Ajovy (fremanezumab-vfrm) and Aimovig (erenumab-aooe) are both medications used to help prevent migraine headache attacks in adults 18 years of age and older. However, the doses, injection schedules, side effects, effectiveness and costs of these medicines can vary.

Migraine headache pain is an intense throbbing pain in one area of the head. Additional symptoms include nausea and/or vomiting and sensitivity to light and sound.

What are Ajovy and Aimovig?

Both Ajovy and Aimovig are medicines used to help prevent a migraine attack and are classified as monoclonal antibodies. They are both in the drug class known as calcitonin gene-related peptide (CGRP) inhibitors. They work by binding to the calcitonin gene-related peptide (CGRP) ligand or receptor to help block the CGRP protein that can lead to migraine headache pain.

Are Ajovy and Aimovig both injections?

Yes, both Ajovy and Aimovig are given as an injection under your skin. They come as an autoinjector or as a single-dose pre-filled syringe. However, the strength and amount of medication in these dosage forms are different for each drug.

• The Ajovy single-dose autoinjector or prefilled syringe contains 225 mg per 1.5 mL solution.
• The Aimovig autoinjector or single-dose prefilled syringe contains 70 mg or 140 mg per 1 mL solution.

An autoinjector is a medical device that usually contains one prefilled dose of medicine in a spring-loaded syringe. You can learn to give yourself the medicine from this device. Many patients prefer autoinjectors over single use syringes as they are easier to use and may cause less hesitation.

Which is better: Ajovy or Aimovig?

Both of these migraine prevention treatments are effective as demonstrated in randomized, placebo-controlled studies. In general, these agents can reduce the number of migraine headache days you experience by about 1.5 to 3 days per month, but your response may vary.

The choice of your medication may depend upon other factors such as your preferred dosing schedule, response to previous treatments, and insurance coverage and cost.

Ajovy

The manufacturer of Ajovy, Teva Pharmaceuticals, conducted Phase III, randomized, placebo-controlled studies to evaluate the safety and effectiveness of Ajovy for the prevention of episodic or chronic migraine.

The study evaluated the use of both quarterly and monthly dosing regimens of subcutaneous Ajovy, compared with placebo, and evaluated responses over a 12-week period.

• Ajovy was found to reduce the number of chronic migraines days per month. Chronic migraine was defined as ≥15 headache days a month. It reduced chronic headaches by an average of 5 days per month, compared to 3.2 days for the placebo (inactive treatment) group.
• Ajovy also reduced the number of days per month that patients experienced an episodic migraine, defined as <15 headache days per month. It reduced episodic headaches by an average of 3.5 days per month, compared to 2.2 days for the placebo (inactive treatment) group.
• Additionally, over one-third of patients with chronic migraine and almost half of patients with episodic migraine had their monthly migraine days reduced by at least half.

Aimovig

Aimovig was also studied in Phase III, randomized and placebo controlled studies for episodic and chronic migraine prevention. Aimovig is manufactured by Amgen.

• In a 12-week, chronic migraine study, those taking Aimovig had on average 6 to 7 fewer monthly migraine days, compared to 4 days for the placebo (inactive treatment) group. Chronic migraine was defined as 15 or more headache days per month, of which at least 8 were migraine days.
• Overall, about 40% of people with chronic migraine taking Aimovig cut their monthly migraine days by 50% or more (vs. 24% for placebo) in this 12 week period.
• In a 6-month study of patients with episodic migraine, Aimovig-treated patients experienced, on average, 3 to 4 fewer monthly migraine days compared to about 2 fewer days for placebo. Episodic migraine was defined as 4 to 14 migraine days per month.
• Overall, up to 50% of patients with an episodic migraine taking Aimovig reduced their monthly migraine days by 50% or more (vs. 27% for placebo in this 6-month period.

How do the doses of Aimovig and Ajovy compare?

There are differences in the doses and strengths of Aimovig and Ajovy, as well as how often you can use them. Aimovig is injected once a month, while Ajovy can be given once a month or once every 3 months (quarterly). Both drugs are available as a prefilled autoinjector or as a prefilled syringe.

Your doctor can determine the best medicine and dose to help prevent your migraine headache. Your doctor, nurse or pharmacist will show you how to inject the medicine.

Both drugs are given subcutaneously (under the skin) by injection so you give this medicine at home. For either drug, you will give the injection in the abdomen (stomach area), thigh, or upper arm.

• Ajovy is given as 225 mg monthly or as 675 mg every 3 months (quarterly). The 675 mg quarterly dose is given as three consecutive injections of 225 mg each (this means you will need to give 3 injections at one time every 3 months). If your prescribed dose is Ajovy 675 mg every 3 months, you must use 3 separate autoinjectors or 3 separate syringes.
• Aimovig is given as a 70 mg injection once a month, but some patients may benefit from a higher 140 mg dose once a month (administered as two consecutive injections of 70 mg each). It cannot be dosed quarterly like Ajovy.

See also:

• Aimovig dosage information (in more detail)
• Ajovy dosage information (in more detail)

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Do Aimovig or Ajovy need to be refrigerated?

Both Aimovig and Ajovy should be refrigerated. Before use, take the product out of the refrigerator and let it sit at room temperature for 30 minutes away from direct sunlight. Ajovy and Aimovig can be kept in the original carton at room temperature for up to 7 days, but then it must be thrown away after 7 days at room temperature.

Side effect comparison between Ajovy and Aimovig

Ajovy and Aimovig are usually well-tolerated. The most common side effect that occurs with both Ajovy and Aimovig is an injection site reaction in at least 3% of patients. Injection site reactions can include pain, inflammation and redness.

Other possible side effects with either Aimovig and Ajovy include:

• Allergic reactions
• Call your health care provider or get emergency medical help right away if you experience swelling of the face, mouth, tongue, or throat, or have trouble breathing. These are all signs of a possible allergic reaction.

Aimovig has some side effects that are not reported with Ajovy.

• Constipation with Aimovig can be serious and may lead to hospitalization or surgery.
• High blood pressure or worsening of high blood pressure can also occur after receiving Aimovig.

See also:
Aimovig side effects and Ajovy side effects (in more detail)

Do latex allergies occur with both Aimovig and Ajovy?

If you have an allergy to latex or rubber you may not be able to use Aimovig. The Aimovig device contains dry natural rubber (a derivative of latex), which may cause allergic reactions in some people sensitive to latex.

In contrast, the Ajovy device is not made with natural rubber latex. If you have a latex allergy, be sure to discuss this with your doctor before you get a prescription.

Which is more affordable: Aimovig or Ajovy?

• The cost for Ajovy subcutaneous solution (225 mg/1.5 mL) syringe is $639 per prefilled syringe using a freely available online discount card.
• The cost for Aimovig subcutaneous solution (70 or 140 mg/mL) autoinjector is also around $630 for a supply of 1 milliliter(s), also using an online discount card.
• These prices are for cash paying customers only and are not valid with insurance plans. These prices can vary based on your location, pharmacy and if you are using a discount coupon or card.

While both of these medications are expensive, your insurance may pay for one or the other, and you would typically be responsible for a copay or coinsurance. Check with your insurance for drug coverage before your doctor writes you a prescription.

Both manufacturers offer a prescription copay assistance plan that can help to lower your out-of-pocket expenses. You may be able to lower your copay to $5 per month if you have commercial insurance.

• Ajovy Prices, Coupons and Patient Assistance Programs
• Aimovig Prices, Coupons and Patient Assistance Programs

What other CGRP antagonists are approved for migraine?

Other FDA-approved anti-CGRP agents for migraine prevention include Eli Lilly’s Emgality (galcanezumab) and Vyepti (eptinezumab) from Lundbeck. Emgality is also approved to treat cluster headache episodes in adults.

Bottom Line

• Ajovy (fremanezumab-vfrm) and Aimovig (erenumab-aooe) are both injectable medications used to help prevent migraine headache attacks in adults 18 years of age and older. However, doses, side effects, schedules, and costs can vary between these medicines.
• In general, these agents can reduce the number of migraine headache days you experience by about 1.5 to 3 days per month, but your response may vary.
• The choice of your medication may depend upon other factors, as well, including dosing schedule, response to previous treatments, and insurance coverage and cost.

This is not all the information you need to know about Ajovy or Aimovig for safe and effective use. Review the full product information, and discuss this information with your doctor or other health care provider.

References

• Aimovig Product Label. Amgen, Thousand Oaks, CA. Feb. 2020. Accessed August 18, 2020. https://www.pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/aimovig/aimovig_pi_hcp_english.ashx
• Ajovy Product Label. Teva Pharmaceuticals. North Wales, PA. Revised 10/2020. Accessed Feb. 24, 2021. https://www.ajovy.com/globalassets/ajovy/ajovy-pi.pdf

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