Timothy C. Hain, MD • Page last modified: September 1, 2018
erunumab is the first FDA approved CGRP inhibitor (Edvinsson, 2015). It is the first of 4 similar drugs to pass the FDA approval process. It has been available since 6/4/2018. More about this new family of migraine drugs is here.
erenumab is an anti-CGRP receptor antibody. It is not directed against CGRP, but against the receptor for CGRP. Compared to placebo, this drug was reported to reduce mean headache days by 6.6 (from 18), compared to a 4.2 day reduction in placebo. Converting this to percentages (not the same as the above calculation), the difference in days between active drug and placebo is 2.4, and that divided by 18, is again about a 10% difference. The safety profile of this drug is similar to placebo. An open label trial (i.e. not controlled) suggested roughly a 50% reduction in migraine days/month, for a dose of 70 mg subcutaneous every 4 weeks. Another phase-2 trial suggested a mean reduction of 2.5 headache days/month compared to placebo. We do not know if erenumab will reduce vertigo from migraine. There is also no long-term data (beyond 18 months) on this drug. We simply do not know if it will, for example, increase white matter lesions in women with migraine with aura. These take many years to develop.
Erunamab was approved by the FDA in May of 2018. It is not in pharmacies, and presently it is ordered through a process involving a manufacturer special pharmacy. The drug company is providing samples. This process presently appears to be fairly inexpensive if you have commercial insurance. Otherwise, if you have no insurance or have Medicare, it appears to be priced at about $575/month (if you pay out of pocket). Medicare does not cover this drug and also does not interact with specialty pharmacies. We are not sure if Medicare will ever cover this drug. Fortunately however, Migraine usually gets better with age and after menopause in women.
It can be injected at home. There are two dose sizes -- 70 mg and 140 mg. We prescribe the 140 mg dose (two injections/month) for most patients who ask to try it.
The steps that you have to go through are as follows:
- There is a 2 page form to fill out, with signatures needed from both you and your physician. The online version of this form is here: You should look at this form that has quite a bit of information on it, some of which is legal, but the main form we need to proceed is on the next line below:
- The page of this form that just has the stuff you need to fill out yourself is here:
- For our office (Chicago Dizziness and Hearing), we have a form in the office that is prefilled with our practice information, and we will sign this and customize it for you. (for our staff, this is under cdh/Nurse .../CGRP)
- It will speed the process along if you fill out the first page (which is the patient page) and either email it to us or bring in the hard copy. Note that your signature is required on the first page. We will fill out the second page that is similar to a prescription.
- The form gets faxed to the special pharmacy at 833-873-1499
- The special pharmacy will call you and check on your insurance coverage. They will not ship drug (to you) until they have done this.
- The special pharmacy will ship you the drug, which needs to be kept in the refrigerator.
- You either inject it yourself, or find someone to help you inject the drug. It is similar to an insulin injection -- subcutaneously, in the usual places such as arm, thigh or stomach