Erenumab

Erenumab
A standard 70mg/mL Aimovig autoinjector
A standard 70mg/mL Aimovig autoinjector
Monoclonal antibody
TypeWhole antibody
SourceHuman
TargetCGRPR
Names
Trade namesAimovig
Other namesAMG-334, erenumab-aooe
Clinical data
Drug classCGRPR blocker[1]
Main usesPrevent migraines[2]
Side effectsConstipation, muscle spasms[1]
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Pregnancy
category
  • AU: B1[3]
  • US: N (Not classified yet)[3]
    Routes of
    use    		Subcutaneous injection
    External links
    AHFS/Drugs.comMonograph
    MedlinePlusa618029
    Legal
    License data
    Legal status
    • US: ℞-only
    • EU: Rx-only
    • In general: ℞ (Prescription only)
    Pharmacokinetics
    Bioavailability82% (estimated)
    MetabolismProteolysis
    Elimination half-life28 days
    Chemical and physical data
    FormulaC6472H9964N1728O2018S50
    Molar mass145871.98 g·mol−1

    Erenumab, sold under the brand name Aimovig, is a medication used to prevent migraine headaches.[2] It is used in those who have at least 4 headaches a month.[4] It is given by injection under the skin.[2]

    Common side effects include constipation and muscle spasms.[1] Other side effects may include swelling due to fluid retention.[1] While there is no evidence of harm with use in prenancy, such use has not been well studied.[5] It is a monoclonal antibody that binds to and blocks calcitonin gene-related peptide receptor (CGRPR).[1]

    Erenumab was approved for medical use in the United States and Europe in 2018.[2][4] In the United Kingdom it costs about £390 every 4 weeks as of 2021.[1] This amount in the United States is about 630 USD.[6]

    Medical uses

    Erenumab is indicated for the prevention of migraine in adults.[7]

    Dosage

    It is given at a dose of 70 mg every four weeks.[1] This may be increased to 140 mg every 4 weeks.[1]

    It is administered by subcutaneous injection.[8]

    Side effects

    Common side effects are constipation, pruritus, muscle spasms, as well as mild and mostly transient reactions at the injection site.[9]

    Interactions

    Erenumab was shown not to interact with ethinyl estradiol, norgestimate or the migraine drug sumatriptan. It is expected to generally have a low potential for interactions because it is not metabolized by cytochrome P450 enzymes.[9]

    Pharmacology

    Mechanism of action

    Erenumab is a fully human monoclonal antibody blocking the calcitonin gene-related peptide receptor (CGRPR).[8][10][11]

    Pharmacokinetics

    After subcutaneous injection, the erenumab has an estimated bioavailability of 82%. Highest blood plasma concentrations are reached after four to six days. Like other proteins, the substance is degraded by proteolysis to small peptides and amino acids. It has an elimination half-life of 28 days.[9]

    History

    Development

    Erenumab was developed by Amgen Inc in conjunction with Novartis.[12]

    In the phase III STRIVE clinical trial 955 patients were divided into three groups in a 1:1:1 ratio. Each group was injected subcutaneously monthly with 0, 70 or 140 mg erenumab over a period of 6 months. The results were measured as mean monthly migraine days in months 4, 5, and 6. At baseline the patients experienced between 4 and 14 migraine days per month with an average of 8.3. The medication significantly reduced the number of migraine days per month by 3.2 in the 70-mg group and 3.7 in the 140-mg group, versus 1.8 in the placebo (0-mg) group.[12][13]

    Approval

    The United States Food and Drug Administration (FDA) approved the medication for the preventive treatment of migraine in adults on May 17, 2018. It was the first of four CGRPR antagonists to be approved that year.[7][14] The list price was reported to be US$6,900 per year.[15] It was approved for medical use in the European Union on July 26, 2018.[16][17]

    In the United Kingdom, Erenumab was approved by the Scottish Medicines Consortium, but the National Institute of Health and Care Excellence rejected the drug on the basis that its cost-effectiveness was not sufficiently proven.[18][19]

    See also

    References

    1. 1 2 3 4 5 6 7 8 BNF 81: March-September 2021. BMJ Group and the Pharmaceutical Press. 2021. p. 498. ISBN 978-0857114105.
    2. 1 2 3 4 "Erenumab-aooe Monograph for Professionals". Drugs.com. Archived from the original on 3 March 2021. Retrieved 15 December 2021.
    3. 1 2 "Erenumab (Aimovig) Use During Pregnancy". Drugs.com. 17 April 2019. Archived from the original on 29 November 2020. Retrieved 5 May 2020.
    4. 1 2 "Aimovig". Archived from the original on 17 October 2020. Retrieved 15 December 2021.
    5. ↑ "Erenumab (Aimovig) Use During Pregnancy". Drugs.com. Archived from the original on 29 November 2020. Retrieved 15 December 2021.
    6. ↑ "Aimovig Prices, Coupons & Savings Tips - GoodRx". GoodRx. Archived from the original on 11 January 2022. Retrieved 15 December 2021.
    7. 1 2 "FDA Approves First-in-Class Drug Erenumab (Aimovig) for Migraine Prevention". Medscape. 17 May 2018. Archived from the original on 25 September 2019. Retrieved 16 April 2021.
    8. 1 2 "Aimovig (erenumab-aooe) FDA Approval History". Drugs.com. Archived from the original on 10 July 2018. Retrieved 16 April 2021.
    9. 1 2 3 "Aimovig: EPAR - Product Information" (PDF). European Medicines Agency. 8 August 2018. Archived (PDF) from the original on 6 October 2018. Retrieved 16 April 2021.
    10. ↑ "Amgen Presents First-Of-Its-Kind Data At AAN Annual Meeting Reinforcing Robust And Consistent Efficacy Of Aimovig (erenumab) For Migraine Patients With Multiple Treatment Failures". Drugs.com. 17 April 2018. Archived from the original on 19 September 2020. Retrieved 16 April 2021.
    11. ↑ Edvinsson L (December 2018). "CGRP Antibodies as Prophylaxis in Migraine". Cell. 175 (7): 1719. doi:10.1016/j.cell.2018.11.049. PMID 30550780.
    12. 1 2 Goadsby PJ, Reuter U, Hallström Y, Broessner G, Bonner JH, Zhang F, et al. (November 2017). "A Controlled Trial of Erenumab for Episodic Migraine". The New England Journal of Medicine. 377 (22): 2123–2132. doi:10.1056/NEJMoa1705848. PMID 29171821.
    13. ↑ Erenumab to prevent migraine: results from phase III STRIBE" Archived 13 August 2018 at the Wayback Machine, Pharma World, December 14, 2017.
    14. ↑ "13 Things You Need to Know About Aimovig". Migraine Again. 1 February 2021. Archived from the original on 3 June 2021. Retrieved 17 March 2021.
    15. ↑ Kolata G (17 May 2018). "F.D.A. Approves First Drug Designed to Prevent Migraines". The New York Times. ISSN 0362-4331. Archived from the original on 11 May 2020. Retrieved 26 September 2019.
    16. ↑ "Aimovig EPAR". European Medicines Agency (EMA). Archived from the original on 17 October 2020. Retrieved 4 May 2020.
    17. ↑ "First drug to prevent chronic migraines approved by EU". The Guardian. 31 July 2018. Archived from the original on 19 September 2018. Retrieved 19 September 2018.
    18. ↑ Gallagher J (26 September 2019). "'Life-changing' migraine drug rejected for NHS". BBC News Online. Archived from the original on 31 July 2021. Retrieved 26 September 2019.
    19. ↑ "New migraine drug not cost-effective NICE says in draft guidance". NICE. Archived from the original on 1 November 2020. Retrieved 26 September 2019.
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