Dr. Ahmed Ajovy vs Emgality (Fremanezumab Vs Galcanezumab): Which drug best prevents migraine recurrence?
Among the preventive migraine medicines, the novel drugs that target the CGRPR (calcitonin gene-related peptide receptors) are considered the most potent.
These drugs are being increasingly used, not only because they are very potent but also because they are very safe and convenient to use.
Drugs that target the CGRPR include:
- Ajovy (Fremanezumab)
- Emgality (Galcanezumab)
- Aimovig (Erenumab)
- Vyepti (Eptinezumab)
It is natural to be apprehensive when you are prescribed any of these novel medications. Hence, we compare here the similarities, differences, safety, and efficacy of Ajovy and Emgality to let you better understand these drugs.
How are Ajovy and Emgality Similar?
Both Ajovy and Emgality belong to the same class of medicines. These drugs inhibit the action of CGRPR and are used in the preventive treatment of episodic and chronic migraine headaches.
These drugs are available as prefilled injection formulations and are administered to the skin once a month. The most common side effect is an injection-site reaction that may manifest as redness, swelling, and pain.
Similarities | Ajovy Vs Emgality |
| What are Ajovy and Emgality? | These are human monoclonal antibodies |
| MOA | Both Ajovy and Emgality inhibit the binding of CGRP to its receptors, inhibiting vasodilation. |
| Uses | Both these drugs are used to reduce the recurrence and severity of migraine headaches. |
| Form | Both Ajovy and Emgality are available as a single prefilled injection. Ajovy is available as 225 mg injections, while Emgality is available as 120 mg injections. |
| Efficacy | Both these drugs are very effective in reducing the number of migraine episodes, migraine headaches, and migraine severity. |
| Administration | Both drugs are administered as a subcutaneous injection |
| Storage | Both injections should be stored in a refrigerator and kept at room temperature for at least 30 minutes before administration. |
| Common Side effect | Both Ajovy and Emgality are associated with injection site reactions and antibody formation with repeated administration. |
| Patients assistance program | Both manufacturers provide Copay assistance plans by which the prices can be lowered. An online discount card is available for both Ajovy and Emgality. |
How are Ajovy and Emgality Different?
Ajovy is Fremanezumab, a human monoclonal antibody marketed by Teva Pharmaceuticals, while Emgality is Galcanezumab. It is also a human monoclonal antibody marketed by Eli Lilly.
The minor differences in pharmacokinetics are tabulated below.
Ajovy | Emgality | |
| Generic | Fremanezumab | Galcanezumab |
| Manufacturer | Teva | Eli Lilly |
| Absorption | The time to reach the maximum plasma concentration after administration is 5 – 7 days. The steady-state concentration is achieved in about 168 days (6 months). | The time to reach the peak plasma concentration is 5 days. |
| Half-life elimination | 31 days | 27 days |
| Dosing | Ajovy can be either administered monthly or three-monthly. The monthly dose is 225 mg subcutaneously while the three-monthly dose is 675 mg subcutaneously | Emgality is administered in a loading dose of 240 mg as two consecutive injections of 120 mg each. This is followed by the monthly maintenance dose of 120 mg. |
| Price | One prefilled injection of 225 mg/1.5 ml costs USD 639 | One injection of Emgality costs around 604 USD. The prices vary at different places, but the starting price is around USD 600 |
Efficacy of Ajovy vs Emgality (Fremanezumab Vs Galcanezumab):
Both Ajovy (Fremanezumab) and Emgality (Galcanezumab) have been shown to be superior to placebo in reducing the severity of migraine headaches and frequency of migraine headaches.
Efficacy of Ajovy (Fremanezumab) in Clinical Trials [Ref]:
Ajovy (Fremanezumab) was studied in two clinical trials that comprised two different patient populations:
- Those with Episodic Migraine (defined as the number of migraine headaches of fewer than 15 days per month)
- Those with Chronic Migraine (defined as patients experiencing migraine headaches for 15 days or more per month)
Ajovy in Episodic Migraine Headache:
Ajovy was studied in patients with episodic migraine that lasted less than 15 days per month. Patients with cardiovascular diseases, thrombotic diseases such as pulmonary embolism, or cerebrovascular diseases were excluded from the study.
Those who fulfilled the inclusion criteria were divided into three different groups:
- Placebo
- Ajovy 225 mg per month
- Ajovy 675 mg three-monthly
The primary end-point was a reduction in the number of migraine days after three months. The secondary end-point was a 50% reduction in the number of migraine days after three months.
The results of the study are tabulated here:
Efficacy Endpoints | Placebo | Ajovy 225 mg monthly | Ajovy 675 mg three-monthly |
Primary end-point (Reduction in monthly migraine days) | |||
| Baseline Migraine Days | 9.1 | 8.9 | 9.2 |
| Reduction in migraine days from Baseline | -2.2 | -3.7 | -3.4 |
| Difference from Placebo | – | -1.5 | -1.2 |
| Significance (P-value) | – | Yes (<0.001) | Yes (<0.001) |
Secondary endpoint (Greater than 50% reduction in the number of migraine days) | |||
| % Responders (50% or greater) | 27.9% | 47.7% | 44.4% |
As seen in the table above, more patients in the Ajovy group had a reduction in the number of migraine days. Almost half of the patients had a 50% reduction in their number of migraine days when on Ajovy compared to placebo.
Ajovy in Chronic Migraine Headache:
In the treatment of chronic migraine, defined as the number of migraine days equal to or greater than 15 days per month, Ajovy resulted in significant improvement compared to the placebo
Patients without cardiovascular, thrombotic disorders such as DVT and pulmonary embolism, or cerebrovascular diseases (stroke) were enrolled in the study and followed after three months.
The end-points of the study were similar to the first study:
- The primary end-point was a reduction in the number of migraine days (of at least moderate severity) per month.
- The secondary end-point was a 50% reduction in the number of migraine days per month (of at least moderate severity.
The results of the study are summarized in the table below:
Efficacy Endpoints | Placebo | Ajovy 225 mg monthly | Ajovy 675 mg three-monthly |
Primary endpoint (Reduction in monthly migraine days) | |||
| Baseline Migraine Days | 20.3 | 20.3 | 20.4 |
| Reduction in the number of migraine days from the baseline | -2.5 | -4.6 | -4.3 |
| Difference from Placebo | -2.1 | -1.8 | |
| Significance (P-value) | <0.001 | <0.001 | |
Secondary endpoint (Greater than 50% reduction in the number of migraine days) | |||
| % Responders (50% reduction or more) | 18.1% | 40.8% | 37.6% |
A significant reduction in the number of migraine days and the percentage of patients with a 50% reduction in the number of migraine days was observed in the Ajovy group compared to the Placebo medicine.
Efficacy of Emgality (Galcanezumab) in Clinical Trials [Ref]:
Emgality (Galcanezumab) got FDA approval after it was found to be effective in episodic and chronic migraine prevention based on three large clinical trials.
Two studies evaluated the efficacy of Emgality (Galcanezumab) in Episodic migraine over 6 month follow-up period. One study evaluated the efficacy of Emgality (Galcanezumab) in the preventive treatment of chronic migraine.
- Those with Episodic Migraine (defined as the number of migraine headaches between 4 and 14 days per month)
- Those with Chronic Migraine (defined as patients experiencing migraine headaches for 15 days or more per month)
Emgality (Galcanezumab) in Episodic Migraine Headache:
Emgality (Galcanezumab) was studied in patients with episodic migraine. Patients with cardiovascular diseases, thrombotic diseases such as pulmonary embolism, or cerebrovascular diseases were excluded from the study.
Those who fulfilled the inclusion criteria were divided into three different groups:
- Placebo
- Emgality 120 mg per month
- Emgality 240 mg per month
Patients in the 120 mg group received an initial loading dose of 240 mg as two 120 mg injections followed by a monthly dose of 120 mg.
The primary end-point was a reduction in the number of migraine days after six months. The secondary end-point was a 50%, 75%, and 100% reduction in the number of migraine days after six months.
The quality of life was also assessed at the end of the trial.
The results of the first study are tabulated here:
| Efficacy Endpoints | Study 1 | Study 2 | ||
Emgality 120 mg | Placebo | Emgality 120 mg monthly | Placebo | |
Primary end-point (Reduction in monthly migraine days) | ||||
| Baseline Migraine Days | 9.2 | 9.1 | 9.1 | 9.2 |
| Reduction in migraine days from Baseline | -4.7 | -2.8 | –4.3 | –2.3 |
| Difference from Placebo | -1.9 | – | –2 | – |
Secondary endpoint (Greater than 50%, 75%, and 100% reduction in the number of migraine days) | ||||
| >/= 50% Responders over 1 to 6 months | 62% | 39% | 59% | 36% |
| >/= 75% Responders over 1 to 6 months | 39% | 19% | 34% | 18% |
| 100% Responders over 1 to 6 months | 16% | 6% | 12% | 6% |
As seen in the table above, more patients in the Emgality group had a significant reduction in the number of migraine days in patients with episodic migraine.
More than half of the patients had a greater than 50% reduction in their number of migraine days. 75% reduction was also seen in a significant number of patients (39%).
16% of the patients had a complete response, reaching a 100% reduction in the number of migraine days.
Emgality in Chronic Migraine Headache:
In the treatment of chronic migraine, defined as the number of migraine days equal to or greater than 15 days per month, Emgality resulted in significant improvement compared to the placebo
Patients without cardiovascular, thrombotic disorders such as DVT and pulmonary embolism, or cerebrovascular diseases (stroke) were enrolled in the study and followed after three months.
Patients in the study received Emgality in a dose of 120 mg, 240 mg, and a placebo each month. Outcomes were evaluated after three months.
The end-points of the study were similar to the first study:
- The primary end-point was a reduction in the number of migraine days.
- The secondary end-point was a 50%, 75%, and a 100% reduction in the number of migraine days per month.
The results of the study are summarized in the table below:
Efficacy Endpoints | Emgality 120 mg | Placebo |
Primary end-point (Reduction in monthly migraine days) | ||
| Baseline Migraine Days | 19.4 | 19.6 |
| Reduction in the number of migraine days from the baseline | –4.8 | –2.7 |
| Difference from Placebo | -2.1 | |
Secondary endpoint (Greater than 50%, 75%, and 100% reduction in the number of migraine days) | ||
| % Responders (50% reduction or more) | 28% | 15% |
A significant reduction in the number of migraine days and the percentage of patients with a 50% reduction in the number of migraine days was observed in the Emgality group compared to Placebo medicine in patients with chronic migraine.
28% of the patients with chronic migraine had at least a 50% reduction in their number of migraine days. There was no significant difference between the 120 mg and 240 mg groups.
Ajovy Vs Emgality: Which is more effective?
Ajovy and Emgality both belong to the same class of medicines and inhibit intracerebral vasodilation by inhibiting the CGRPR.
The two drugs have not been directly compared. The results of the two drugs are summarized below for comparison. However, these results may not be indicative of the actual differences in the efficacies of the two drugs.
Efficacy | Ajovy | Vs | Emgality | |
| Reduction in the number of migraine days | Episodic Migraine | -3.5 | Vs | -4.5 |
| Chronic Migraine | -4.5 | Vs | -4.8 | |
| 50% or greater reduction in the number of migraine days | Episodic Migraine | 46% | Vs | 60.5% |
| Chronic Migraine | 39% | Vs | 28% | |
Emgality (Galcanezumab) is probably more effective since it reduces the number of migraine days by 4.5 days compared to 3.5 days in patients with episodic migraine.
Similarly, in patients with chronic migraine, it reduces the number of migraine days by 4.8 days vs 4.5 days in the Ajovy group.
A 50% or greater reduction in the number of migraine days was achieved in 60.5% and 28% of the patients in the Emglaity group with episodic and chronic migraine, respectively.
On the other hand, only 46% and 39% of the patients had a 50% or more reduction in the number of their migraine days, respectively.
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