Products
Fremanezumab was approved in the United States in 2018 and in the EU and Switzerland in 2019 as a solution for injection for subcutaneous use (Ajovy).
Structure and properties
Fremanezumab is a humanized IgG2Δa/kappa monoclonal antibody directed against CGRP (calcitonin gene-related peptide). The antibody is produced by biotechnological methods, consists of 1324 amino acids, and has a molecular mass of 148 kDa.
Effects
Fremanezumab (ATC N02CD03) decreases the number of monthly headache days, thereby reducing the use of analgesics and migraine medications. The effects are due to the binding of the antibody to CGRP, the Calcitonin Gene-Related Peptide. CGRP is a neuropeptide that plays an important role in triggering migraine attacks. It consists of 37 amino acids and is expressed in the peripheral and central nervous systems. Two isoforms exist, CGRP-α (Figure) and CGRP-β, which differ in three amino acids. Both are agonists at the CGRP receptor. Fremanezumab binds to both isoforms. CGRP has potent vasodilatory properties and plays a central role in pain initiation as well as neurogenic inflammation. Migraineurs have been found to have elevated levels of CGRP during an attack, and intravenous administration of the peptide can induce attacks in migraineurs. Triptans, which are administered for the treatment of migraine attacks, also inhibit the release of CGRP.
Indications
For the prevention of migraine attacks in adults.
Dosage
According to the SmPC. The drug is injected subcutaneously. Fremanezumab has a long half-life of 30 days and a correspondingly long dosing interval. Both monthly and quarterly use (every 3 months) are possible. With quarterly dosing, the dose is higher.
Contraindications
- Hypersensitivity
For complete precautions, see the drug label.
Interactions
Fremanezumab does not interact with CYP450 isozymes.
Adverse effects
The most common potential adverse effects include injection site reactions such as pain, induration, and skin redness (erythema).
