Erenumab (Aimovig) is a humanized monoclonal antibody that targets the calcitonin-gene related peptide receptor (CGRPR) by blocking it. It is the first of the CGRPR that has been approved by the FDA for the prevention of migraine. Galcanezumab (Emgality) is another monoclonal antibody that blocks the same pathway.

Erenumab (Aimovig) Uses:

• Migraine prophylaxis:

  • It is indicated for the prevention of migraine.

Erenumab (Aimovig) dose in Adults

Erenumab (Aimovig) dose in the treatment of Migraine prophylaxis:

• 70 mg subQ once a month initially
• A dose of 140 mg once monthly may be required in some patients.

• Missed dose:

  • If a dose is missed, deliver it right away, then plan the subsequent monthly dose starting from the day of the last injection.

Erenumab use in children:

The drug's effectiveness and safety in children have not been shown.

Erenumab Pregnancy Risk Category: B1

• Studies on animal reproduction have not revealed negative foetal effects.

Use of Erenumab while breastfeeding

• It is unknown if the drug will be excreted into breastmilk.
• Manufacturers recommend weighing the risks to the infant from drug exposure and the benefits for the mother.

Erenumab (Aimovig) Dose in Kidney disease:

• Renal  impairment is not expected to alter the pharmacokinetics of the study.
• The manufacturer has not recommended any adjustments in the dose (It has not been studied in patients with kidney disease).

Erenumab (Aimovig) Dose in Liver disease:

• Liver impairment is not expected to alter the pharmacokinetics of the study.
• The manufacturer has not recommended any adjustments in the dose (It has not been studied in liver disease).

Side Effects of Erenumab (Aimovig):

• Gastrointestinal:

  • Constipation

• Immunologic:

  • Antibody development

• Local:

  • Injection site reaction
  • Pain at the injection site
  • Redness at the injection site

• Neuromuscular & skeletal:

  • Muscle cramps
  • Muscle spasm

• Dermatologic:

  • Injection site pruritus

Contraindications to Erenumab (Aimovig):

Severe allergic reactions to any component of the drug or the drug itself.

Warnings and precautions

• Hypersensitivity

  • It can cause allergic reactions such as a rash or urticaria.
  • Most allergic reactions are mild-to-moderate and resolve within hours. However, it is possible for delayed reactions (> 1 week) to occur.
  • If a hypersensitivity reaction is observed, treatment must be stopped and the appropriate treatment instituted.

Erenumab: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

Monitor the response to treatment (the number of monthly migraine episodes).

How to administer Erenumab (Aimovig)?

• Only a subcutaneous route is used to administer it. 
• After proper training, self-administration is possible.
• The injection should remain at room temperature for 30 min before it is administered. 
• It should not be heated in a microwave or any other heat source (such hot water).
• You should not shake the injection. The injection should be given into the anterior abdomen, 3 to 5 cms from the navel, thighs, upper arms or buttocks.
• Avoid administration to infected areas.
• You should inject the entire contents of your injection at once with a single-use, prefilled syringe/autoinjector.

Mechanism of action of Erenumab (Aimovig):

Erenumab, a monoclonal human antibody, blocks the binding to calcitonin gene related peptides (CGRP) by its receptors.

Metabolism:

• Metabolism of the drug occurs via non-staurable proteolytic degradation.

Bioavailability:

• 82%

Half-life elimination:

• 28 days

Time to peak:

• About 6 days

International Brands of Erenumab:

• Aimovig
• Aimovig 140 Dose

Erenumab Brand Names in Pakistan:

No Brands Available in Pakistan.