What to do if Emgality, Aimovig, and Ajovy do not last a full month
Yesterday I saw a 48-year-old man who has been suffering from migraine headaches since his teens. He did not respond to a wide variety of drugs and non-drug therapies, but Emgality has been very effective. The only problem is that the effect lasts three and a half weeks. During the week before the next shot, his migraine headaches become severe and frequent. Sumatriptan helps but his disability as measured by the MIDAS scale is in the moderate range. He is a high-level executive in a large corporation and needs better control of his migraines. He had tried the other two monoclonal antibodies for migraines – Aimovig and Ajovy – and they were less effective.
Fortunately, there is a good solution to his problem. I advised him to take Emgality injections every three and a half weeks. This is a higher frequency than what is recommended by the FDA and some doctors and patients may have concerns about the safety. The one-month interval is based on averages derived from large studies. People, however, are not average. Some metabolize drugs faster or need a higher or a lower dose of a drug. Another reassuring fact about Emgality is that it is approved at a much higher dose for cluster headaches. For migraine, we give a 240 mg loading dose and then, 120 mg monthly. Patients with cluster headaches get monthly injections of 300 mg.
I have patients who have the same problem of the short duration of effect with Aimovig and Ajovy as well.
A major obstacle to the more frequent use of these drugs is the fact that insurance companies will only pay for 12 shots a year. These drugs cost about $600 to $700 a dose, so the cost is a major factor for many people. The way I get around it is by providing patients with free samples. Because we have three similar competing drugs, we get samples of all three. If you are having a similar problem, ask your doctor for a free sample. Some academic centers and large hospitals do not allow doctors to receive samples but most doctors in private practice can get them.
I have taken emgality shots for almost 2 years. I get them for free through the Lillys’ free program. It has worked very good. Then I take Naratriptan if I get one. They are not as painful when I do get one now.
I applaud your persistence in finding creative solutions for your patients. The headache specialist I see in North Carolina is similarly inclined, and his approach has made a huge positive impact on my well-being as a chronic migraine patient. Although I also saw good results from monthly injections of Emgality, I was still having 10+ headache days per month. So my doctor had me add a preventive dose of Nurtec (every other day) and now my headache days are down to about six a month. This is a huge improvement from the daily headaches I experienced for seven years. Patients are not robots, and we appreciate doctors who can think outside the box about our care.