Fremanezumab (Ajovy®)

Fremanezumab (Ajovy®) is a monoclonal antibody therapy that has been approved for treatment of chronic migraine.

Fremanezumab (Ajovy®) is a humanised monoclonal antibody that binds to the calcitonin gene-related peptide (CGRP) ligand, inhibiting the function of CGRP at its receptor on the trigeminal nerve, and thereby preventing migraine attacks. It comes as 225mg solution for injection in pre-filled syringes/pens to be given subcutaneously in the abdomen, thighs and upper arms once a month by the patient or a carer.

We would advise against the use of this drug during pregnancy and breast feeding, as well as in those with major cardiovascular disease.

Side-effects include hypersensitivity (allergic) and injection site reactions such as redness, swelling, itching and induration.

We are not aware that this medication is harmful in the following situations but advise caution and therefore do not prescribe if you:

1. Are pregnant, breastfeeding, or planning pregnancy
2. Are female and potentially fertile and not using reliable contraception
3. Have significant ischaemic cardiovascular disease (i.e. recent myocardial infarction (heart attack) or have severe or unstable angina.

It is a mandatory requirement that patients starting treatment are lifestyle compliant and keep headache diaries in the format recommended by The Walton Centre, so that response to treatment can be assessed. Headache diaries are available to download and print.

The diaries will be reviewed after around 12 weeks of treatment to assess your response, and only those patients who have had more than 30% improvement in their headache days will continue on treatment. In patients who have not responded, other management options will be considered. We will continue to keep your treatment under review on an annual basis and only continue treatment if you continue to respond.

If you are currently receiving botox treatment, this treatment will be stopped as both these treatments have a similar mode of action and therefore, you would not need to be on both at the same time.

Fremanezumab prescription management
To make it more convenient for patients, a third part company (Alcura Homecare) will deliver your injections directly to your home address or preferred location. Initially the delivery will be each month and then every three months, after your 12-week review. This service is funded by Teva. Please note that this homecare service arrangement is mandatory and you consenting to start fremanezumab means you have agreed for your details to be shared with Alcura Homecare, which is external to the NHS, to process the delivery of your medication.

Frequently asked questions

Who will be prescribing my fremanezumab injections?
Your clinical team at The Walton Centre will be responsible for prescribing your fremanezumab injections for the duration of your treatment. However, your prescriptions will be managed by a homecare company called Alcura Homecare. Your initial prescription will be for a 12-week supply and then if you have responded well, a follow-up prescription for 52 weeks will be written by your consultant.

When can I start my fremanezumab treatment once it has all been agreed with my clinical team?

It takes on average about four weeks from completing the prescription to receiving your first delivery of fremanezumab. However, due to service demand, the waiting time can increase to around a couple of months. Once your fremanezumab prescription has been written by your clinical team, it will be processed by the pharmacy homecare team and then posted to Alcura Homecare.

What should I expect while waiting to start my fremanezumab injections?
Once Alcura Homecare has received your prescription, they will contact you via telephone directly to register you on their systems and arrange prescription delivery. Please note they may call you on a withheld number and usually only make three attempts. Please try to answer their call when received.

Who will be administering my fremanezumab injections?
Fremanezumab is available as a pre-filled pen and is to be self-administered. The Alcura nursing team will provide you with training on how to administer the pen device. This training will either be in person or via video, depending on nurse availability and your preference. Teva have designed information resources for patients. Please be advised click on the links below to read the material and watch the video:

Patient information leaflet

Understanding how fremanezumab works and how to inject videos

What do I need to do to after I have started my fremanezumab injections?
It is a mandatory requirement that all patients are reviewed after around 12-weeks to assess response to treatment. To be able to do this, your consultant will require your headache diaries to ensure this review occurs in a timely manner. Once reviewed your follow-up prescription can be arranged, if there is adequate response.

Who should I contact if I have a query?

• Query relating to prescription delivery, contact Alcura Homecare on 08009800686
• Query relating to your prescription, contact Alcura Homecare on 08009800686
• Query relating to your headache diaries or administering your injections, contact your consultant’s secretary