The US Food and Drug Administration (FDA) approved the fully human monoclonal antibody, Erenumab (Aimovig, Amgen, and Novartis) for the prevention of a migraine in adult patients. The drug is the first in its class to receive FDA approval.

"Aimovig provides patients with a novel option for reducing the number of days with a migraine. We need new treatments for this painful and often debilitating condition," said Eric Bastings, MD, deputy director of the Division of Neurology Products in the FDA's Center for Drug Evaluation and Research.

The agency said it gave the nod because of strong results from several recent clinical trials. The once-monthly self-injectable drug, which is a calcitonin-gene-related peptide (CGRP) antagonist, is the first in its class to receive FDA approval for this indication.

Findings from the LIBERTY trial were presented at the American Academy of Neurology (AAN) 2018 annual meeting last month. The study, which included 246 patients with refractory episodic migraine, showed that a 50% or greater reduction in mean monthly migraine days (MMDs) was achieved by 30% of those treated subcutaneously once monthly with erenumab 140 mg vs. 13.7% of those receiving matching placebo.

Race to Market

In addition to erenumab, three other anti-CGRP antibody treatments have been in a race to market. This includes fremanezumab (Teva Pharmaceuticals) and galcanezumab (Eli Lilly and Co), which are currently under review. The manufacturer of eptinezumab (Alder BioPharmaceuticals) is expecting to file for FDA approval by the end of 2018.

"Having a treatment designed to specifically address the complex nature of a migraine is an important and welcome step forward in headache medicine," said Stewart J. Tepper, MD, professor of neurology at the Geisel School of Medicine at Dartmouth Medical School, in a company press release.

"Importantly, in clinical trials, Aimovig patients were able to start and stay on therapy with a discontinuation rate of 2% due to adverse events and experienced sustained migraine prevention," said Tepper

According to the company release, the US list price for erenumab will be $575 for a once-monthly 70- or 140-mg single-use prefilled autoinjector, or $6900 annually. Costs to patients will vary depending on insurance status, but the company notes that its programs may help reduce a patient’s out-of-pocket costs to as little as $5 per month for those who are eligible. 

The European Medicines Agency accepted a marketing authorization application for the CGRP receptor blocker in June 2017; the FDA accepted its new drug application 1 month later.

"For years, the migraine community has been advocating for new treatment options that are specifically designed to treat this migraine, a debilitating and often stigmatized disease," Kevin Lenaburg, executive director of the Coalition for Headache And Migraine Patients (CHAMP), said in another release.

"Today we celebrate the tireless work of researchers and their ability to bring a new therapeutic approach to the millions of Americans who are seeking fewer migraine days," added Lenaburg.