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Aimovig

Last reviewed on RxList: 5/24/2018
Drug Description

AIMOVIG™
(erenumab-aooe) injection, for subcutaneous use

DESCRIPTION

Erenumab-aooe is a human immunoglobulin G2 (IgG2) monoclonal antibody that has high affinity binding to the calcitonin gene-related peptide receptor. Erenumab-aooe is produced using recombinant DNA technology in Chinese hamster ovary (CHO) cells. It is composed of 2 heavy chains, each containing 456 amino acids, and 2 light chains of the lambda subclass, each containing 216 amino acids, with an approximate molecular weight of 150 kDa.

AIMOVIG (erenumab-aooe) injection is supplied as a sterile, preservative-free, clear to opalescent, colorless to light yellow solution for subcutaneous administration. Each 1 mL single-dose prefilled autoinjector and single-dose prefilled glass syringe contains 70 mg erenumab-aooe, acetate (1.5 mg), polysorbate 80 (0.10 mg), and sucrose (73 mg). Enclosed within the autoinjector is a single-dose, prefilled glass syringe. The solution of AIMOVIG has a pH of 5.2.

Indications & Dosage

INDICATIONS

AIMOVIG is indicated for the preventive treatment of migraine in adults.

DOSAGE AND ADMINISTRATION

Recommended Dosing

The recommended dosage of AIMOVIG is 70 mg injected subcutaneously once monthly. Some patients may benefit from a dosage of 140 mg injected subcutaneously once monthly, which is administered as two consecutive subcutaneous injections of 70 mg each.

If a dose of AIMOVIG is missed, administer as soon as possible. Thereafter, AIMOVIG can be scheduled monthly from the date of the last dose.

Important Administration Instructions

AIMOVIG is for subcutaneous use only.

The needle shield within the white cap of the AIMOVIG prefilled autoinjector and gray needle cap of the AIMOVIG prefilled syringe contain dry natural rubber (a derivative of latex), which may cause allergic reactions in individuals sensitive to latex.

AIMOVIG is intended for patient self-administration. Prior to use, provide proper training to patients and/or caregivers on how to prepare and administer AIMOVIG using the single-dose prefilled autoinjector or single-dose prefilled syringe, including aseptic technique [see Instructions For Use]:

  • Prior to subcutaneous administration, allow AIMOVIG to sit at room temperature for at least 30 minutes protected from direct sunlight [see Storage And Handling]. Do not warm by using a heat source such as hot water or a microwave.
  • Do not shake the product.
  • Inspect visually for particulate matter and discoloration prior to administration [see Dosage Forms And Strengths]. Do not use if the solution is cloudy or discolored or contains flakes or particles.
  • Administer AIMOVIG in the abdomen, thigh, or upper arm subcutaneously. Do not inject into areas where the skin is tender, bruised, red, or hard.
  • Both prefilled autoinjector and prefilled syringe are single-dose and deliver the entire contents.

HOW SUPPLIED

Dosage Forms And Strengths

AIMOVIG is a sterile, clear to opalescent, colorless to light yellow solution available as follows:

  • Injection: 70 mg/mL in a single-dose prefilled SureClick® autoinjector
  • Injection: 70 mg/mL in a single-dose prefilled syringe

AIMOVIG (erenumab-aooe) injection is a sterile, clear to opalescent, colorless to light yellow solution for subcutaneous administration.

The needle shield within the white cap of the AIMOVIG prefilled autoinjector and gray needle cap of the AIMOVIG prefilled syringe contain dry natural rubber (a derivative of latex). Each single-dose prefilled  SureClick® autoinjector or single-dose prefilled syringe of AIMOVIG contains a Type 1 glass syringe andstainless steel needle and delivers 1 mL of 70 mg/mL solution.

AIMOVIG is supplied as follows:

SureClick® Autoinjector

Pack of 1 autoinjector: 70 mg/mL single-dose prefilled autoinjector NDC 55513-841-01

Pack of 2 autoinjectors: 140 mg/2 mL (2 x 70 mg/mL single-dose prefilled autoinjectors) NDC 55513-841-02

Syringe

Pack of 1 syringe: 70 mg/mL single-dose prefilled syringe NDC 55513-840-01

Pack of 2 syringes: 140 mg/2 mL (2 x 70 mg/mL single-dose prefilled syringes) NDC 55513-840-02

Storage And Handling

  • Store refrigerated at 2°C to 8°C (36°F to 46°F) in the original carton to protect from light until time of use.
  • If removed from the refrigerator, AIMOVIG should be kept at room temperature (up to 25°C [77°F]) in the original carton and must be used within 7 days. Throw away AIMOVIG that has been left at room temperature for more than 7 days.
  • Do not freeze.
  • Do not shake.

AIMOVIG™ (erenumab-aooe), Manufactured by: Amgen Inc. One Amgen Center Drive, Thousand Oaks, CA 91320-1799 USA, U.S. License No. 1080. Marketed by: Amgen Inc. (Thousand Oaks, CA 91320), and Novartis Pharmaceuticals Corporation (East Hanover, NJ 07936). Revised: May 2018

Side Effects & Drug Interactions

SIDE EFFECTS

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

The safety of AIMOVIG has been evaluated in 2,537 patients with migraine who received at least one dose of AIMOVIG, representing 2,310 patient-years of exposure. Of these, 2,057 patients were exposed to 70 mg or 140 mg once monthly for at least 6 months, 1,198 patients were exposed for at least 12 months, and 287 patients were exposed for at least 18 months.

In placebo-controlled clinical studies (Studies 1, 2, and 3) of 2,184 patients, 787 patients received at least one dose of AIMOVIG 70 mg once monthly, 507 patients received at least one dose of AIMOVIG 140 mg once monthly, and 890 patients received placebo during 3 months or 6 months of double-blind treatment [see Clinical Studies]. Approximately 84% were female, 91% were white, and the mean age was 42 years at study entry.

The most common adverse reactions (incidence ≥ 3% and more often than placebo) in the migraine studies were injection site reactions and constipation. Table 1 summarizes the adverse reactions that occurred during the first 3 months in the migraine studies (Studies 1, 2, and 3).

Table 1: Adverse Reactions Occurring with an Incidence of at Least 2% for Either Dose of AIMOVIG and at Least 2% Greater than Placebo During the First 3 Months in Studies 1, 2, and 3

Adverse Reaction AIMOVIG 70 mg Once Monthly
N = 787 %
AIMOVIG 140 mg Once Monthly
N = 507 %
Placebo
N = 890 %
Injection site reactionsa 6 5 3
Constipation 1 3 1
Cramps, muscle spasms < 1 2 < 1
aInjection site reactions include multiple adverse reactions related terms, such as injection site pain and injection site erythema.

In Studies 1, 2, and 3, 1.3% of patients treated with AIMOVIG discontinued double-blind treatment because of adverse events. The most frequent injection site reactions were injection site pain, injection site erythema, and injection site pruritus.

Immunogenicity

As with all therapeutic proteins, there is potential for immunogenicity. The detection of antibody formation, including neutralizing antibodies, is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to erenumab-aooe in the studies described below with the incidence of antibodies in other studies or to other products may be misleading.

The immunogenicity of AIMOVIG has been evaluated using an immunoassay for the detection of binding anti-erenumab-aooe antibodies. For patients whose sera tested positive in the screening immunoassay, an in vitro biological assay was performed to detect neutralizing antibodies.

In controlled studies with AIMOVIG, the incidence of anti-erenumab-aooe antibody development was 6.2% (48/778) in patients receiving AIMOVIG 70 mg once monthly (2 of whom had in vitro neutralizing activity) and 2.6% (13/504) in patients receiving AIMOVIG 140 mg once monthly (none of whom had in vitro neutralizing activity). The neutralizing anti-erenumab-aooe antibody positive rate may be underestimated because of limitations of the assay. Although these data do not demonstrate an impact of anti-erenumab-aooe antibody development on the efficacy or safety of AIMOVIG in these patients, the available data are too limited to make definitive conclusions.

DRUG INTERACTIONS

No Information provided

Warnings & Precautions

WARNINGS

No Information provided

PRECAUTIONS

No Information provided

Patient Counseling Information

Advise the patient to read the FDA-approved patient labeling (PATIENT INFORMATION and Instructions for Use).

Information On Preparation And Administration

Provide guidance to patients and caregivers on proper subcutaneous administration technique, including aseptic technique, and how to use the single-dose prefilled autoinjector or single-dose prefilled syringe [see DOSAGE AND ADMINISTRATION]. Instruct patients and/or caregivers to read and follow the Instructions for Use each time they use AIMOVIG.

Instruct patients prescribed 140 mg to administer the once monthly dosage as two separate subcutaneous injections of 70 mg each.

Advise latex-sensitive patients that the needle shield within the white cap of the AIMOVIG prefilled autoinjector and gray needle cap of the AIMOVIG prefilled syringe contain dry natural rubber (a derivative of latex) that may cause allergic reactions in individuals sensitive to latex [see DOSAGE AND ADMINISTRATION].

For more information, go to www.aimovig.com or call 1-800-77-AMGEN (1-800-772-6436).

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment Of Fertility

Carcinogenesis

The carcinogenic potential of erenumab-aooe has not been assessed.

Mutagenesis

Genetic toxicology studies of erenumab-aooe have not been conducted.

Impairment Of Fertility

Mating studies have not been conducted on erenumab-aooe. No histopathological changes in male or female reproductive organs were observed in monkeys administered erenumab-aooe (0, 25, or 150 mg/kg) by subcutaneous injection twice weekly for up to 6 months. Serum erenumab-aooe exposures (AUC) at the higher dose tested were more than 100 times that in humans at a dose of 140 mg once monthly.

Use In Specific Populations

Pregnancy

Risk Summary

There are no adequate data on the developmental risk associated with the use of AIMOVIG in pregnant women. No adverse effects on offspring were observed when pregnant monkeys were administered erenumab-aooe throughout gestation (see Data). Serum erenumab-aooe exposures in pregnant monkeys were greater than those in humans at clinical doses.

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2%-4% and 15%-20%, respectively. The estimated rate of major birth defects (2.2%-2.9%) and miscarriage (17%) among deliveries to women with migraine are similar to rates reported in women without migraine.

Clinical Considerations

Disease-Associated Maternal And/Or Embryo/Fetal Risk

Published data have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy.

Data

Animal Data

In a study in which female monkeys were administered erenumab-aooe (0 or 50 mg/kg) twice weekly by subcutaneous injection throughout pregnancy (gestation day 20-22 to parturition), no adverse effects on offspring were observed. Serum erenumab-aooe exposures (AUC) in pregnant monkeys were approximately 20 times that in humans at a dose of 140 mg once monthly.

Lactation

Risk Summary

There are no data on the presence of erenumab-aooe in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for AIMOVIG and any potential adverse effects on the breastfed infant from AIMOVIG or from the underlying maternal condition.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Geriatric Use

Clinical studies of AIMOVIG did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Overdosage & Contraindications

OVERDOSE

No Information provided

CONTRAINDICATIONS

None.

Clinical Pharmacology

CLINICAL PHARMACOLOGY

Mechanism Of Action

Erenumab-aooe is a human monoclonal antibody that binds to the calcitonin gene-related peptide (CGRP) receptor and antagonizes CGRP receptor function.

Pharmacodynamics

In a randomized, double-blind, placebo-controlled study in healthy volunteers, concomitant administration of erenumab-aooe (140 mg intravenous, single-dose) with sumatriptan (12 mg subcutaneous, given as two 6 mg doses separated by one hour) had no effect on resting blood pressure compared with sumatriptan alone. AIMOVIG is for subcutaneous use only.

Pharmacokinetics

Erenumab-aooe exhibits non-linear kinetics as a result of binding to the CGRP receptor. The Cmax mean and AUClast mean following subcutaneous administration of a 70 mg once monthly and a 140 mg once monthly dose in healthy volunteers or migraine patients are included in Table 2.

Less than 2-fold accumulation was observed in trough serum concentrations (Cmin) for episodic and chronic migraine patients following subcutaneous administration of 70 mg once monthly and 140 mg once monthly doses (see Table 2). Serum trough concentrations approached steady state by 3 months of dosing. The effective half-life of erenumab-aooe is 28 days.

Table 2: Pharmacokinetic Parameters of AIMOVIG

  AIMOVIG 70 mg Subcutaneously Once Monthly AIMOVIG 140 mg Subcutaneously Once Monthly
Cmax mean (SD)a,b 6.1 (2.1) mcg/mL 15.8 (4.8) mcg/mL
AUClast mean (SD)a,b 159 (58) day*mcg/mL 505 (139) day*mcg/mL
Cmin (SD)
Episodic migraine 5.7 (3.1) mcg/mL 12.8 (6.5) mcg/mL
Chronic migraine 6.2 (2.9) mcg/mL 14.9 (6.5) mcg/mL
a SD = standard deviation
b from a single-dose study

Absorption

Following a single subcutaneous dose of 70 mg or 140 mg erenumab-aooe administered to healthy adults, median peak serum concentrations were attained in approximately 6 days, and estimated absolute bioavailability was 82%.

Distribution

Following a single 140 mg intravenous dose, the mean (SD) volume of distribution during the terminal phase (Vz) was estimated to be 3.86 (0.77) L.

Metabolism And Excretion

Two elimination phases were observed for erenumab-aooe. At low concentrations, the elimination is predominantly through saturable binding to target (CGRP receptor), while at higher concentrations the elimination of erenumab-aooe is largely through a non-specific, non-saturable proteolytic pathway.

Specific Populations

The pharmacokinetics of erenumab-aooe were not affected by age, gender, race, or subtypes of migraine spectrum (episodic or chronic migraine) based on population pharmacokinetics analysis.

Patients With Renal Or Hepatic Impairment

Population pharmacokinetic analysis of integrated data from the AIMOVIG clinical studies did not reveal a difference in the pharmacokinetics of erenumab-aooe in patients with mild or moderate renal impairment relative to those with normal renal function. Patients with severe renal impairment (Egfr < 30 mL/min/1.73 m²) have not been studied. No dedicated clinical studies were conducted to evaluate the effect of hepatic impairment or renal impairment on the pharmacokinetics of erenumab-aooe. Renal or hepatic impairment is not expected to affect pharmacokinetics of erenumab-aooe.

Drug Interaction Studies

P450 Enzymes

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

Oral Contraceptives

In an open-label drug interaction study in healthy female volunteers, erenumab-aooe (140 mg subcutaneous, single-dose) did not affect the pharmacokinetics of a combined oral contraceptive containing ethinyl estradiol and norgestimate.

Sumatriptan

In a study in healthy volunteers, concomitant administration of erenumab-aooe with sumatriptan had no effect on the pharmacokinetics of sumatriptan [see CLINICAL PHARMACOLOGY].

Clinical Studies

The efficacy of AIMOVIG was evaluated as a preventive treatment of episodic or chronic migraine in three randomized, double-blind, placebo-controlled studies: two studies in patients with episodic migraine (4 to 14 migraine days per month) (Study 1 and Study 2) and one study in patients with chronic migraine (≥ 15 headache days per month with ≥ 8 migraine days per month) (Study 3). The studies enrolled patients with a history of migraine, with or without aura, according to the International Classification of Headache Disorders (ICHD-III) diagnostic criteria.

Episodic Migraine

Study 1 (NCT 02456740) was a randomized, multi-center, 6-month, placebo-controlled, double-blind study evaluating AIMOVIG for the preventive treatment of episodic migraine. A total of 955 patients with a history of episodic migraine were randomized to receive either AIMOVIG 70 mg (N = 317), AIMOVIG 140 mg (N = 319), or placebo (N = 319) by subcutaneous injection once monthly (QM) for 6 months. Patients were allowed to use acute headache treatments including migraine-specific medications (i.e., triptans, ergotamine derivatives) and NSAIDs during the study.

The study excluded patients with medication overuse headache as well as patients with myocardial infarction, stroke, transient ischemic attacks, unstable angina, coronary artery bypass surgery, or other revascularization procedures within 12 months prior to screening.

The primary efficacy endpoint was the change from baseline in mean monthly migraine days over months 4 to 6. Secondary endpoints included the achievement of a ≥ 50% reduction from baseline in mean monthly migraine days over months 4 to 6 (“≥ 50% MMD responders”), the change from baseline in mean monthly acute migraine-specific medication days over months 4 to 6, and the change from baseline in mean Migraine Physical Function Impact Diary (MPFID) over months 4 to 6. The MPFID measures the impact of migraine on everyday activities (EA) and physical impairment (PI) using an electronic diary administered daily. Monthly MPFID scores are averaged over 28 days, including days with and without migraine; scores are scaled from 0 to 100. Higher scores indicate worse impact on EA and PI. Reductions from baseline in MPFID scores indicate improvement.

A total of 858 (90%) patients completed the 6-month double-blind study. Patients had a median age of 42 years (range: 18 to 65 years), 85% were female, and 89% were white. Three percent of patients were taking concomitant preventive treatments for migraine. The mean migraine frequency at baseline was approximately 8 migraine days per month and was similar across treatment groups.

AIMOVIG treatment demonstrated statistically significant improvements for key efficacy endpoints compared to placebo, as summarized in Table 3.

Table 3: Efficacy Endpoints Over Months 4 to 6 in Study 1

  AIMOVIG 70 mg Once Monthly
N = 312
AIMOVIG 140 mg Once Monthly
N = 318
Placebo
N = 316
Monthly Migraine Days (MMD)
Change from baseline -3.2 -3.7 -1.8
Difference from placebo -1.4 -1.9  
p-value <0.001 <0.001  
≥ 50% MMD responders
% Responders 43.3% 50.0% 26.6%
Difference from placebo 16.7% 23.4%  
Odds ratio relative to placebo 2.1 2.8  
p-value <0.001 <0.001  
Monthly acute migraine-specific medication days
Change from baseline -1.1 -1.6 -0.2
Difference from placebo -0.9 -1.4  
p-value <0.001 <0.001  

Figure 1: Change from Baseline in Monthly Migraine Days in Study 1a

Change from Baseline in Monthly Migraine Days in Study 1<sup>a</sup> - Illustration

Figure 2 shows the distribution of change from baseline in mean monthly migraine days over months 4 to 6 in bins of 2 days by treatment group. A treatment benefit over placebo for both doses of AIMOVIG is seen across a range of changes from baseline in monthly migraine days.

Figure 2: Distribution of Change from Baseline in Mean Monthly Migraine Days over Months 4 to 6 by Treatment Group in Study 1

Distribution of Change from Baseline in Mean
Monthly Migraine Days over Months 4 to 6 by Treatment Group in Study 1 - Illustration

Compared to placebo, patients treated with AIMOVIG 70 mg once monthly and 140 mg once monthly showed greater reductions from baseline in mean monthly MPFID everyday activity scores averaged over months 4 to 6 [difference from placebo: -2.2 for AIMOVIG 70 mg and -2.6 for AIMOVIG 140 mg; p-value < 0.001 for both], and in mean monthly MPFID physical impairment scores averaged over months 4 to 6 [difference from placebo: -1.9 for AIMOVIG 70 mg and -2.4 for AIMOVIG 140 mg; p-value < 0.001 for both].

Study 2 (NCT 02483585) was a randomized, multi-center, 3-month, placebo-controlled, double-blind study evaluating AIMOVIG for the preventive treatment of episodic migraine. A total of 577 patients with a history of episodic migraine were randomized to receive either AIMOVIG 70 mg (N = 286) or placebo (N = 291) by subcutaneous injection once monthly for 3 months. Patients were allowed to use acute headache treatments including migraine-specific medications (i.e., triptans, ergotamine derivatives) and NSAIDs during the study.

The study excluded patients with medication overuse headache as well as patients with myocardial infarction, stroke, transient ischemic attacks, unstable angina, coronary artery bypass surgery, or other revascularization procedures within 12 months prior to screening.

The primary efficacy endpoint was the change from baseline in monthly migraine days at month 3. Secondary endpoints included the achievement of a ≥ 50% reduction from baseline in monthly migraine days (“≥ 50% MMD responders”), the change from baseline in monthly acute migraine-specific medication days at month 3, and the proportion of patients with at least a 5-point score reduction from baseline in MPFID at month 3.

A total of 546 (95%) patients completed the 3-month double-blind study. Patients had a median age of 43 years (range: 18 to 65 years), 85% were female, and 90% were white. Six to seven percent of patients were taking concomitant preventive migraine treatment. The mean migraine frequency at baseline was approximately 8 migraine days per month and was similar between treatment groups.

AIMOVIG treatment demonstrated statistically significant improvements for key efficacy endpoints compared to placebo, as summarized in Table 4.

Table 4: Efficacy Endpoints at Month 3 for Study 2

  AIMOVIG 70 mg Once Monthly
N = 282
Placebo
N = 288
Monthly Migraine Days (MMD)
Change from baseline -2.9 -1.8
Difference from placebo -1.0  
p-value <0.001  
≥ 50% MMD responders
% Responders 39.7% 29.5%
Difference from placebo 10.2%  
Odds ratio relative to placebo 1.6  
p-value 0.010  
Monthly acute migraine-specific medication days
Change from baseline -1.2 -0.6
Difference from placebo -0.6  
p-value 0.002  

Figure 3: Change from Baseline in Monthly Migraine Days in Study 2a

Change from Baseline in Monthly Migraine
Days in Study 2<sup>a</sup> - Illustration

Figure 4 shows the distribution of change from baseline in monthly migraine days at month 3 in bins of 2 days by treatment group. A treatment benefit over placebo for AIMOVIG is seen across a range of changes from baseline in monthly migraine days.

Figure 4: Distribution of Change from Baseline in Monthly Migraine Days at Month 3 by Treatment Group in Study 2

Distribution of Change from Baseline in
Monthly Migraine Days at Month 3 by Treatment Group in Study 2 - Illustration

The pre-specified analysis for the MPFID was based on at least a 5-point reduction within-patient responder definition. AIMOVIG 70 mg once monthly was not significantly better than placebo for the proportion of responders for everyday activity [difference from placebo: 4.7%; odds ratio = 1.2; p-value = 0.26] and physical impairment [difference from placebo: 5.9%; odds ratio = 1.3; p-value = 0.13]. In an exploratory analysis of the change from baseline in the mean MPFID scores at month 3, patients treated with AIMOVIG 70 mg, as compared to placebo, showed nominally greater reductions of physical impairment scores [difference from placebo: -1.3; p-value = 0.021], but not of everyday activities scores [difference from placebo: -1.1; p-value = 0.061].

Chronic Migraine

Study 3 (NCT 02066415) was a randomized, multi-center, 3-month, placebo-controlled, double-blind study evaluating AIMOVIG as a preventive treatment of chronic migraine. A total of 667 patients with a history of chronic migraine with or without aura were randomized to receive AIMOVIG 70 mg (N = 191), AIMOVIG 140 mg (N = 190), or placebo (N = 286) by subcutaneous injections once monthly for 3 months. Patients were allowed to use acute headache treatments including migraine-specific medications (i.e., triptans, ergotamine derivatives) and NSAIDs during the study.

The study excluded patients with medication overuse headache caused by opiate overuse and patients with concurrent use of migraine preventive treatments. Patients with myocardial infarction, stroke, transient ischemic attacks, unstable angina, coronary artery bypass surgery, or other revascularization procedures within 12 months prior to screening were also excluded.

The primary efficacy endpoint was the change from baseline in monthly migraine days at month 3. Secondary endpoints included the achievement of a ≥ 50% reduction from baseline in monthly migraine days (“≥ 50% MMD responders”) and change from baseline in monthly acute migraine-specific medication days at month 3.

 A total of 631 (95%) patients completed the 3-month double-blind study. Patients had a median age of 43 years (range: 18 to 66 years), 83% were female, and 94% were white. The mean migraine frequency at baseline was approximately 18 migraine days per month and was similar across treatment groups.

AIMOVIG treatment demonstrated statistically significant improvements for key efficacy outcomes compared to placebo, as summarized in Table 5.

Table 5: Efficacy Endpoints at Month 3 in Study 3

  AIMOVIG 70 mg Once Monthly
N = 188
AIMOVIG 140 mg Once Monthly
N = 187
Placebo
N = 281
Monthly Migraine Days (MMD)
Change from baseline -6.6 -6.6 -4.2
Difference from placebo -2.5 -2.5  
p-value <0.001 <0.001  
≥ 50% MMD responders
% Responders 39.9% 41.2% 23.5%
Difference from placebo 16.4% 17.7%  
Odds ratio relative to placebo 2.2 2.3  
p-value <0.001 <0.001  
Monthly acute migraine-specific medication days
Change from baseline -3.5 -4.1 -1.6
Difference from placebo -1.9 -2.6  
p-value <0.001 <0.001  

Figure 5: Change from Baseline in Monthly Migraine Days in Study 3a

Change from Baseline in Monthly Migraine
Days in Study 3<sup>a</sup> - Illustration

Figure 6 shows the distribution of change from baseline in monthly migraine days at month 3 in bins of 3 days by treatment group. A treatment benefit over placebo for both doses of AIMOVIG is seen across a range of changes from baseline in migraine days.

Figure 6: Distribution of Change from Baseline in Monthly Migraine Days at Month 3 by Treatment Group in Study 3

Distribution of Change from Baseline in
Monthly Migraine Days at Month 3 by Treatment Group in Study 3 - Illustration

Medication Guide

PATIENT INFORMATION

AIMOVIG™
(AIM-oh-vig)
(erenumab-aooe) injection, for subcutaneous use

What is AIMOVIG?

AIMOVIG is a prescription medicine used for the preventive treatment of migraine in adults.

It is not known if AIMOVIG is safe and effective in children under 18 years of age.

Before you start using AIMOVIG, tell your healthcare provider about all your medical conditions, including if you are:

  • Allergic to rubber or latex. The needle shield within the white cap of the single-dose prefilled SureClick® autoinjectors and the gray needle cap of the single-dose prefilled syringes contain dry natural rubber.
  • Pregnant or plan to become pregnant. It is not known if AIMOVIG will harm your unborn baby.
  • Breastfeeding or plan to breastfeed. It is not known if AIMOVIG passes into your breast milk. You and your healthcare provider should decide if you will take AIMOVIG or breastfeed.

Tell your pharmacist or healthcare provider about all the medicines you take, including any prescription and over-the-counter medicines, vitamins, or herbal supplements.

How should I take AIMOVIG?

  • See the detailed “Instructions for Use” on complete information on how to take AIMOVIG.
  • Take AIMOVIG exactly as your healthcare provider tells you to take it.
  • Before you inject, always check the label of your single-dose prefilled autoinjector or single-dose prefilled syringe to make sure you have the correct medicine and the correct dose of AIMOVIG.
  • AIMOVIG is injected under your skin (subcutaneously) 1 time each month.
  • AIMOVIG comes in 2 different types of devices: a single-dose (1 time) prefilled autoinjector or a single-dose (1 time) prefilled syringe. Your healthcare provider will prescribe the type and dose that is best for you.
    • If your healthcare provider prescribes the 70 mg dose for you, take 1 injection.
    • If your healthcare provider prescribes the 140 mg dose for you, take 2 separate injections one after another, using a different prefilled autoinjector or prefilled syringe for each injection. If you want to use the same body site for the two separate injections, make sure the second injection it is not at the same spot you used for the first injection.
  •  If you forget to take AIMOVIG or are not able to take the dose at the regular time, take your missed dose as soon as you remember. After that, you can continue to take AIMOVIG 1 time each month from the date of your last dose.

What are possible side effects of AIMOVIG?

The most common side effects of AIMOVIG include: pain, redness, or swelling at the injection site and constipation.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all of the possible side effects of AIMOVIG. Ask your pharmacist or healthcare provider for more information.

Call your healthcare provider for medical advice about side effects. You may report side effects to the FDA at 1-800- FDA-1088. You may also report side effects to Amgen at 1-800-77-AMGEN (1-800-772-6436).

How should I store AIMOVIG?

  • Store AIMOVIG in the refrigerator between 36°F to 46°F (2°C to 8°C).
  • Keep AIMOVIG in the original carton. This will protect the medicine from light.
  • After removing AIMOVIG from the refrigerator, it can be stored at room temperature between 68°F to 77°F (20°C to 25°C) for up to 7 days.
  • Throw away AIMOVIG that has been left at room temperature for more than 7 days.
  • Do not freeze.
  • Do not shake.

Keep AIMOVIG and all medicines out of the reach of children.

General information about the safe and effective use of AIMOVIG.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use AIMOVIG for a condition for which it is not prescribed. Do not give AIMOVIG to other people, even if they have the same symptoms that you have. It can harm them. You can ask your pharmacist or healthcare provider for information about AIMOVIG that is written for healthcare professionals.

What are the ingredients in AIMOVIG?

  • Active Ingredient: erenumab-aooe
  • Inactive Ingredients: acetate, polysorbate 80, and sucrose.

Instructions for Use

AIMOVIG™
(AIM-oh-vig)
(erenumab-aooe) Injection, For Subcutaneous Use

Single-Dose Prefilled SureClick® Autoinjector

Guide to parts

Guide to parts - Illustration

Important: Needle is inside

Important

Before you use AIMOVIG SureClick autoinjector, read this important information:

Storing your AIMOVIG SureClick autoinjector

  • Keep the autoinjector out of the reach of children.
  • Keep the autoinjector in the original carton to protect from light.
  • The autoinjector should be kept in the refrigerator at 36°F to 46°F (2°C to 8°C).
  • After removing AIMOVIG from the refrigerator, it can be stored at room temperature between 68°F to 77°F (20°C to 25°C) for up to 7 days.
  • Throw away AIMOVIG that has been left at room temperature for more than 7 days.
  • Do not freeze.

Using your AIMOVIG SureClick autoinjector

  • The needle shield within the white cap of the AIMOVIG autoinjector contains dry natural rubber, which is made from latex. Tell your healthcare provider if you are allergic to latex.
  • It is important that you do not try to give the injection unless you or your caregiver has received training from your healthcare provider.
  • Do not use the autoinjector after the expiration date on the label.
  • Do not shake the autoinjector.
  • Do not remove the white cap from the autoinjector until you are ready to inject.
  • Do not freeze or use the autoinjector if it has been frozen.
  • Do not use the autoinjector if it has been dropped on a hard surface. Part of the autoinjector may be broken even if you cannot see the break. Use a new autoinjector, and call 1-800-77-AMGEN (1-800-772-6436).

Step 1: Prepare

STOP Read this before you inject.

Check your prescription.

AIMOVIG comes as a single-dose (1 time) prefilled autoinjector. Your healthcare provider will prescribe the dose that is best for you.

  • If your healthcare provider prescribes the 70 mg dose for you, take 1 injection, using a prefilled autoinjector.
  • If your healthcare provider prescribes the 140 mg dose for you, take 2 separate injections one after another, using a different prefilled autoinjector for each injection.

Before you inject, always check the label of your single-dose prefilled autoinjector to make sure you have the correct medicine and the correct dose of AIMOVIG.

A Remove autoinjector from the carton. You may need to use more than 1 autoinjector based on your prescribed dose.

Carefully lift the autoinjector straight up out of the carton.

Leave the autoinjector at room temperature for at least 30 minutes before injecting.

  • Do not put the autoinjector back in the refrigerator after it has reached room temperature.
  • Do not try to warm the autoinjector by using a heat source such as hot water or microwave.
  • Do not leave the autoinjector in direct sunlight.
  • Do not shake the autoinjector.
  • Do not remove the white cap from the autoinjector yet.

B. Inspect the autoinjector.

Inspect the autoinjector - Illustration

Make sure the medicine in the window is clear and colorless to slightly yellow.

  • Do not use the autoinjector if the medicine is cloudy or discolored or contains flakes or particles.
  • Do not use the autoinjector if any part appears cracked or broken.
  • Do not use the autoinjector if the autoinjector has been dropped.
  • Do not use the autoinjector if the white cap is missing or not securely attached.
  • Do not use the autoinjector if the expiration date printed on the label has passed.

In all cases, use a new autoinjector, and call 1-800-77-AMGEN (1-800-772-6436).

C. Gather all materials needed for your injection.

Wash your hands thoroughly with soap and water.

On a clean, well-lit work surface, place the:

  • New autoinjector
  • Alcohol wipes
  • Cotton balls or gauze pads
  • Adhesive bandages
  • Sharps disposal container

Gather all materials needed for your injection - Illustration

D. Prepare and clean your injection site.

Prepare and clean your injection site - Illustration

You can use:

  • Your thigh
  • Stomach area (abdomen), except for a 2 inch area right around your navel
  • Outer area of upper arm (only if someone else is giving you the injection)

Clean your injection site with an alcohol wipe. Let your skin dry.

  • Do not touch this area again before injecting.
  • If you want to use the same body site for the two separate injections needed for the 140 mg dose, make sure the second injection is not at the same spot you used for the first injection.
  • Do not inject into areas where the skin is tender, bruised, red, or hard.
  • Avoid injecting directly into raised, thick, red, or scaly skin patch or lesion, or areas with scars or stretch marks.

Step 2: Get ready

E. Pull the white cap straight off, only when you are ready to inject. Do not leave the white cap off for more than 5 minutes. This can dry out the medicine.

Pull the white cap straight off - Illustration

It is normal to see a drop of liquid at the end of the needle or green safety guard.

  • Do not twist or bend the white cap.
  • Do not put the white cap back onto the autoinjector.
  • Do not remove the white cap from the autoinjector until you are ready to inject.

F. Stretch or pinch your injection site to create a firm surface.

Stretch method

Stretch method - Illustration

Stretch skin firmly by moving your thumb and fingers in opposite directions, creating an area about 2 inches wide.

OR

Pinch method

Pinch method - Illustration

Pinch skin firmly between your thumb and fingers, creating an area about 2 inches wide.

Important: Keep skin stretched or pinched while injecting.

Step 3: Inject

G. Hold the stretch or pinch. With the white cap off, place the autoinjector on your skin at 90 degrees.

Hold the stretch or pinch - Illustration

Important: Do not touch the purple start button yet.

H. Firmly push the autoinjector down onto skin until the autoinjector stops moving.

Firmly push the autoinjector down onto skin until the
autoinjector stops moving - Illustration

Important: You must push all the way down but do not touch the purple start button until you are ready to inject.

I. When you are ready to inject, press the purple start button. You will hear a click.

When you are ready to inject, press the purple start
button - Illustration

J. Keep pushing down on your skin. Your injection could take about 15 seconds. When the injection is complete, you may hear or feel a click and the window will turn yellow.

Keep pushing down on your skin - Illustration

Note: After you remove the autoinjector from your skin, the needle will be automatically covered.

After you remove the autoinjector from your skin,
the needle will be automatically covered - Illustration

Important: When you remove the autoinjector, if the window has not turned yellow, or if it looks like the medicine is still injecting, this means you have not received a full dose. Call your healthcare provider immediately.

Step 4: Finish

K. Discard the used autoinjector and the white cap.

Discard the used autoinjector and the white cap - Illustration

Put the used AIMOVIG autoinjector and white cap in a FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) the SureClick autoinjector in your household trash.

If you do not have a FDA-cleared sharps disposal container, you may use a household container that is:

  • Made of a heavy-duty plastic
  • Can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out
  • Upright and stable during use
  • Leak-resistant
  • Properly labeled to warn of hazardous waste inside the container

When your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. There may be state or local laws about how you should throw away used needles and syringes. For more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the FDA's website at: http://www.fda.gov/safesharpsdisposal

  • Do not reuse the autoinjector.
  • Do not recycle the autoinjector or sharps disposal container or throw them into household trash.

Important: Always keep the sharps disposal container out of the reach of children.

L. Examine the injection site.

If there is blood, press a cotton ball or gauze pad on your injection site. Do not rub the injection site. Apply an adhesive bandage if needed.

M. Check your prescription. If your dose is 140 mg, repeat Steps 1 through 4.

The second injection will complete your dose.

Commonly asked questions

What will happen if I press the purple start button before I am ready to do the injection on my skin?

Even when you press the purple start button, the injection will only happen when the green safety guard is also pushed into the autoinjector.

Can I move the autoinjector around on my skin while I am choosing an injection site?

It is okay to move the autoinjector around on the injection site as long as you do not press the purple start button. However, if you press the purple start button and the green safety guard is pushed into the autoinjector, the injection will begin.

Can I release the purple start button after I start my injection?

You can release the purple start button, but continue to hold the autoinjector firmly against your skin during the injection.

Will the purple start button pop up after I release my thumb?

The purple start button may not pop up after you release your thumb if you held your thumb down during the injection. This is okay.

What do I do if I did not hear a click after pushing the device down on my skin for 15 seconds?

If you did not hear a click, you can confirm a complete injection by checking that the window has turned yellow.

Whom do I contact if I need help with the autoinjector or my injection?

If you need more information or help, visit www.aimovig.com or call 1-800-77- AMGEN (1-800-772-6436).

For more information, go to www.aimovig.com or call 1-800-77-AMGEN (1-800-772- 6436).

Symbol Table - Illustration

Instructions for Use

AIMOVIG™
(AIM-oh-vig)
(erenumab-aooe) Injection, For Subcutaneous Use

Single-Dose Prefilled Syringe

Guide to parts

Guide to parts - Illustration

Important: Needle is inside

Important

Before you use AIMOVIG prefilled syringe, read this important information:

Storing your AIMOVIG prefilled syringe

  • Keep the syringe out of the reach of children.
  • Keep the syringe in the original carton to protect from light.
  • The syringe should be kept in the refrigerator at 36°F to 46°F (2°C to 8°C).
  • After removing AIMOVIG from the refrigerator, it can be stored at room temperature between 68°F to 77°F (20°C to 25°C) for up to 7 days.
  • Throw away AIMOVIG that has been left at room temperature for more than 7 days.
  • Do not freeze.

Using your AIMOVIG prefilled syringe

  • The gray needle cap of the prefilled syringe contains dry natural rubber, which is made from latex. Tell your healthcare provider if you are allergic to latex.
  • It is important that you do not try to give the injection unless you or your caregiver has received training from your healthcare provider.
  • Do not use a syringe after the expiration date on the label.
  • Do not shake the syringe.
  • Do not remove the gray needle cap from the syringe until you are ready to inject.
  • Do not use the syringe if it has been frozen.
  • Do not use a syringe if it has been dropped on a hard surface. Part of the syringe may be broken even if you cannot see the break. Use a new syringe, and call 1-800-77-AMGEN (1-800-772-6436).

Step 1: Prepare

STOP Read this before you inject.

Check your prescription.

AIMOVIG comes as a single-dose (1 time) prefilled syringe. Your healthcare provider will prescribe the dose that is best for you.

  • If your healthcare provider prescribes the 70 mg dose for you, take 1 injection, using a prefilled syringe.
  • If your healthcare provider prescribes the 140 mg dose for you, take 2 separate injections one after another, using a different prefilled syringe for each injection.

Before you inject, always check the label of your single-dose prefilled syringe to make sure you have the correct medicine and the correct dose of AIMOVIG.

A. Remove AIMOVIG prefilled syringe from the carton. You may need to use more than 1 prefilled syringe based on your prescribed dose.

Grab the syringe barrel to remove the syringe from the tray.

Place finger or thumb on edge of tray to secure it while you remove the syringe.

Place finger or thumb on edge of tray to secure it while
you remove the syringe - Illustration

Grab Here

Grab Here - Illustration

For safety reasons:

  • Do not grab the plunger rod.
  • Do not grab the gray needle cap.
  • Do not remove the gray needle cap until you are ready to inject.
  • Do not remove the finger flange. This is part of the syringe.

Leave the syringe at room temperature for at least 30 minutes before injecting.

  • Do not put the syringe back in the refrigerator after it has reached room temperature.
  • Do not try to warm the syringe by using a heat source such as hot water or microwave.
  • Do not leave the syringe in direct sunlight.
  • Do not shake the syringe.

Important: Always hold the prefilled syringe by the syringe barrel.

B. Inspect the AIMOVIG prefilled syringe.

Inspect the AIMOVIG prefilled syringe - Illustration

Always hold the syringe by the syringe barrel.

Make sure the medicine in the syringe is clear and colorless to slightly yellow.

  • Do not use the syringe if the medicine is cloudy or discolored or contains flakes or particles.
  • Do not use the syringe if any part appears cracked or broken.
  • Do not use the syringe if the syringe has been dropped.
  • Do not use the syringe if the gray needle cap is missing or not securely attached.
  • Do not use the syringe if the expiration date printed on the label has passed.

In all cases, use a new syringe, and call 1-800-77-AMGEN (1-800-772-6436).

C. Gather all materials needed for your injection. Wash your hands thoroughly with soap and water. On a clean, well-lit work surface, place the:

  • New syringe
  • Alcohol wipes
  • Cotton balls or gauze pads
  • Adhesive bandages
  • Sharps disposal container

Gather all materials needed for your injection - Illustration

D. Prepare and clean your injection site.

Prepare and clean your injection site - Illustration

You can use:

  • Your thigh
  • Stomach area (abdomen), except for a 2 inch area right around your navel
  • Outer area of upper arm (only if someone else is giving you the injection)

Clean your injection site with an alcohol wipe. Let your skin dry.

  • Do not touch this area again before injecting.
  • If you want to use the same body site for the two separate injections needed for the 140 mg dose, make sure the second injection is not at the same spot you used for the first injection.
  • Do not inject into areas where the skin is tender, bruised, red, or hard. Avoid injecting directly into raised, thick, red, or scaly skin patch or lesion, or areas with scars or stretch marks.

Step 2: Get ready

E. Pull gray needle cap straight out and away from your body, only when you are ready to inject. Do not leave the gray needle cap off for more than 5 minutes. This can dry out the medicine.

Pull gray needle cap straight out - Illustration

It is normal to see a drop of liquid at the end of the needle.

  • Do not twist or bend the gray needle cap.
  • Do not put the gray needle cap back onto the syringe.
  • Do not remove the gray needle cap from the syringe until you are ready to inject.

Important: Throw the gray needle cap into the sharps disposal container.

F. Pinch your injection site to create a firm surface.

Pinch your injection site to create a firm surface - Illustration

Pinch skin firmly between your thumb and fingers, creating an area about 2 inches wide.

Important: Keep skin pinched while injecting.

Step 3: Inject

G. Hold the pinch. With the gray needle cap off, insert the syringe into your skin at 45 to 90 degrees.

Hold the pinch - Illustration

Do not place your finger on the plunger rod while inserting the needle.

H. Place your finger on the plunger rod. Using slow and constant pressure, push the plunger rod all the way down until the prefilled syringe stops moving.

Place your finger on the plunger rod - Illustration

I. When done, release your thumb, and gently lift the syringe off of your skin.

When done, release your thumb, and gently lift the
syringe off of your skin - Illustration

Important: When you remove the syringe, if it looks like the medicine is still in the syringe barrel, this means you have not received a full dose. Call your healthcare provider immediately.

Step 4: Finish

J. Discard the used syringe and the gray needle cap.

Discard the used syringe and the gray needle cap - Illustration

Put the used AIMOVIG syringe and gray needle cap in a FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) the syringe in your household trash.

If you do not have a FDA-cleared sharps disposal container, you may use a household container that is:

  • Made of a heavy-duty plastic
  • Can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out
  • Upright and stable during use
  • Leak-resistant
  • Properly labeled to warn of hazardous waste inside the container

When your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. There may be state or local laws about how you should throw away used needles and syringes. For more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the FDA's website at: http://www.fda.gov/safesharpsdisposal.

  • Do not reuse the syringe.
  • Do not recycle the syringe or sharps disposal container or throw them into household trash.

Important: Always keep the sharps disposal container out of the reach of children.

K Examine the injection site.

If there is blood, press a cotton ball or gauze pad on your injection site. Do not rub the injection site. Apply an adhesive bandage if needed.

L Check your prescription. If your dose is 140 mg, repeat Steps 1 through 4. The second injection will complete your dose.

For more information, go to www.aimovig.com or call 1-800-77-AMGEN (1-800-772-6436).

Symbol table - Illustration

This Instructions for Use has been approved by the U.S. Food and Drug Association.

FDA Logo

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

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