STEPS

New Drug Reviews

Erenumab (Aimovig) for Migraine Prophylaxis in Adults

 

Am Fam Physician. 2019 Jun 15;99(12):781-782.

Erenumab-aooe (Aimovig) is a once-monthly injected monoclonal antibody labeled for migraine prophylaxis in adults. It is one of three biologic products that block the receptor of calcitonin gene–related peptide, a vasodilatory neurotransmitter that accumulates during active migraine.1,2

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DrugDosageDose formCost*

Erenumab (Aimovig)

70 mg once monthly; select patients may benefit from 140 mg once monthly

70-mg single-use prefilled autoinjector or prefilled syringe

$600 for 70-mg dose


*—Estimated retail price for one month of treatment based on information obtained at https://www.goodrx.com (accessed April 25, 2019).

DrugDosageDose formCost*

Erenumab (Aimovig)

70 mg once monthly; select patients may benefit from 140 mg once monthly

70-mg single-use prefilled autoinjector or prefilled syringe

$600 for 70-mg dose


*—Estimated retail price for one month of treatment based on information obtained at https://www.goodrx.com (accessed April 25, 2019).

Safety

Erenumab, which has been studied in 2,537 patients with migraine who received at least one dose, has no notable drug-drug interactions or any contraindications. There is no clinically significant increase in blood pressure when sumatriptan (Imitrex) is added for breakthrough migraine pain. Erenumab is available as a prefilled autoinjector that contains a latex derivative and may cause a reaction in patients with latex allergy.1 Erenumab should not be used in patients younger than 18 years because safety and effectiveness have not been established. No increase in birth defects or miscarriage has been observed, and there are no data on presence in breast milk or effect on milk production.1

Tolerability

Injection site reactions (pain, erythema, and pruritus) are the most common adverse effects, experienced by 5% to 6% of patients. Allowing erenumab to come to room temperature for 30 minutes before administration may decrease injection site reactions. Patients receiving 140-mg doses also reported experiencing constipation (3%). In a series of 2,199 patients taking erenumab for three to six months, 1.3% discontinued therapy because of adverse effects.35

Effectiveness

Erenumab has been evaluated for prophylaxis in patients with episodic or chronic migraine. In patients with episodic migraine (i.e., an average of eight migraine days per month), after four to six months of treatment, 43.3% of patients receiving 70 mg

Address correspondence to Alex M. Shreiber, PharmD, at alexmshreiber@gmail.com. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

References

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1. DailyMed. Aimovig–erenumab-aooe prescribing information. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b998ed05-94b0-47fd-b28f-cddd1e128fd8. Accessed February 3, 2019....

2. Silberstein SD. Preventive migraine treatment. Continuum (Minneap Minn). 2015;21(4 Headache):973–989.

3. Goadsby PJ, Reuter U, Hallström Y, et al. A controlled trial of erenumab for episodic migraine. N Engl J Med. 2017;377(22):2123–2132.

4. Tepper S, Ashina M, Reuter U, et al. Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Neurol. 2017;16(6):425–434.

5. Dodick DW, Ashina M, Brandes JL, et al. ARISE: a phase 3 randomized trial of erenumab for episodic migraine. Cephalalgia. 2018;38(6):1026–1037.

6. Center for Drug Evaluation and Research. Clinical review. BLA 761077. Aimovig (erenumab-aooe) injection. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/761077Orig1s000MedR.pdf. Accessed February 3, 2019.

7. Joszt L. Erenumab for migraine is cost-effective, but longterm harms remain unclear. In Focus Blog. AJMC. https://www.ajmc.com/focus-of-the-week/erenumab-for-migraine-is-costeffective-but-longterm-harms-remain-unclear. Accessed February 3, 2019.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, MMedEd, Assistant Medical Editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

 

 

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