Aimovig (erenumab-aooe) is a biologic drug approved for the preventive treatment of migraine in adults. As a monoclonal antibody, it is intended to reduce the number of migraine days for those who suffer from either episodic or chronic migraine.
What Are Biologic Drugs?
Biologic drugs are a different class of medication compared to conventional drugs, which are small molecules created through chemical synthesis. Biologics are large, complex molecules derived from living sources such as microorganisms or animal cells.
Biologics are manufactured using sophisticated biotechnological methods. Because of their large size and intricate protein structures, they cannot be replicated as exact copies, which is why you see “biosimilars” rather than “generics” for this class of drug. This complexity also allows them to interact with specific targets within the body with a high degree of precision.
Due to their protein-based nature, biologic drugs are administered via injection or infusion. If taken orally, these large molecules would be broken down by the digestive system, similar to how the body digests food, rendering them ineffective. This administration method ensures the drug reaches the bloodstream intact.
How Aimovig Works as a Monoclonal Antibody
Aimovig is a human monoclonal antibody, a type of biologic engineered in a lab to function like a natural antibody. It is designed to identify and interact with a very specific target in the body related to migraine pain. This targeted approach is a hallmark of monoclonal antibody therapies.
The medication works by blocking the receptor for a protein called calcitonin gene-related peptide (CGRP). CGRP is a protein found in the sensory nerves of the head and neck. During a migraine attack, CGRP is released and contributes to the inflammation and widening of blood vessels in the brain that cause migraine pain.
By binding to the CGRP receptor, Aimovig prevents the CGRP protein from attaching and initiating its cascade of effects. This blockade of the CGRP pathway helps to prevent the development of a migraine headache. It is one of the first medications in a class called CGRP inhibitors approved specifically for migraine prevention.
Administration and What to Expect
As a large-molecule biologic, Aimovig is administered as a subcutaneous injection into the tissue layer just under the skin. Patients can self-administer the medication at home, typically in the thigh, abdomen, or upper arm. The standard dosing is once per month, offering a different schedule than daily oral preventive medications.
The medication is available in a prefilled autoinjector or a prefilled syringe. The usual starting dose is 70 mg monthly, although some individuals may benefit from a higher 140 mg dose. The injection device must be allowed to come to room temperature before use and should be used within 7 days of removal from the refrigerator.
Common side effects associated with Aimovig include reactions at the injection site, such as pain or redness, and constipation. Constipation can sometimes be serious, and it is important for patients to monitor for this and discuss it with their doctor. Unlike some other monoclonal antibodies, Aimovig has not been shown to suppress the immune system.
Comparing Aimovig to Traditional Migraine Treatments
Aimovig differs from older migraine treatment strategies. Many traditional preventive medications were not originally developed for migraines; they include drugs like certain beta-blockers, antidepressants, or anticonvulsants. Aimovig, however, was specifically designed to target a mechanism known to be involved in migraine development.
This targeted action contrasts with acute migraine treatments, such as triptans or over-the-counter pain relievers like NSAIDs. Acute medications are taken to relieve the pain and symptoms once a migraine attack has already begun. Aimovig is a preventive therapy taken on a regular schedule to reduce the number of migraine days.
The development of CGRP inhibitors like Aimovig has provided a new option for adults, particularly for those who have not found success with or cannot tolerate older preventive treatments. Clinical studies have shown that patients taking Aimovig experienced a reduction of several migraine days per month compared to a placebo.