Ajovy (fremanezumab)

Ajovy is a preventive treatment for migraine. It is part of a class of medications called calcitonin gene-related peptide (CGRP) monoclonal antibodies.

Preventive treatments are often recommended for people living with chronic or debilitating migraine attacks. There are lots of options for preventive treatments, so it can be helpful to learn about these before speaking to your doctor. This article will help you better understand Ajovy as one of your options.

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Medically reviewed by Dr Trudy Cheng. Last updated October 30, 2022.

What is Ajovy?

Ajovy (fremanezumab) is a preventive migraine medication. It is part of a class of medications called calcitonin gene-related peptide (CGRP) monoclonal antibodies. There are several other CGRP monoclonal antibodies available in Australia (Vyepti, Emgality, and Aimovig).

Migraine is a neurological disorder that can be debilitating. Some of the symptoms include head pain, light or sound sensitivity, nausea, visual disturbances, and more.

Your doctor might recommend that you take a preventive treatment (like Ajovy) if you have chronic or debilitating migraine attacks.

Image of Ajovy box and autoinjector

At a glance

Brand nameAjovy
Active ingredientFremanezumab
ManufacturerTeva Pharma Australia Pty Ltd
Dosage225 mg per month, or 675 mg every 3 months
AdministrationSubcutaneous injection (self-administered)
AvailabilityPrescription-only
Cost per 225 mg dose$850 (full cost); $42.50 (PBS pricing); $6.60 (PBS pricing with a concession card)
PBS Status?Listed on PBS (August 1, 2021).

Cost & access in Australia

Ajovy is available in Australia for the preventive treatment of migraine in adults. It is a prescription medication so you will need to see your GP or neurologist to access it. 

You can now access Ajovy through the Pharmaceutical Benefits Scheme (PBS). Patients must fulfil the following criteria to be eligible for PBS coverage:

  • You have a diagnosis of chronic migraine (15 or more headache days per month for at least 3 months)
  • Three other treatments have failed (for example through a lack of efficacy or intolerable side effects)
  • You must be managed for medication overuse headache
  • Your first script is prescribed by a neurologist (however a GP can continue the scripts)

If you are not seeing a neurologist at the moment, you can find one in our doctor directory

Under the PBS, Ajovy is $42.50, or $6.60 for concession card holders. If you aren’t eligible for PBS coverage you can still access this medication at the full price ($850).

Please note that you cannot get both Ajovy and Botox on the PBS. PBS pricing is also only available for monthly treatment, not the quarterly dosage (675 mg).

Side effects

Most medications can cause side effects. These will often be minor and go away in a short period of time (1). However, it’s possible that you will experience a more serious complication or allergic reaction that could require immediate medical attention.

Keep in mind that side effects can vary depending on your age, other health conditions you might have, or other medications you take.

Mild side effects (1) 

  • Pain, hardening or redness
  • Itching
  • Rash

Speak to your doctor if you have any of these less serious side effects and they worry you.

Serious side effects (1)

  • Chest tightness, cough, wheezing, difficulty breathing
  • Swelling of face, lips, tongue, or other body part
  • Drop in blood pressure (fainting, dizziness)
  • Rash, itching or hives
  • Stomach pain or vomiting

Call your doctor immediately or seek emergency medical attention in a hospital if you experience any of these serious side effects.

Two clinical trials assessing the safety and efficacy of Ajovy found that mild injection site reactions are quite common (2, 3). These are temporary and will usually subside within a few hours or days after the injection. Serious side effects were quite uncommon, affecting <1-2% of participants. None of the serious effects were more common in the treatment group compared to placebo.

Even so, other side effects could occur in some people. After receiving medical advice about any side effects you experience, you or your neurologist can report them to the Therapeutic Goods Administration (TGA).

How it works

Ajovy is part of a group of drugs called calcitonin gene-related peptide (CGRP) monoclonal antibodies. These are the newest type of preventive migraine medication, and the first preventive treatment to be designed specifically for migraine.

CGRP is a molecule found in the body, and people living with migraine have increased amounts of CGRP. When this molecule binds to its receptor, it results in a series of events that are involved in a migraine attack. Ajovy targets the CGRP molecule so that it can no longer bind to the CGRP receptor – which will hopefully block the series of events that lead to migraine.

Diagram showing CGRP molecules and receptor
1. CGRP is a molecule that exists throughout the body, including in the brain.
Diagram showing CGRP attaching to the receptor
2. When CGRP binds to its receptor, this plays a role in causing a migraine attack.
Diagram showing how Ajovy binds to CGRP molecules
3. Ajovy binds to the CGRP molecules to prevent them from binding to the receptor.

Dosage

Ajovy comes in a pre-filled syringe or auto-injector pen containing one 225 mg dose. You can take it either monthly or every three months.

  • The monthly dose is 225 mg (one injection)
  • The quarterly dose is 675 mg (three injections, one after the other) (1).

Ajovy is most effective if you take it at regular intervals, so it could be helpful to set a reminder or mark the day in your calendar. If you forget to take a dose, inject it as soon as possible and resume your monthly or quarterly dosing. Speak to your doctor if you’re not sure what to do.

This medication is not a cure – there is no absolute cure for migraine at this stage. Ajovy is designed for regular use in order to prevent migraine, so your attacks could return if you stop taking it. You can consult your doctor if you have any questions about how long you should take Ajovy.

How is Ajovy administered?

Ajovy is injected subcutaneously (under the skin) with a syringe or autoinjector pen. Your doctor can recommend which format is best for you. It can be injected in your abdomen, thigh, or upper arm.

Diagram of Ajovy autoinjector pen with description
Diagram of Ajovy pre-filled syringe with description

A medical professional will teach you how to self administer this safely. If you are uncomfortable with self administration, your family member, GP, nurse or neurologist could help with this. 

Here are a few things to remember when injecting Ajovy:

  • Ensure it is not expired or damaged. The liquid should be clear or slightly yellow, and check for cracks or leaks on the syringe.
  • Hygiene is essential. Wash your hands before injecting, and wipe the injection site with an alcohol wipe afterwards.
  • Dispose of sharps safely. All needles need to go in a sharps disposal container.

You might have side effects. Pain, redness, and itching are all common injection site reactions. Keep a cold compress or ice pack at hand in case you experience these symptoms.

How effective is Ajovy?

Just like other migraine preventives, the efficacy of Ajovy can vary from person to person. Some might find it very effective, while others might find it doesn’t help much at all. 

The tables below show the results of two clinical trials that measured the safety and efficacy of Ajovy. One study was for episodic migraine and the other was for chronic migraine, and both were conducted in a three month period. Participants either received a monthly 225 mg dose or a single dose of 675 mg at the start of the trial.

Episodic migraine (4)

 225 mg dose (n = 290)675 mg dose (n = 291)Placebo (n = 294)
Average migraine days per month at baseline8.99.39.1
Average migraine days per month during treatment4.75.36.4
Average reduction in migraine days‒4.2‒4.0‒2.7
Percentage of patients with 50% or more reduction in monthly headache days47.7%44.4%27.9%

Source: Clinical Trial Identifier NCT02629861 (4)

Chronic migraine (5)

 225 mg dose (n = 375)675 mg dose (n = 375)Placebo (n = 371)
Average migraine days per month at baseline16.016.216.4
Average migraine days per month during treatment11.011.313.2
Average reduction in migraine days‒5.0‒4.9‒3.2
Percentage of patients with 50% or more reduction in monthly headache days40.8%37.6%18.1%

Source: Clinical Trial Identifier NCT02621931 (5)

These studies show a clinically significant reduction in migraine days for people with both episodic or chronic migraine. However, if you try Ajovy and find that it doesn’t work for you, don’t be discouraged. Some people will not respond to one CGRP monoclonal antibody but find another very helpful. You can discuss your options with your doctor.

Other considerations & interactions

When taking a new medication it is important to consider your overall health, including lifestyle factors, health conditions, or other medications. Certain foods, vaccines, or other factors can affect how a medication works. These are called interactions.

Generic image of supplements as an example of interactions

Some interactions cause the drug to be less effective, but there are also interactions that can be harmful or unsafe.

At this stage there are no known interactions between Ajovy and other medications or foods. However, it is still a relatively new medication, and that doesn’t mean they don’t exist. You should tell your doctor about any other medications or supplements you are taking.

There is also very little research about Ajovy and (1):

  • Pregnancy
  • Breastfeeding
  • Children under 18

Ajovy is not approved for people under 18. If you are pregnant, breastfeeding, or planning a pregnancy, you should consult your doctor. They will help you make a decision about whether or not you should take this medication.

Further information & resources

If you’d like to learn more about anything in this article, you can check out the following resources:

References:

  1. Therapeutic Goods Administration, 2022, ARTG ID 342612 [AJOVY fremanezumab Consumer Medicine Information (CMI) Summary]. Retrieved from: https://www.tga.gov.au/resources/artg/342612 
  2. D Dodick et al, 2018, Effect of Fremanezumab Compared With Placebo for Prevention of Episodic Migraine. DOI: 10.1001/jama.2018.4853
  3. S Silberstein et al, 2017, Fremanezumab for the Preventive Treatment of Chronic Migraine. DOI: 10.1056/NEJMoa1709038
  4. Teva Branded Pharmaceutical Products R&D, 2021, Efficacy and Safety of 2 Dose Regimens of TEV-48125 Versus Placebo for the Preventive Treatment of Episodic Migraine. Retrieved from: https://clinicaltrials.gov/ct2/show/results/NCT02629861
  5. Teva Branded Pharmaceutical Products R&D, 2021, Comparing Efficacy and Safety of 2 Dose Regimens of Subcutaneous Administration of TEV-48125 Versus Placebo for the Preventive Treatment of Chronic Migraine. Retrieved from: https://clinicaltrials.gov/ct2/show/results/NCT02621931
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