthcare provider.

Common side effects associated with Emgality include pain, redness, itching, and irritation at the injection site. These reactions are generally localized and temporary.

In some cases, an allergic reaction to Emgality may occur. Signs of an allergic reaction include:

• Hives
• Difficulty breathing
• Swelling of the face, lips, tongue, or throat

Importantly, allergic reactions may manifest several days after an injection, necessitating vigilance.

As with any medication, Emgality may have additional side effects beyond the commonly observed ones. Patients should seek emergency medical help if they experience severe or persistent adverse effects. Contacting a healthcare provider promptly to discuss any concerns related to side effects is crucial.

Aimovig

Aimovig may lead to specific side effects. Patients should be aware of potential adverse reactions and promptly communicate any symptoms to their healthcare provider.

Common side effects associated with Aimovig include constipation, pain, swelling, or redness at the injection site. These effects are typically localized and transient.

In rare instances, severe constipation or constipation accompanied by symptoms such as:

• Severe stomach pain
• Vomiting
• Abdominal swelling

Additionally, patients should contact their healthcare provider promptly if they experience severe headaches, blurred vision, or sensations of pulsing in the neck or ears.

Allergic reactions to Aimovig, though uncommon, may present with:

• Hives
• Difficulty breathing
• Swelling of the face, lips, tongue, or throat

Vigilance is essential as allergic reactions can manifest even days after an injection.

Patients should seek emergency medical attention for severe or persistent side effects and consult their healthcare provider for guidance on managing any concerns related to Aimovig.

5. Cost

The out-of-pocket costs of Emgality and Aimovig can be high, but manufacturer discounts and pharmacy savings programs are available to lower prices.

Emgality

The cost of Emgality varies depending on the dosage and pharmacy. Emgality is available in two strengths: 100 mg/mL and 120 mg/mL. The prices range from $724.70 for 1 milliliter to $1,797.49 for 3 milliliters. Emgality offers several discount options, including printable coupons, copay cards, and rebates.

Eligible commercially insured patients using the Emgality Savings Card may pay $0 per 30-day supply, with a maximum annual savings of $4,900. This card allows up to 12 uses within a calendar year. Emgality also has patient assistance programs, such as the Emgality Free Sharps Container Program and Lilly Cares Foundation Patient Assistance Program, providing cost-free or discounted medicines to eligible individuals.

In addition to these programs, GoodRx coupons for Emgality offer discounts at various pharmacies. The price with a GoodRx discount ranges from $626.09 to $758.19, depending on the pharmacy, providing savings of up to 23% off the retail price.

Aimovig

Aimovig is priced at $786.46 for 1 milliliter, regardless of the two available strengths: 70 mg/mL and 140 mg/mL. Aimovig offers savings through printable coupons and the Aimovig Ally Access Card.

Eligible commercially insured patients using the Aimovig Ally Access Card may pay $5 per prescription up to a monthly and yearly maximum benefit. The card allows multiple uses per prescription per calendar year. Patients can also submit a rebate request for out-of-pocket costs per prescription fill.

GoodRx coupons for Aimovig provide discounts ranging from 9% to 25% off the retail price at various pharmacies. The price with a GoodRx discount ranges from $726.47 to $822.95.

Wrap Up

Emgality and Aimovig are effective CGRP inhibitor medications for preventing migraines. They have similar mechanisms of action, dosing regimens, and safety profiles. Real-world data suggests Emgality may lead to a greater reduction in monthly migraine days, but Aimovig showed a slightly better response rate in clinical trials.

The choice between Emgality and Aimovig depends on your specific migraine patterns, treatment goals, and cost considerations. Emgality also has the additional benefit of treating episodic cluster headaches. Talk to your doctor about whether Emgality or Aimovig is more suitable for your individual needs.

FAQs on Emgality and Aimovig

Are Emgality and Aimovig safe for long-term use?

The long-term safety of Emgality and Aimovig beyond 1 year of treatment has not yet been established through clinical trials. However, no specific safety issues or risks have been identified with longer-term treatment.

How fast do Emgality and Aimovig work?

Patients may experience a reduced migraine frequency within the first month of treatment, although the full effects may take several months to be seen. Maximum benefits usually occur within 3-6 months.

Can I use Emgality and Aimovig if I am also taking other medications?

Emgality and Aimovig can typically be safely used with most other prescription or over-the-counter medications. However, you should always check with your doctor about potential risks of interaction with your other medications.