Galcanezumab (Emgality) for Migraine and Cluster Headaches

Jennifer Ren-Si Cheung; Deborah R. Erlich

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Apr 15, 2020 Issue

STEPS

New Drug Reviews

Galcanezumab (Emgality) for Migraine and Cluster Headaches

JENNIFER REN-SI CHEUNG, MD, Tufts University School of Medicine and Cambridge Health Alliance, Boston, Massachusetts

DEBORAH R. ERLICH, MD, MMedEd, Tufts University School of Medicine and Beth Israel Lahey Health, Boston, Massachusetts

Am Fam Physician. 2020 Apr 15;101(8):502-503.

Galcanezumab (Emgality) is a once-monthly injected monoclonal antibody that inhibits calcitonin gene–related peptide, a vasodilator. Galcanezumab is labeled for the treatment of cluster headache and is one of three monoclonal antibodies labeled for migraine prophylaxis in adults.1

Safety

In otherwise healthy adults, galcanezumab has not been shown to cause significant safety concerns or drug interactions. Hypersensitivity reactions including dyspnea, urticaria, and rash may occur. Galcanezumab may be taken with other headache medications such as topiramate (Topamax), propranolol, nonsteroidal anti-inflammatory drugs, acetaminophen, triptans, and inhaled oxygen. Galcanezumab may cause vasoconstriction and has not been evaluated in patients with a history of thrombosis or cardiovascular disease, or in those with significant cardiovascular risk factors. Galcanezumab has not been studied in children, patients older than 65 years, or pregnant or lactating women and should not be used in these patients. No dose adjustments are needed for body weight, sex, age, or renal or hepatic impairment. Galcanezumab has not been studied in patients with severe renal dysfunction (creatinine clearance less than 30 mL per minute per 1.73 m² [0.50 mL per second per m²]) and should be avoided in these patients.1

Enlarge Print

Drug	Dosage	Dose form	Cost*
Galcanezumab (Emgality)	120 mg or 240 mg once monthly for migraine prophylaxis 300 mg monthly for treatment of cluster headache (until end of cluster period)	Prefilled pen or syringe	$560

*—Estimated lowest GoodRx price for one month's treatment. Actual cost will vary with insurance and by region. Information obtained at https://www.goodrx.com (accessed March 4, 2020; zip code: 66211).

Drug	Dosage	Dose form	Cost*
Galcanezumab (Emgality)	120 mg or 240 mg once monthly for migraine prophylaxis 300 mg monthly for treatment of cluster headache (until end of cluster period)	Prefilled pen or syringe	$560

Tolerability

Galcanezumab is well tolerated by most patients. Injection site reactions will occur in up to 23% of patients. Up to 4% will discontinue use due to adverse effects.

Effectiveness

In two studies that included a total of 1,773 patients with episodic migraines (average of nine migraine days per month), approximately 60% of patients receiving galcanezumab and no other

Address correspondence to Jennifer Ren-Si Cheung, MD, at jencheung@challiance.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. DailyMed. Drug label information: Emgality—galcanezumab injection, solution. Accessed December 14, 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=33a147be-233a-40e8-a55e-e40936e28db0...

2. Silberstein SD, Stauffer VL, Day KA, et al. Galcanezumab in episodic migraine: subgroup analyses of efficacy by high versus low frequency of migraine headaches in phase 3 studies (EVOLVE-1 & EVOLVE-2) [published correction appears in J Headache Pain. 2019;20(1):118]. J Headache Pain. 2019;20(1):75.

3. Stauffer VL, Dodick DW, Zhang Q, et al. Evaluation of galcanezumab for the prevention of episodic migraine: the EVOLVE-1 randomized clinical trial [published correction appears in JAMA Neurol. 2019;76(7):872]. JAMA Neurol. 2018;75(9):1080–1088.

4. Förderreuther S, Zhang Q, Stauffer VL, et al. Preventive effects of galcanezumab in adult patients with episodic or chronic migraine are persistent: data from the phase 3, randomized, double-blind, placebo-controlled EVOLVE-1, EVOLVE-2, and REGAIN studies. J Headache Pain. 2018;19(1):121.

5. Detke HC, Goadsby PJ, Wang S, et al. Galcanezumab in chronic migraine: the randomized, double-blind, placebo-controlled REGAIN study. Neurology. 2018;91(24):e2211–e2221.

6. Goadsby PJ, Dodick DW, Leone M, et al. Trial of galcanezumab in prevention of episodic cluster headache. N Engl J Med. 2019;381(2):132–141.

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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