Emgality may prevent but certainly does not treat migraine headaches. Whether it offers any advantages compared to Amovig or Ajovy remains unknown. These expensive preventive therapies seem indistinguishable from each other and offer relatively modest advantages over inactive placebos.
For those suffering at least 4 migraines each month, preventive therapy ought to be considered. Among the options are these recently released drugs that interfere with the CGRP pathway. Older, much less expensive options include beta blockers (metoprolol, propranolol), anti-depressants (amitriptyline, nortriptyline), and anti-seizure therapies (valproate, topiramate).
At present no evidence exists to substantiate claims of superiority of any of the choices. Convenience, price, insurance coverage and side effect profile are principal determinants of which medicine any given patient will receive.
Eli Lilly, the drug maker, conceived and designed the pivotal study as well as interpreted the results and performed the statistical analysis. In addition most of the authors of the study either were employees of the company or received financial support from Lilly. Even with all of this potential for bias, only 1 in 9 participants were free of migraines during the study compared to 1 in 16 with an inactive placebo. Another study demonstrated more than 50% reduction in headache in only about 1 in 4 individuals on therapy versus 1 in 6 or 7 with placebo.
The major difference between Emgality and Amovig or Ajovy revolves around dose frequency. Emgality offers the option of 1 injection each month or 3 injections at the same time every 3 months.
Side effects appear infrequent except for sticker shock. While negotiating prices with insurance companies and pharmacy benefit managers, Lilly is offering up to 12 months “free” to those with commercial insurance. However funny games with pricing are not allowed for Medicare, Medicaid or Tricare.