Emgality vs. Nurtec for Migraines

Migraine is a highly prevalent condition affecting more than 10% of people worldwide, occurring most often among those aged 20-50 years, with about 3 times higher rates in women than men.

Emgality and Nurtec ODT are two recent treatment options targeting the calcitonin gene-related peptide (CGRP) pathway implicated in migraines. Emgality prevents migraines through monthly injections, while Nurtec ODT treats acute migraines and prevents recurrence through a quick-dissolving oral tablet.

With migraines impacting many critical productive years of life, effective treatments are essential. A recent head-to-head trial compared these CGRP-focused medications for reducing monthly migraine days.

This article analyzes the key similarities and differences between Emgality and Nurtec across parameters like administration, efficacy, side effects, and cost to inform treatment decisions for this highly prevalent condition.

1. Mechanism of Action

Understanding how Emgality and Nurtec work at a molecular level provides insight into their therapeutic potential. While both target the CGRP pathway implicated in migraines, they do so through distinct mechanisms of action.

Emgality

Emgality, with the generic name galcanezumab, operates as a CGRP antagonist.

As a CGRP inhibitor, Emgality blocks the CGRP receptors, specifically targeting the calcitonin gene-related peptide. By inhibiting CGRP, Emgality interferes with the signaling pathway associated with migraines, thereby preventing or reducing the frequency of migraine headaches in adults.

This mechanism of action aims to disrupt the physiological processes that contribute to the initiation and propagation of migraines.

Nurtec ODT

Nurtec ODT, featuring the generic name rimegepant, functions as a calcitonin gene-related peptide (CGRP) receptor blocker.

The mechanism of action involves blocking the CGRP receptors in the brain. By doing so, Nurtec ODT aims to rapidly alleviate migraine symptoms, such as headache, nausea, vomiting, light sensitivity, and sound sensitivity, during acute migraine attacks.

Additionally, when used preventively, it continues to block CGRP receptors to reduce the occurrence of episodic migraines. The orally disintegrating tablet dissolves in the mouth, allowing quick absorption into the bloodstream and prompt relief.

2. Dosage and Administration

The route of administration and dosing regimen are key differentiators between Emgality and Nurtec. Understanding how to take these medications properly supports safety and efficacy.

Emgality

Emgality is administered via subcutaneous injections, with dosage and administration tailored to the purpose. For migraine prophylaxis, the initial dose comprises 240 mg subcutaneously, followed by a monthly maintenance dose of 120 mg subcutaneously. In the case of cluster headaches, a dose of 300 mg is administered at the onset of the cluster period, followed by monthly injections until the end of the cluster period.

Patients are instructed to follow the prescribed dosing regimen carefully, with missed doses administered as soon as possible. Emgality is stored in the refrigerator, protected from light, and should be used within the recommended timeframe. Patients need to adhere to storage and handling instructions.

Nurtec ODT

Nurtec ODT offers a convenient orally disintegrating tablet for migraine management. The acute treatment involves taking one tablet (75mg) as needed during a migraine attack, with a maximum of one tablet in 24 hours. For preventive treatment of episodic migraines, one tablet (75mg) is taken every other day (every 48 hours). The tablet is placed under or onto the tongue, dissolving quickly without water, and can be swallowed with saliva.

Nurtec ODT can be stored at room temperature, and its safety profile with more than 18 doses in 30 days is unknown. Patients are advised to handle the tablet with dry hands and to remove it from the package only when ready to take it, ensuring proper administration and efficacy.

3. Efficacy

In the CHALLENGE-MIG clinical trial comparing Emgality (galcanezumab-gnlm) and Nurtec ODT (rimegepant) for the preventive treatment of episodic migraine, both medications targeted calcitonin gene-related peptide (CGRP) through different mechanisms. Emgality, a monoclonal antibody (mAb), binds to CGRP, while Nurtec ODT is a gepant that blocks the CGRP receptor.

The trial's primary endpoint was the percentage of patients achieving a ≥50% reduction in monthly migraine headache days. Preliminary results indicated that Emgality did not demonstrate statistical superiority over Nurtec ODT. Both medications showed similar response rates, with Emgality displaying clinically meaningful efficacy and safety consistent with prior 6-month studies. In the 3-month trial, Emgality performed numerically better than Nurtec ODT on key secondary endpoints.

Despite Emgality not meeting the primary endpoint for statistical superiority, the study offers valuable insights. Emgality is notable as the only CGRP medication with label indications for ≥50%, ≥75%, and 100% reductions in monthly migraine headache days. Full trial results, expected to be released later this year, will provide a comprehensive understanding of the comparative efficacy of Emgality and Nurtec ODT.

4. Side Effects

Being aware of potential adverse reactions empowers patients to monitor their health when using these migraine medications.

Emgality

Emgality may have side effects that patients should be aware of. Common side effects associated with Emgality include pain, redness, itching, and irritation at the injection site.

These effects are generally mild and localized. In some cases, an allergic reaction to Emgality may occur, presenting as:

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

It's essential to seek emergency medical help if signs of an allergic reaction manifest. Additionally, Emgality may interact with other medications, and patients should inform their healthcare providers about all current medicines to prevent potential drug interactions.

Nurtec ODT

Nurtec ODT also has its set of potential side effects. The most common side effect is nausea, especially when used for acute treatment of migraine attacks.

For preventive treatment of episodic migraines, common side effects include nausea, indigestion, and stomach pain. Allergic reactions to Nurtec ODT can be serious, with symptoms such as:

• Difficulty breathing
• Shortness of breath
• Swelling of the throat, tongue, mouth, lips, face, or eyes
• Hives
• Rash
• Itching

An allergic reaction called delayed hypersensitivity reactions may occur days after taking the medicine. Patients experiencing such symptoms should seek immediate medical attention. Like Emgality, Nurtec ODT may also interact with other medications, and patients should inform their healthcare providers about all medicines to avoid potential drug interactions.

5. Cost

Financial considerations play a significant role in access to migraine treatment. Comparing the costs of Emgality and Nurtec provides helpful context.

Emgality

Emgality has a list price of $679.20 for one 120 mg prefilled pen or syringe. However, the actual amount a patient pays depends on their insurance plan. The cost for a 30-day supply can be influenced by factors such as insurance coverage and support programs.

Emgality offers various savings options, including a Savings Card for eligible commercially insured patients, potentially reducing the cost to $0 per 30-day supply with a maximum annual savings of $4,900.

Patient assistance programs like the Emgality Free Sharps Container Program and the Lilly Cares Foundation Patient Assistance Program may provide cost-free or discounted medicines to those who qualify based on specific criteria.

Nurtec ODT

Nurtec costs around $1,011.38 for a supply of 8 tablets (75 mg). Similar to Emgality, the actual out-of-pocket cost varies based on insurance coverage.

Nurtec offers a Savings Program where eligible commercially insured patients may pay $0 per 30-day prescription, and the offer is valid once per 30 days per patient until December 31, 2024.

The Nurtec ODT OneSource program provides temporary assistance for eligible commercially insured patients, allowing them to pay $0 for their medication while coverage is being determined.

Wrap Up

Migraines can substantially impact the quality of life, but new CGRP-targeted medications like Emgality and Nurtec ODT provide evidence-based options for preventing and treating attacks. A head-to-head clinical trial found that monthly injections of Emgality and the acute oral medication Nurtec had comparable efficacy in reducing monthly migraine days over 3 months. Though Emgality performed numerically better on some secondary measures, both demonstrated clinically meaningful benefits consistent with prior studies.

With similar effectiveness but different mechanisms of action and administration methods, patients have expanded choices for managing migraines.

In consultation with their healthcare provider, patients can determine whether preventive Emgality injections or acute and preventive Nurtec tablets align better with their preferences and needs. Considering out-of-pocket costs as well, individualized treatment plans can leverage these new CGRP-focused medications to reduce migraine burden. Continued research on their long-term safety and efficacy will further define the roles of Emgality and Nurtec in migraine care.

FAQs on Emgality and Nurtec

How long does it take for Nurtec to work?

Nurtec starts working within 60 minutes for most patients. Maximum plasma concentrations are reached in 1.5 hours to 2.5 hours.

How many doses of Nurtec can be taken per month?

Nurtec can be taken up to 18 doses per month, with a maximum of 1 dose per 48 hours.

Can Emgality and Nurtec be used together?

Using both Emgality for migraine prevention and Nurtec for acute migraine attacks could be an option for some patients, but discussion with a doctor is needed.

Who should not use Nurtec or Emgality?

Those with a serious hypersensitivity/allergic reaction to the medications or any ingredients should avoid them. People with cardiovascular disease may need dose monitoring.