The new migraine drug called Aimovig (Erenumab) is about to be released and is being hailed as big news for migraine sufferers. Aimovig is the first of its kind, in that it’s not meant to only mask the symptoms of migraine, but to actually prevent them. It is one of a few drugs in this class that have been developed and will soon become available in the United States.
Aimovig is in a new class of drugs which blocks a calcitonin gene-related peptides (CGRP). In the 1980’s, researchers discovered people having migraine attacks have high levels of CGRP in their blood. They further found when chronic migraine sufferers were injected with this peptide, it triggered a migraine, but did nothing when injected into someone who doesn’t get migraines. It was this discovery that prompted the development of this class of drugs (NPR).
Here is how the drug performed in trials:
A total of 955 patients underwent randomization: 317 were assigned to the 70-mg erenumab group, 319 to the 140-mg erenumab group, and 319 to the placebo group. The mean number of migraine days per month at baseline was 8.3 in the overall population; by months 4 through 6, the number of days was reduced by 3.2 in the 70-mg erenumab group and by 3.7 in the 140-mg erenumab group, as compared with 1.8 days in the placebo group (P<0.001 for each dose vs. placebo). A 50% or greater reduction in the mean number of migraine days per month was achieved for 43.3% of patients in the 70-mg erenumab group and 50.0% of patients in the 140-mg erenumab group, as compared with 26.6% in the placebo group (P<0.001 for each dose vs. placebo), and the number of days of use of acute migraine–specific medication was reduced by 1.1 days in the 70-mg erenumab group and by 1.6 days in the 140-mg erenumab group, as compared with 0.2 days in the placebo group (P<0.001 for each dose vs. placebo). Physical-impairment scores improved by 4.2 and 4.8 points in the 70-mg and 140-mg erenumab groups, respectively, as compared with 2.4 points in the placebo group (P<0.001 for each dose vs. placebo), and everyday-activities scores improved by 5.5 and 5.9 points in the 70-mg and 140-mg erenumab groups, respectively, as compared with 3.3 points in the placebo group (P<0.001 for each dose vs. placebo). The rates of adverse events were similar between erenumab and placebo (A Controlled Trial of Erenumab for Episodic Migraine).
While a 50% reduction in the mean number for episodic migraine and 40% reduction in the mean number for chronic migraine is impressive, it would appear that most patients would still require other medications alongside Aimovig to treat the symptoms of migraine. Additionally, while the short-term side effects being reported were mostly mild, with Aimovig being such a new drug, the long term effects are as yet unknown, so I would exercise caution when deciding whether or not to take this drug. Given what we’ve learned about so many drugs after their first 10 to 25 years on the market, I am personally wary of taking brand new drugs. Talk to your doctor about how safe they feel it is for you.
Another concern is cost and insurance coverage. I don’t know which insurance companies plan to cover Aimovig, but I would definitely check with my insurer before talking to your neurologist about switching to it, as Aimovig costs $575 a month ($6,900 a year) as it’s a monoclonal antibody, which is produced in a living cell rather than a laboratory and is not likely to go down in price (WMUR). However, the maker of Aimovig does have a cost savings program in place to help some patients (Aimovig).
Of course if you’re one of many migraine sufferers who has gone years without sufficient relief, these concerns may be fairly low on your list and it seems that so far the report of side effects have been mild. I myself lived for years where I spent long periods of time locked in my bedroom with the shades drawn because I couldn’t tolerate light, sound or even touch because my migraines were so severe. At that time, I would have auctioned off one of my kidneys for some relief. Hopefully this drug will see far fewer people suffer to such a degree and is only the beginning to providing real breakthroughs in migraine prevention. Still, one must consider the big picture when trying a new drug.