There is now another potent weapon in the arsenal of pharmacologic therapies for migraine prevention.
Late last week representatives of the new drug’s parent company, Teva, announced that the FDA had given final approval for fremanezumab, the tongue-twisting generic name for what will be marketed as Ajovy™, to be used for migraine prevention.
Depending upon the dose chosen, Ajovy may be administered subcutaneously (under the skin) with an “autoinjector” (similar to an Epi-pen) once per month or once every 3 months. Teva anticipates that Ajovy will become available for general clinical use within 2 weeks.
Like erenumab (Aimovig™), approved in May, Ajovy is a CGRP (calcitonin gene related peptide) antagonist. CGRP is a naturally occurring protein which acts as a "messenger" in the migraine circuitry that generates and conducts the head pain signal which drives a migraine attack. Both of the approved CGRP antagonists exert their therapeutic effect by "short-circuiting” the CGRP portion of migraine circuitry. Aimovig does so by blocking the head pain receptor which CGRP seeks to activate, while Ajovy directly inactivates the protein.
Which is better, Aimovig or Ajovy? "Impossible to know at this point," responds Dr. John F Rothrock, vice chair of neurology at George Washington University and a subspecialist in the areas of headache and stroke. "From the clinical trials that gained them their approval, both clearly are effective in a substantial portion of those patients with migraine whose headache burden justifies prevention therapy. Each appears to be extremely well-tolerated, but for neither do we have safety data that are truly long-term. It appears they will be priced about the same.” Lacking any direct comparison of the two therapies, Rothrock concluded, there is not yet any compelling reason to choose one drug over the other.
Given that both therapies work on the same target (CGRP), is a logical to assume that if the patient fails one of the therapies then he or she will fail the other? Again, no clear answer. "Both drugs work by blocking CGRP," explains Dr. Amanda Tinsley, director of the George Washington University Headache Center, “but they differ in the way they achieve that blockage. Will that translate into a difference in treatment response patterns? It’s way too early to know."
Despite the unanswered questions, migraineurs can take heart from the knowledge that the arsenal of migraine therapies is growing…and should continue to grow over the year to come. For more information regarding the CGRP antagonists, check out these articles on our site: Mabs and Pants and The CGRP Antagonists: Revolutionary Breakthrough or 'Here We Go Again'?