For NEW Patient Copay Assistance information, please click on this link

Get your patients started on AJOVY. Begin here

Safety profile in clinical trials for AJOVY

The safety profile of AJOVY
as established by long-term
clinical trials

Dr Sacco discusses common issues to consider when choosing a preventive therapy, as well as the safety profile of AJOVY.
Show Transcript

Hello, thank you for joining us to learn more about AJOVY—the long-acting anti-CGRP injection with lasting protection against migraine. Today we’ll talk about understanding the safety profile of AJOVY.

I’m Dr Sara Sacco and I’m the Director at the Carolinas Headache Clinic in Charlotte, North Carolina.

I’m sure you’ll agree that the safety profile of preventive migraine therapy is just as important as efficacy and considerations could include concomitant medications, over-active immune responses, constipation, hypertension, and or latex allergies in your decision-making process. As we begin this presentation, I’d like you to keep these considerations in mind when assessing AJOVY.

Today, we’ll review the safety profile of AJOVY as well as its efficacy and administration options so you can make an informed decision when prescribing.

You’ll recall AJOVY is indicated for the preventive treatment of migraine in adults. Please note AJOVY is contraindicated in patients with serious hypersensitivity to fremanezumab-vfrm or to any of the excipients. Reactions have included anaphylaxis and angioedema.

I’d like to start with how AJOVY was designed. It was specifically bioengineered to reduce unwanted activation of the immune system which is achieved by its antibody type. AJOVY is a fully humanized IgG2Δa monoclonal antibody that selectively targets the CGRP ligand and no other related calcitonin family members. This is particularly helpful when deciding on preventive therapy, especially for patients needing to limit unnecessary immune activity.

AJOVY is also not metabolized by cytochrome P450 enzymes. Therefore, interactions with concomitant medications that are substrates, inducers, or inhibitors of cytochrome P450 enzymes are unlikely.

Before we go any further, it’s important to understand the core clinical trials that established our safety data, so you can be confident when making treatment decisions. Let’s review the study designs for the HALO and Long-term Extension studies. AJOVY was studied in HALO—two phase 3, 12-week, randomized, double-blind, placebo-controlled, parallel-group trials. Patients were randomized to either AJOVY monthly dosing, AJOVY quarterly dosing, or the placebo arm, after which they underwent a screening visit, a 28-day preintervention, and a run-in period, followed by a 12-week intervention period, with a final evaluation at Week 12. Some of the patients in the 12-week HALO studies rolled over into the Long-Term Extension study—a 12-month, multicenter, randomized, double-blind, parallel-group clinical trial. The Long-Term Extension study was not placebo controlled, but patients were blinded as to the dosing regimen.

Let’s move on to the safety results of the HALO and Long-Term Extension studies. Shown here are the adverse reactions reported by at least 2% of the patients on AJOVY and greater than placebo. What’s notable here when keeping the side effects of preventive therapies top of mind is that less than 1% of patients experienced constipation or hypertension with AJOVY compared to less than 1% for placebo. And ≤2% of patients discontinued due to adverse events in both the AJOVY and placebo treatment arms.

In the Long-Term Extension study, you can see the adverse reactions that occurred in more than 6% of patients. I’d like to add that no new safety signals were identified in the Long-Term Extension study.

Please note, hypersensitivity reactions, including rash, pruritus, drug hypersensitivity, and urticaria were reported with AJOVY in clinical trials. Most reactions were mild to moderate, but some led to discontinuation or required corticosteroid treatment. Most reactions were reported from within hours to one month after administration. Cases of anaphylaxis and angioedema have been reported in the postmarketing setting. If a hypersensitivity reaction occurs, consider discontinuing AJOVY and institute appropriate therapy.

Now that we have established the safety profile of AJOVY, let me briefly remind you of the efficacy results so that you have the full picture. As a general note, we will only be discussing episodic migraine results. If you’d like to review the results of the chronic migraine trial, please visit AJOVYhcp.com.

The primary endpoint in the HALO episodic migraine trial was mean change from baseline in the monthly average number of migraine days for both monthly and quarterly dosing options during the 12-week period.

As you can see, AJOVY demonstrated a statistically significant improvement in the mean reduction from baseline of 4.3 migraine days at month 3 versus 3.1 days for placebo. The Long-Term Extension study further demonstrated a mean reduction of 5.1 migraine days with monthly dosing. Comparable results were also seen for quarterly dosing.

We’ve discussed the safety and efficacy of AJOVY. Let’s now move beyond the medicine itself to another important aspect of injectable therapy—the administration process. AJOVY is available in an autoinjector. And, 97% of healthcare professional and patient evaluators found the AJOVY Autoinjector easy to use in two Human Factor studies.

It has a button-free, push-down mechanism. For safety, the device locks after use with no visible needle. It’s also made without any natural rubber latex, which is helpful for patients who may be allergic. With AJOVY, there’s no loading dose, no dose titration, and it can be administered at home or in the office.

Let’s bring this back to your practice. Earlier I mentioned certain considerations you might make when evaluating patients for preventive migraine therapy. In summary, AJOVY may be an appropriate treatment option because it has an established safety profile, it’s not metabolized by cytochrome P450 enzymes, delivers sustained efficacy, and is available in an easy-to-use Autoinjector.

We hope you found this information helpful and consider AJOVY—the long-acting anti-CGRP injection with lasting protection against migraine for your patients. To learn more about AJOVY or review the full Prescribing Information, please visit AJOVYhcp.com.

The most common side effects of AJOVY as reported in the pivotal phase 3 trials were injection-site reactions1

Adverse reactions reported by ≥2% of patients
and greater than placebo in the HALO trials1

HALO-CM and HALO-EM

(pivotal clinical trials)

AJOVY 225 mg Monthly

(n=290)

AJOVY 675 mg Quarterly

(n=667)

Placebo Monthly

(n=668)

Injection-site reactions*

43%

45%

38%

*Injection-site reactions include multiple adverse reactions–related terms, such as injection-site pain, induration, and erythema.

In the HALO phase 3 clinical trials2:

  • <1% of patients experienced constipation vs <1% for placebo
  • <1% of patients experienced hypertension vs <1% with placebo
  • ≤2% of patients discontinued due to adverse events in the AJOVY and placebo treatment arms
  • <1% of patients in both phase 3 trials developed antibodies to AJOVY1

Adverse reactions reported by ≥6% of patients
in the long-term extension study3

CM

AJOVY 225 mg Monthly

(n=558)

AJOVY 675 mg Quarterly

(n=550)

Injection-site reactions

23%

19%

EM

AJOVY 225 mg Monthly

(n=386)

AJOVY 675 mg Quarterly

(n=394)

Injection-site reactions

23%

18%

Rates of injection-site reactions are averaged. Injection-site reactions included injection-site induration, pain, erythema, hemorrhage, and pruritus.

In the Long-Term Extension study2:

  • No new safety signals were identified
  • 6% of patients discontinued due to lack of efficacy or adverse events
  • Discontinuation rates were comparable for both monthly (5%) and quarterly (7%) dosing

Adverse reactions reported by ≥2% of patients
and greater than placebo in the FOCUS trial4

FOCUS trial

AJOVY 225 mg Monthly

(n=285)

AJOVY 675 mg Quarterly

(n=276)

Placebo Monthly

(n=277)

Injection-site reactions1‡

14%

15%

12%

Injection-site reactions include multiple related adverse event terms, such as injection-site pain, induration, and erythema.4

In the FOCUS phase 3b clinical trial:

  • Most injection-site reactions were rated as mild to moderate2
  • Discontinuation rate due to adverse events was <1%2
  • The most common adverse event experienced among patients receiving AJOVY included injection-site reactions (14%)2
  • Injection-site reactions were evaluated differently in HALO phase 3 and FOCUS studies2
  • In the phase 3 trials, injection-site reactions were assessed for erythema, induration, ecchymosis, and pain immediately and 1 hour after study drug administration. If a patient had severe injection-site induration, erythema, and/or ecchymosis and/or grade 3 (severe) or grade 4 (worst possible) injection-site pain at 1 hour after completion of study drug administration, the patient was reassessed 3 hours after study drug administration and hourly thereafter until the reaction/pain was of moderate or less severity2

 

AJOVY is not metabolized by cytochrome P450 enzymes; therefore, interactions with concomitant medications that are substrates, inducers, or inhibitors of cytochrome P450 enzymes are unlikely.1

AJOVY has a long half-life. This should be taken into consideration for women who are pregnant or plan to become pregnant while using AJOVY. There are no adequate data on the developmental risk associated with the use of AJOVY in pregnant women. Teva has a pregnancy exposure registry for pregnant women; healthcare providers are encouraged to register pregnant patients by calling 1-833-927-2605 or visiting www.tevamigrainepregnancyregistry.com.1

What to explore next