The Role of CGRP in Migraines
Both Ajovy and Qulipta are part of a class of drugs called calcitonin gene-related peptide (CGRP) inhibitors. CGRP is a protein in the nervous system that is understood to play a crucial role in the intense pain and inflammation associated with migraine attacks. During a migraine, CGRP levels increase significantly. By targeting the CGRP pathway, these medications can effectively reduce the frequency and severity of migraines, making them the first class of drugs specifically designed for this purpose.
How Ajovy and Qulipta Work
While both medications target CGRP, they do so in slightly different ways, which defines their drug classification.
- Ajovy (fremanezumab): Ajovy is a humanized monoclonal antibody. It works by binding directly to the CGRP ligand itself, preventing it from attaching to its receptor. This direct-binding action neutralizes the CGRP protein before it can initiate pain signals.
- Qulipta (atogepant): Qulipta is a small-molecule CGRP receptor antagonist, also known as a "gepant". Instead of binding to the CGRP protein, Qulipta blocks the CGRP receptor. By occupying the receptor site, it prevents the CGRP protein from binding and activating the pain pathway.
Efficacy: How Well Do They Work?
Direct head-to-head clinical trials comparing Ajovy and Qulipta are not readily available, but data from their respective trials show that both are effective at reducing monthly migraine days (MMDs). A network meta-analysis suggested Ajovy may reduce more monthly migraine days compared to atogepant, though both are considered highly effective.
- Ajovy Efficacy: In clinical trials for episodic migraine, patients taking Ajovy experienced an average reduction of 3.4 to 3.7 MMDs, compared to a 2.2-day reduction for placebo. For chronic migraine, the reduction was 4.6 MMDs.
- Qulipta Efficacy: In its pivotal ADVANCE trial for episodic migraine, patients taking Qulipta saw a reduction of 3.7 to 4.2 MMDs over a 12-week period. Qulipta is also the first and only oral CGRP antagonist approved to prevent both episodic and chronic migraine.
Administration: A Key Difference
The most significant difference for patients is how these medications are administered.
- Ajovy: Administered as a subcutaneous injection. Patients have two dosing options: once per month or once every three months. This flexibility may appeal to those who prefer less frequent dosing.
- Qulipta: Taken as a once-daily oral tablet, with or without food. This is ideal for patients who are averse to needles.
Side-by-Side Comparison: Ajovy vs. Qulipta
| Feature | Ajovy (fremanezumab) | Qulipta (atogepant) |
|---|---|---|
| Drug Class | CGRP Inhibitor (Monoclonal Antibody) | CGRP Inhibitor (Gepant/Receptor Antagonist) |
| Administration | Subcutaneous Injection | Oral Tablet |
| Dosing Frequency | Monthly or Quarterly (every 3 months) | Once Daily |
| Approved For | Preventive treatment of migraine in adults; episodic migraine in children 6+ weighing at least 45kg | Preventive treatment of episodic and chronic migraine in adults |
| Common Side Effects | Injection site reactions (pain, redness, itching) | Nausea, constipation, fatigue/sleepiness |
| Drug Half-Life | ~31 days (744 hours) | ~11 hours |
Side Effects and Safety
The safety profiles of both drugs are well-established, but their common side effects differ based on their administration and class.
- Ajovy's Most Common Side Effect: The most frequently reported adverse reactions are related to its injection method, including pain, swelling, or redness at the injection site. Hypersensitivity reactions can occur from hours up to a month after administration.
- Qulipta's Most Common Side Effects: The most common side effects are nausea, constipation, and fatigue or sleepiness. Qulipta also has more known drug interactions (208) compared to Ajovy (3), requiring careful review of a patient's current medications. Dosage adjustments may be necessary for patients with severe renal impairment.
Cost and Insurance
Both Ajovy and Qulipta are brand-name drugs with no generic versions available. The list price for a 30-day supply of Qulipta is approximately $991-$1,128, while a single monthly dose of Ajovy is around $745-$834. However, the actual patient cost depends heavily on insurance coverage. Both manufacturers offer savings programs that can potentially reduce the copay to as little as $0 for eligible, commercially insured patients.
Conclusion: Which Medication is Better?
There is no single answer to whether Ajovy or Qulipta is universally "better." The optimal choice is highly individualized and should be made in consultation with a healthcare provider.
- Qulipta may be better for individuals who strongly prefer a daily pill over an injection and for whom potential drug interactions have been carefully managed by their doctor.
- Ajovy may be better for individuals who value the convenience of a monthly or quarterly dose and are comfortable with self-injection. Its long half-life means the medication stays in the system longer, which can be beneficial for consistent prevention.
Ultimately, the decision rests on a balance of lifestyle preference, side effect tolerability, clinical effectiveness for the individual, and insurance coverage.
For more information from a third-party source, you can visit the Drugs.com comparison page.
Disclaimer: This information is for general knowledge and should not be taken as medical advice. Consult with a healthcare professional before starting any new supplement regimen.
