Pediatric migraine: Neurodevelopmental mechanisms, clinical phenotypes, and modern therapeutics

Table 8 Comparison of calcitonin gene-related peptide monoclonal antibodies in pediatric patients

Feature	Erenumab (Aimovig)	Fremanezumab (Ajovy)	Galcanezumab (Emgality)	Eptinezumab (Vyepti)
Mechanism	Targets the CGRP receptor	Targets the CGRP ligand	Targets the CGRP ligand	Targets the CGRP ligand
Route	Subcutaneous injection	Subcutaneous injection	Subcutaneous injection	Intravenous infusion
Dosing frequency	Monthly	Monthly or quarterly	Monthly	Quarterly (every 12 weeks)
Pediatric evidence	Phase 3 trials (OASIS) recently completed/ongoing.	Strong evidence from phase 3 SPACE study; FDA filed for pediatric indication	Phase 3 trials ongoing; shown efficacy in small retrospective cohorts	Phase 3 trials (PROSPECT-1) ongoing; unique for its IV rapid onset
Key safety notes	Association with constipation (unique to receptor blockade)	Most common AE is injection-site erythema	Most common AE is injection-site reaction	Potential for infusion-related reactions; high safety rating in meta-analyses

CGRP: Calcitonin gene-related peptide; FDA: Food and Drug Administration; AEs: Adverse events.