Aimovig

1 September 2021

Is This Why Aimovig Won’t Work For You?

James Discoveries & Stats, Medications 0

Aimovig (erenumab) has been a great help for many migraine patients, but not all. Do we know of any reasons why it doesn’t work with some people?

Different medications - problems together?

A good doctor doesn’t want to randomly throw medications in your direction, trying on after the other. A good doctor knows which drugs have good scientific evidence behind them, and if possible which seem to work best for a patient like you – perhaps someone with your symptoms, or your lifestyle, or your medical history.

Now we all know that each person is very different and complex, so we will never type in “10 facts about Me” and have the computer spit out the perfect treatment. But we do have some clues once in a while that help us choose one treatment over the other.

Last year at the 62nd Annual Scientific Meeting of the American Headache Society, a report was presented entitled “CGRP Monoclonals: Efficacy, Side Effects, and Switching”. It attempted to start answering questions about which CGRP related medications were good for whom, and whether or not a patient should consider switching. Another concern is that more side effects were showing up in the real world than had shown up in clinical trials (not uncommon, but something to watch).

There were a couple of interesting notes in particular regarding erenumab, brand name Aimogvig.

First, and not surprisingly, patients with “moderate or severe refractory chronic migraine” were less likely to be helped. That is, those with significant chronic migraine that has not responded to several other common treatments. However, if patients had “mild refractory chronic migraine”, the medication may help.

The second predictor that Aimovig may not work was that the patient was taking opioids.

Opioid medications have helped many migraine patients, but must be used with extreme care because they are notorious for making the migraine condition worse. Occasional or very temporary use may be helpful for pain, but there are usually better options.

So for some reason, patients taking opioids were less likely to benefit from erenumab. This raises an interesting question – if patients stopped taking opioid medications for several months, might they be able get more benefit from Aimovig? Or, if they stopped taking opioids upon starting Aimovig, would symptoms improve several months later?

For the average patient, the study found that most patients could tell after a couple of months if Aimovig was going to be worth it for them. (A good rule of thumb for most treatments is to try them for three months.)

And what about trying a different but similar medication? In this small study, there did not seem to be a general benefit – but remember, for an individual, it may be worth it. The study did note that some patients did switch because of financial reasons, and “more than half of the patients did well”.

22 October 2020

What Is Surprising Us About The New CGRP Preventatives?

James Discoveries & Stats, Medications, News 0

Can you believe it? It was in the spring of 2018 that Aimovig (erenumab) was approved in the USA. My! Time flies!

Really, all the CGRP related drugs are still extremely new, when it comes to prescription drugs for migraine. Long term trials are still a future hope. And we’re just starting to guess at some trends that we may be seeing from patients.

But what are some of the trends we’re seeing? Let’s take a moment to talk about them, and you can comment if you’ve had a similar of very different experience.

(1) For many, these drugs are working better than expected!

First, the (very) good news. For many patients, these CGRP inhibitors are working better than the clinical trials even led us to believe.

As drug companies rush to market new migraine drugs, we expect to see headlines that use phrases such as “life-changing!”. But in the case of drugs like Avojy and Aimovig, this does seem to be the case with many patients – a very significant improvement in their symptoms.

And these are not always “just any” patient. These are patients who have not had a lot of success with other medications.

So there are good reasons to have a lot of hope that these new drugs will help many more people around the world in the next few years.

(2) Sometimes these drugs are less effective after a while.

This is a biggie. Reports are coming in that, for many patients, the benefits tend to “wear off” after a while.

Will switching to another CGRP preventative help? It’s very possible, and it’s not at all a surprise that you may need to try more than one before you find the right fit.

But this is one that researchers are going to pay a lot of attention to in the next few years. Which patients are having this issue, and why? Will some CGRP preventatives work better than others? Even if they’re not as beneficial as they were in the first few weeks, do they still provide significant benefit? What’s your experience?

(3) Side Effects

Any surprises with side effects? Side effects are not a huge problem for many patients, but it is starting to sound like constipation is an issue for some, especially with Aimovig (and in this case, switching may provide significant benefit). It seems that it may be more likely to make constipation issues worse if you already have a pre-existing condition.

In a recent discussion published in The American Journal of Managed Care, two neurologists pointed out some of the other side effects they’re seeing – “. . . a worsening of Reynaud syndrome, fatigue, hair loss, sexual dysfunction, and in women, some reports of irregular menstrual periods.”

Again, discussing side effects shouldn’t make it sound like patients are running away from these medications in droves because they’re all having major problems. Side effects may be rare, but we have to keep an eye on them because certain patients may be more prone to certain side effects than others.

If you’ve been taking a new preventative, such as Vyepti, Aimovig, Ajovy, or Emgality, how long have you been on it? What has your experience been? Anything you might share could be a help for our community.

28 September 2020

Aimovig after Concussion?

James Discoveries & Stats, Medications 0

Now that several CGRP related medications are on the market for migraine, researchers are interested in finding other uses for the same drugs (even to fight COVID-19). One case in point is the use of Aimovig (erenumab) for headache from a hit in the head.

There are a series of different types of headache that are due to head or neck trauma. Under the heading of “Acute headache attributed to traumatic injury to the head“, the International Classification of Headache Disorders 3 points out that the common definition is a headache that starts within 7 days of the injury, although this is “somewhat arbitrary”, because there is some evidence that the headache could start up to three months later. The problem is that, the longer the interval, the harder it is to connect the headache with the injury.

Millions and millions of head injuries happen every year, so this is a very common issue. A concussion is really a type of brain injury, and there is still a lot that we don’t know about how concussions affect the body (although we’ve learned a lot in the past 20 years).

So from this small initial study, how did Aimovig measure up when it comes to post-traumatic headache (due to mild traumatic brain injury, or concussion)?

It should be noted that these patients were all women, and had suffered from their headaches for over a year (to several years). They had also already tried at least one other daily preventative for headache. So this is not a case of someone with a bit of a headache a couple of weeks after a fall – these are ongoing, difficult cases. And the headaches were moderate to severe.

Taking erenumab, the patients found that, on average, the pain decreased by about half. All five patients were able to stop taking at least one other medication. Four out of five patients continued taking erenumab after the study was completed. But even better, patient #5 stopped taking it because their headaches disappeared completely.

There were no serious side effects, though three patients did have some constipation.

It’s a small study, but for challenging headaches like these the results look good. It may be that other CGRP receptor blockers will also have a wider application for headache treatment.

For more, read the study abstract here: Use of CGRP receptor blocker erenumab in the management of post-traumatic headache: a case series of 5 women

27 April 2020

CGRP Drugs and Weight Gain

James Information, Medications, Tips 3

Do CGRP injections cause weight gain? If so, what can I do about it?

This is a (somewhat belated) response to a question from Char in the United States. If you have a question, use the button on the right to fill in the form.

Char was specifically asking if there is a CGRP injection that doesn’t cause weight gain.

One of the concerns that doctors have had regarding the new CGRP medications is that they are – well, new! Of course, every medication has to be new at some point. But what that means is that long term testing is really only starting. (For some of the concerns expressed early on, check out At Stake: The Possible Long-Term Side Effects of CGRP Antagonists. Weight change is one of the questions that is highlighted.)

So at this moment in history, we are waiting for long term trials, and also watching carefully clinical experience – that means your experienced with the drugs.

Many people are being helped by the new medications, but there are reports of weight change – not just weight gain, but weight loss. The Robbins Headache Clinic reported on some of the early experiences they had with the CGRP medications. Here’s what they’ve written about weight changes:

Bloating & Weight Changes: weight gain can be a problem, and if significant enough we stop the medication. This does not appear to be as much a problem as with other medications such as Lyrica, Depakote, gabapentin and the tricyclic anti-depressants, but we are seeing it. This could be because our feeding and hunger is centered in the hypothalamus which is not protected by the blood-brain barrier. A few people have lost weight, and if it is significant then we stop the medication.
CGRP QUESTIONS/ANSWERS

So in short, they saw both weight gain and weight loss. However – and this is important – CGRP related medications don’t seem to be the worst offenders when it comes to weight gain.

The Pain News Network also reported on a survey of those using the new medications. According to the survey, 12% of patients reported some weight gain (see New Migraine Prevention Drugs Making Inroads).

We have to remember that these are not controlled studies. And so we come to a very important question – are these drugs directly causing weight gain?

Here’s a simple example. If you are constantly nauseous, and a CGRP injection significantly improves your health, what just might happen? You might eat more.

This is the argument that Drugs.com makes for Aimovig. “Does Aimovig cause weight gain or loss?” – no, but changing migraine symptoms may. You may think that their answer is a little overconfident, but the fact remains that there may very well be a complex set of reasons why you gain or lose weight on a CGRP drug.

So back to Char’s concern – what to do?

First, be sure you are communicating your concerns with your doctor. This is a case when customized medical help is very important. Your doctor can help you find the best solutions for you.

Second, and this will help your doctor, be sure to keep a detailed diary of your symptoms and any changes that you notice.

Third, try another CGRP medication. Unfortunately, we simply do not know enough at this point to give you a list of CGRP related medications that are least likely to cause weight gain for you. Like many classes of drugs, it can make a significant difference if you try another drug of the same class.

And, of course, as your symptoms (hopefully!) lessen, take the time to learn and re-learn some basic healthy habits.

We would love to hear your experiences and suggestions – leave a comment! 🙂

4 November 2019

Combining CGRP Inhibitors with – Botox

James Medications 2

Now that some of the new CGRP inhibitors have hit the market, studies are beginning to see how they might work with together with other treatments. At the University of Utah, the treatment includes Botox (onabotulinumtoxinA or ONA) and Aimovig (erenumab).

The patients trying the combination treatment, in this case, had already tried 3, 4, 5, or more treatments without success. Many also suffered from depression, anxiety, insomnia, and other co-morbid disorders. Most, though not all, were women.

Both ONA and the CGRP inhibitors such as Aimovig are given by injection. Botox every 12 weeks, Aimovig every 4. (The upcoming drug eptinezumab is meant to be given every 12 weeks, so it would be interesting to see how that works with ONA as well.)

The benefits of ONA are known to be inconsistent over the 12 weeks between treatments. In other words, there may be days, especially near the end, when it’s not helping the way it did at its peak. So combining it with another medication may help the situation.

In this study, which is small but ongoing, the results were not spectacular but they were promising for some patients. Slightly more than half of the patients did see significant improvement with the combination. The bulk of the rest found no improvement, although 18% found that their “headache burden” actually got worse.

So once again this is a treatment that may be a tremendous benefit to some patients. And remember, these were generally patients who have tried several other treatments without success.

One of the biggest challenges when it comes to combination treatment, and combination treatments that work with many but not all patients, is insurance coverage. It is in the best interest of insurance companies in many cases to see stable improvement of migraine symptoms. But convincing them that this is the way to go may take time.

We would be interested to hear your comments if you have tried any of the new CGRP inhibitors in combination with Botox treatment. Leave a comment!