Ajovy vs Emgality: How do they compare?

Key Points

• Ajovy (fremanezumab-vfrm) and Emgality (galcanezumab-gnlm) are both injectable medications that may be used to prevent migraine headaches. Emgality is also used to treat episodic cluster headache.
• Both medications belong to the calcitonin-gene related peptide antagonist drug class and work similarly.
• The most common side effects from Ajovy and Emgality are injection site reactions. Serious allergic reactions are more rare, but possible.
• While there are no head-to-head clinical trials of Ajovy and Emgality, both medications reduced the number of migraine days per month by about 4 in separate clinical studies.

What are Ajovy and Emgality used for?

Ajovy (fremanezumab-vfrm) and Emgality (galcanezumab-gnlm) can both be used to prevent migraine headaches in adults. Emaglity may also be used to treat episodic cluster headaches in adults. Both medications were FDA approved in September 2018.

How do Ajovy and Emgality work?

Ajovy and Emgality belong to the drug class called calcitonin-gene related peptide (CGRP) antagonists, also known as CGRP inhibitors. They attach to a protein found in the brain and nervous system called CGRP and prevent it from interacting with its receptor. CGRP is thought to play a role in migraine and cluster headache by causing inflammation and vasodilation (widening of blood vessels).

How are Ajovy and Emgality given?

Both Ajovy and Emgality are injected under the skin. They can both be self-administered at home. Both medications are available in prefilled pens (autoinjectors) and prefilled syringes.

The recommended dose of Ajovy for prevention of migraine is 225 mg injected under the skin every month, or 675 mg injected every 3 months. The latter requires three injections of 225 mg given in a row at three different injection sites. Ajovy can be injected into the stomach (except for 2 inches around the belly button), front of the thighs, or back of the upper arms.

The recommended dose of Emgality for prevention of migraine is 240 mg injected under the skin as a loading dose, and then 120 mg injected once a month thereafter. For treatment of episodic cluster headache, the usual dose is 300 mg injected at the onset of the cluster period followed by 300 mg injected once a month until the end of the cluster period. Emgality can be injected into the stomach (except for 2 inches around the belly button), front of the thighs, back of the upper arms, or buttocks.

How does the effectiveness of Ajovy and Emgality compare?

Ajovy and Emgality were studied in separate clinical trials. In one study, the effectiveness of Ajovy for the prevention of migraine was determined by the monthly average number of migraine days during a 3-month period. People who took Ajovy had about 3-4 less migraine days per month compared to about 2 less in people taking a placebo.

In a study of Emgality for the prevention of migraine, people who took the medication over a 6-month period experienced 4 less migraine headache days per month compared to 2 less days per month in people taking a placebo.

For the treatment of episodic cluster headache, researchers looked at the change in weekly cluster headache attack frequency over 3 weeks. People taking Emgality had about 9 fewer attacks per week compared to 5 fewer attacks in people taking a placebo.

What are the side effects of Ajovy and Emgality?

The side effects of Ajovy and Emgality that were reported during clinical trials are similar. Around 18% of people taking Emgality to prevent migraine experienced injection site reactions, such as pain, redness, and itching. This was compared to 13% of people injecting a placebo (no active medication). In clinical trials of Ajovy, 43-45% of people reported injection site reactions compared to 38% of people injecting a placebo.

Serious allergic reactions are possible from taking Ajovy or Emgality. Some reactions can occur up to 1 month after taking a dose. Get medical help right away if you experience swelling in your face or throat, trouble breathing, or rash.

Can you take Ajovy and Emgality together?

There is limited information on the use of two CGRP inhibitors at the same time. There is a theoretical risk of side effects from taking more than one CGRP inhibitor at the same time, such as high blood pressure and constipation. Your healthcare provider can help you find the best treatment options for your headaches that minimizes your risk of side effects.

Can you switch from Emgality to Ajovy OR Ajovy to Emgality?

Yes, you can switch from Emgality to Ajovy or vice versa. It is possible that if one medication is not working well for you, the other may work better. Talk to your healthcare provider about the safest way to switch between these two medications.

Below is a table comparing Ajovy and Emgality using data from separate clinical trials.

This is not all the information you need to know about Ajovy (fremanezumab-vfrm) or Emgality (galcanezumab-gnlm) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.