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Clinician’s Corner: CGRP prevention

CGRP (calcitonin-gene-related peptide) when released causes intense inflammation in the coverings of the brain (the meninges), and for most migraine patients, causes the pain of a migraine attack.  This peptide dilates blood vessels which causes several pain processes, most notably migraine headache.

Mechanism:  drug therapy is directed against calcitonin gene related peptide (CGRP) or its receptor to prevent migraine and cluster headache.

MONOCLONAL ANTIBODIES—-Prevention

Aimovig (erenumab-aooe)     70mg ——

Injections are given once a month

Side effects: injection site reaction and constipation. Constipation may be significant, best to avoid in patients already suffering from constipation, or taking constipation inducing meds (TCA’s, opioids)

Storage: Store under refrigeration. Allow to come to room temperature for 30 minutes before administration

Ajovy (fremanezumab-vfrm) —-cost $600.00 per month.  Approved Sept-2018

Recommended dosage for migraine prevention is one dose once a month or 3 injections given at one time every 3 months. : Two subcutaneous dosing options of AJOVY are available to administer the recommended dosage:

Storage: Remove AJOVY from the refrigerator. Prior to use, allow AJOVY to sit at room temperature for 30 minutes protected from direct sunlight.

Emgality (galcanezumab)

Emgality has two uses:

  • Preventive treatment of migraine
  • Treatment of episodic cluster headache

Aimovig, Ajovy, Emgality:

  • All three were approved between May and September 2018
  • All three cost the same $725.00 per injection. All have copay coupons for commercial insurance.
  • All three can be injected in the abdomen, upper thigh, or upper arm. All list injection site reactions as side effects
  • Aimovig contains latex, the others are latex-free.
  • Only Emgality, thus far is approved for cluster headache treatment. It also is available as an auto-injector (like the Trulicity device)

Vyepti (eptinezumab-jjmr) approved February 2020

Dosing: Vyepti is administered by IV infusion in a health care setting, every 3 months.

Your Thompson Pharmacist says:

As you can imagine these $700 migraine treatments require prior authorization from your physician.  Your physician most often can call the insurance company and get approval, usually based on patient history.

Be sure to keep a good migraine headache diary.  Keep track of your headache triggers and log in when you get a headache and what you treated it with.  Remember to take your migraine prevention medications as prescribed by your physician.  More than eight migraine headaches per month indicates that a drug for prevention is needed.  Go Ahead and Ask… at Thompson Pharmacy… it’s All for YOU!!