Galcanezumab (Emgality®)

Galcanezumab (Emgality®) is a monoclonal antibody treatment which is now available on the NHS as a possible treatment for preventing migraine in people who:

• have four or more migraine days a month
• have tried at least three other preventative medications which have not worked
• have completed three months of headache diaries (including HIT-6)
• lifestyle modifications (medication and caffeine use) have been addressed

Galcanezumab is given once a month as a subcutaneous injection, which can be self-administered by the patient or carer. Training resources regarding the subcutaneous injection technique, including a video demo, are available on the manufacturer’s website on https://emgality.lilly.com/dosing-for-migraine. The first dose of Galcanezumab is 240 mg (2 x 120mg injections), followed by monthly 120 mg injections.

Galcanezumab requires storage in a refrigerator (2°C- 8°C) in its original package. Prefilled pens can be kept unrefrigerated up to seven days when stored at temperatures up to 30°C.

Galcanezumab is generally well tolerated but potential side effects include injection site pain or reactions (which are usually mild and subside within 24 hours), rashes and constipation. Due to limited safety data, Galcanezumab should not be used during pregnancy or during the first few days of breastfeeding.

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 12 weeks of treatment to assess response. NICE advises that treatment is stopped at that point if:
a. in episodic migraine (i.e <15 headache days a month) the headache frequency does not reduce by at least 50%
b. in chronic migraine (i.e =15 headache days a month with at least 8 of those having features of migraine) the headache frequency does not reduce by at least 30%

Evaluation of the need to continue treatment will continue regularly thereafter, and patients are instructed to bring their filled diaries to every hospital appointment.
NICE does not recommend trying a second antibody therapy if you fail to respond to Galcanezumab.

Galcanezumab prescription management

To make it more convenient for patients, a third party company (Healthcare at Home) 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 Eli-Lilly. Please note that this homecare service arrangement is mandatory and you consenting to start galcanezumab means you have agreed for your details to be shared with Healthcare at Home, which is external to the NHS, to process the delivery of your medication.

Frequently asked questions

Q1. Who will be prescribing my galcanezumab injections?
Your clinical team at The Walton Centre will be responsible for prescribing your galcanezumab injections for the duration of your treatment. However, your prescriptions will be managed by a homecare company called Healthcare at 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.

Q2. When can I start my galcanezumab 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 galcanezumab. However, due to service demand the waiting time can increase to around a couple of months. Once your galcanezumab prescription has been written by your clinical team, it will be processed by the pharmacy homecare team and then posted to Healthcare at Home.

Q3. What should I expect while waiting to start my galcanezumab injections?
Once Healthcare at Home 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.

Q4. Who will be administering my galcanezumab injections?
Galcanezumab is available as a pre-filled pen and is to be self-administered. Prior to administering your first dose, please watch the video demo and read through the information available at https://emgality.lilly.com/how-to-inject-for-migraine. If you require further assistance with self-administering, please see contact list below for the details of who to contact.

Q5. What do I need to do to after I have started my galcanezumab 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.

Q6. Who should I contact if I have a query?

• Query relating to prescription delivery, contact Healthcare at Home on 03331039837
• Query relating to your prescription, contact Healthcare at Home on 03331039837
• Query relating to your headache diaries or administering your injections, contact your consultant’s secretary