Ajovy vs. Emgality

See how Ajovy and Emgality compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both Ajovy and Emgality are injectable CGRP antibodies for migraine prevention, but Ajovy can be dosed once every 3 months while Emgality is only dosed monthly.

  • Emgality is also approved to prevent episodic cluster headache, a use Ajovy does not have, while Ajovy is approved for adolescents with episodic migraine and Emgality is not.

  • Injection site reactions are reported more often with Ajovy (up to 45%) than with Emgality (up to 18%), though both carry similar warnings about hypersensitivity and Raynaud's phenomenon.

Ajovy vs. Emgality Drug Summary

Ajovy

Ajovy (fremanezumab-vfrm) is a CGRP monoclonal antibody used to prevent migraine in adults and in adolescents ages 6 to 17 who weigh at least 45 kg. It is delivered through a prefilled syringe or autoinjector, given either once a month or once every 3 months.

Emgality

Emgality (galcanezumab-gnlm) is a CGRP monoclonal antibody used to prevent migraine in adults and to treat episodic cluster headache. It is given as a once-monthly subcutaneous injection, starting with a loading dose on day one.

Ajovy vs. Emgality Side Effects

Ajovy

Most common
Injection site reactions (38% to 45%)

Emgality

Most common
Injection site reactions (up to 18%)

Ajovy vs. Emgality Dosage

Ajovy

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 225 mg once monthly At the start
Maximum dose 675 mg every 3 months If needed
Dose changes 1 increase As tolerated

Emgality

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 240 mg loading dose Day 1
Maximum dose 300 mg once monthly If needed
Dose changes 2 increases As tolerated

Ajovy vs. Emgality Indications

Ajovy

Ajovy is FDA-approved to prevent migraine attacks in adults and in adolescents ages 6 to 17 who weigh at least 45 kg. It is not approved to treat a migraine attack that has already started or for children under 6 or under 45 kg.

  • Prevents chronic and episodic migraine in adults

  • Approved for adolescents 6 to 17 (45 kg or more) with episodic migraine

  • Not approved for treating an active migraine attack

  • Not approved for children under 6 or under 45 kg

Emgality

Emgality is FDA-approved to prevent migraine in adults and to reduce the frequency of episodic cluster headache attacks in adults. It is not approved for use in anyone under 18 or for treating a migraine attack once it starts.

  • Prevents chronic and episodic migraine in adults

  • Also approved to reduce episodic cluster headache attacks

  • Not approved for use in anyone under 18

  • Not approved for treating an active migraine attack

Ajovy vs. Emgality Pros and Cons

Ajovy

Ajovy stands out among CGRP antibodies for its quarterly dosing option, letting patients get as few as 4 injections a year instead of 12. It is also the only one of the two approved for adolescents with episodic migraine, though it is not approved for cluster headache prevention.

Pros

  • Offers a once-every-3-months dosing option, needing as few as 4 injections a year

  • Approved for adolescents 6 to 17 with episodic migraine, an age group Emgality does not cover

  • Long-standing safety record since its 2018 FDA approval

Cons

  • Injection site reactions are reported more often than with Emgality (up to 45% vs up to 18%)

  • Not approved for cluster headache prevention, unlike Emgality

  • No loading dose option, so full effect may build more gradually than with Emgality's day-one dose

Emgality

Emgality is the only CGRP antibody also approved to prevent episodic cluster headache attacks, a use Ajovy lacks. It requires monthly injections with no quarterly option, though its injection site reactions occur less often than Ajovy's.

Pros

  • Only CGRP antibody also shown to reduce frequency of episodic cluster headache attacks

  • Injection site reactions occur less often than with Ajovy (up to 18% vs up to 45%)

  • Starts with a loading dose on day one, which may build effect faster in the first month

Cons

  • No quarterly dosing option; needs a monthly injection indefinitely

  • Not approved for use in anyone under 18, unlike Ajovy

  • Starting the loading dose requires two separate injections on day one

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