1HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use
EMGALITY safely and effectively. See full prescribing information
for EMGALITY.
EMGALITY (galcanezumab-gnlm) injection, for subcutaneous use
Initial U.S. Approval: 2018---------------------------- INDICATIONS AND USAGE --------------------------EMGALITY® is a calcitonin-gene related peptide antagonist indicated in
adults for the:•preventive treatment of migraine. (1.1)•

treatment of episodic cluster headache. (1.2)------------------------DOSAGE AND ADMINISTRATION----------------------•For subcutaneous use only. (2.1, 2.2, 2.3)•

Migraine recommended dosage: 240 mg loading dose
(administered as two consecutive injections of 120 mg each),followed by monthly doses of 120 mg. (2.1)•

Episodic cluster headache recommended dosage: 300 mg(administered as three consecutive injections of 100 mg each) at
the onset of the cluster period, and then monthly until the end of
the cluster period. (2.2)•

Administer in the abdomen, thigh, back of the upper arm, orbuttocks subcutaneously. (2.3)----------------------DOSAGE FORMS AND STRENGTHS--------------------•

Injection: 120 mg/mL solution in a single-dose prefilled pen (3)•Injection: 120 mg/mL solution in a single-dose prefilled syringe (3)•Injection: 100 mg/mL solution in a single-dose prefilled syringe (3)------------------------------- CONTRAINDICATIONS -----------------------------EMGALITY is contraindicated in patients with serious hypersensitivity
to galcanezumab-gnlm or to any of the excipients. (4)------------------------ WARNINGS AND PRECAUTIONS ----------------------Hypersensitivity Reactions: If a serious hypersensitivity reaction
occurs, discontinue administration of EMGALITY and initiate
appropriate therapy. Hypersensitivity reactions can occur days afteradministration, and may be prolonged. (5.1)------------------------------- ADVERSE REACTIONS -----------------------------The most common adverse reactions (incidence ≥2% and at least 2%
greater than placebo) in EMGALITY clinical studies were injection site
reactions. (6.1)
To report SUSPECTED ADVERSE REACTIONS, contact Eli Lilly
and Company at 1-800-LillyRx (1-800-545-5979) or FDA at
1-800-FDA-1088 or www.fda.gov/medwatch.
See 17 for PATIENT COUNSELING INFORMATION and FDAapproved patient labeling.
Revised: 03/2021

FULL PRESCRIBING INFORMATION: CONTENTS*

11

DESCRIPTION

1

INDICATIONS AND USAGE
1.1 Migraine
1.2 Episodic Cluster Headache

12

2

DOSAGE AND ADMINISTRATION
2.1 Recommended Dosing for Migraine
2.2 Recommended Dosing for Episodic Cluster Headache
2.3 Important Administration Instructions

CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.2 Pharmacodynamics
12.3 Pharmacokinetics

13

NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

14

CLINICAL STUDIES
14.1 Migraine
14.2 Episodic Cluster Headache

16

HOW SUPPLIED/STORAGE AND HANDLING
16.1 How Supplied
16.2 Storage and Handling

17

PATIENT COUNSELING INFORMATION

3DOSAGE FORMS AND STRENGTHS

4CONTRAINDICATIONS5WARNINGS AND PRECAUTIONS
5.1 Hypersensitivity Reactions

6

ADVERSE REACTIONS
6.1 Clinical Trials Experience
6.2 Immunogenicity
6.3 Postmarketing Experience8

USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.2 Lactation
8.4 Pediatric Use
8.5 Geriatric Use* Sections or subsections omitted from the full prescribing information
are not listed.

2
FULL PRESCRIBING INFORMATION
1

INDICATIONS AND USAGE

1.1

Migraine

EMGALITY is indicated for the preventive treatment of migraine in adults.
1.2

Episodic Cluster Headache

EMGALITY is indicated for the treatment of episodic cluster headache in adults.
2

DOSAGE AND ADMINISTRATION

2.1

Recommended Dosing for Migraine

The recommended dosage of EMGALITY is 240 mg (two consecutive subcutaneous injections of 120 mg each) once as aloading dose, followed by monthly doses of 120 mg injected subcutaneously.
If a dose of EMGALITY is missed, administer as soon as possible. Thereafter, EMGALITY can be scheduled monthly fromthe date of the last dose.
2.2

Recommended Dosing for Episodic Cluster Headache

The recommended dosage of EMGALITY is 300 mg (three consecutive subcutaneous injections of 100 mg each) at theonset of the cluster period, and then monthly until the end of the cluster period.
If a dose of EMGALITY is missed during a cluster period, administer as soon as possible. Thereafter, EMGALITY can bescheduled monthly from the date of the last dose until the end of the cluster period.
2.3

Important Administration Instructions

EMGALITY is for subcutaneous use only.
EMGALITY is intended for patient self-administration. Prior to use, provide proper training to patients and/or caregivers on
how to prepare and administer EMGALITY using the single-dose prefilled pen or single-dose prefilled syringe, including
aseptic technique [see How Supplied/Storage and Handling (16.2) and Instructions for Use]:• Protect EMGALITY from direct sunlight.
• Prior to subcutaneous administration, allow EMGALITY to sit at room temperature for 30 minutes. Do notwarm by using a heat source such as hot water or a microwave.
• Do not shake the product.
• Inspect EMGALITY visually for particulate matter and discoloration prior to administration, whenever solution
and container permit [see Dosage Forms and Strengths (3) and How Supplied/Storage and Handling (16.1)].
Do not use EMGALITY if it is cloudy or there are visible particles.
• Administer EMGALITY in the abdomen, thigh, back of the upper arm, or buttocks subcutaneously. Do notinject into areas where the skin is tender, bruised, red, or hard.
• Both the prefilled pen and prefilled syringe are single-dose and deliver the entire contents.
3

DOSAGE FORMS AND STRENGTHSEMGALITY is a sterile clear to opalescent, colorless to slightly yellow to slightly brown solution available as follows:• Injection: 120 mg/mL in a single-dose prefilled pen• Injection: 120 mg/mL in a single-dose prefilled syringe• Injection: 100 mg/mL in a single-dose prefilled syringe
4

CONTRAINDICATIONS3
EMGALITY is contraindicated in patients with serious hypersensitivity to galcanezumab-gnlm or to any of the excipients[see Warnings and Precautions (5.1)].
5

WARNINGS AND PRECAUTIONS

5.1

Hypersensitivity Reactions

Hypersensitivity reactions, including dyspnea, urticaria, and rash, have occurred with EMGALITY in clinical studies andthe postmarketing setting. Cases of anaphylaxis and angioedema have also been reported in the postmarketing setting. If
a serious or severe hypersensitivity reaction occurs, discontinue administration of EMGALITY and initiate appropriate
therapy [see Contraindications (4), Adverse Reactions (6.1), and Patient Counseling Information (17)]. Hypersensitivity
reactions can occur days after administration and may be prolonged.
6

ADVERSE REACTIONS

The following clinically significant adverse reactions are described elsewhere in the labeling:• Hypersensitivity Reactions [see Contraindications (4) and Warnings and Precautions (5.1)]
6.1

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 with rates in clinical trials of another drug and may not reflect the rates observed inclinical practice.
Migraine
The safety of EMGALITY has been evaluated in 2586 patients with migraine who received at least one dose of
EMGALITY, representing 1487 patient-years of exposure. Of these, 1920 patients were exposed to EMGALITY once
monthly for at least 6 months, and 526 patients were exposed for 12 months.
In placebo-controlled clinical studies (Studies 1, 2, and 3), 705 patients received at least one dose of EMGALITY 120 mg
once monthly, and 1451 patients received placebo, during 3 months or 6 months of double-blind treatment [see ClinicalStudies (14.1)]. Of the EMGALITY-treated patients, approximately 85% were female, 77% were white, and the mean age
was 41 years at study entry.
The most common adverse reaction was injection site reactions. In Studies 1, 2, and 3, 1.8% of patients discontinued
double-blind treatment because of adverse events. Table 1 summarizes the adverse reactions that occurred within up to 6
months of treatment in the migraine studies.
Table 1: Adverse Reactions Occurring in Adults with Migraine with an Incidence of at least 2% for EMGALITY andat least 2% Greater than Placebo (up to 6 Months of Treatment) in Studies 1, 2, and 3
Adverse Reaction

Injection site reactionsaa

EMGALITY 120 mg
Monthly(N=705)%

PlaceboMonthly(N=1451)%

18

13

Injection site reactions include multiple related adverse event terms, such as injection site pain, injection site reaction,
injection site erythema, and injection site pruritus.

Episodic Cluster Headache
EMGALITY was studied for up to 2 months in a placebo-controlled trial in patients with episodic cluster headache (Study4) [see Clinical Studies (14.2)]. A total of 106 patients were studied (49 on EMGALITY and 57 on placebo). Of the
EMGALITY-treated patients, approximately 84% were male, 88% were white, and the mean age was 47 years at study
entry. Two EMGALITY-treated patients discontinued double-blind treatment because of adverse events.

4Overall, the safety profile observed in patients with episodic cluster headache treated with EMGALITY 300 mg monthly is
consistent with the safety profile in migraine patients.
6.2

Immunogenicity

As with all therapeutic proteins, there is potential for immunogenicity. The detection of antibody formation 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 galcanezumab-gnlm in the studies described below with
the incidence of antibodies in other studies or to other products may be misleading.
The immunogenicity of EMGALITY has been evaluated using an in vitro immunoassay for the detection of binding antigalcanezumab-gnlm antibodies. For patients whose sera tested positive in the screening immunoassay, an in vitro ligandbinding immunoassay was performed to detect neutralizing antibodies.
In controlled studies with EMGALITY up to 6 months (Study 1, Study 2, and Study 3), the incidence of anti-galcanezumabgnlm antibody development was 4.8% (33/688) in patients receiving EMGALITY once monthly (32 out of 33 of whom hadin vitro neutralizing activity). With 12 months of treatment in an open-label study, up to 12.5% (16/128) of EMGALITYtreated patients developed anti-galcanezumab-gnlm antibodies, most of whom tested positive for neutralizing antibodies.
Although anti-galcanezumab-gnlm antibody development was not found to affect the pharmacokinetics, safety or efficacy
of EMGALITY in these patients, the available data are too limited to make definitive conclusions.
6.3

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of EMGALITY. Because these reactions
are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or
establish a causal relationship to EMGALITY exposure.
Immune System Disorders — Anaphylaxis, angioedema [see Contraindications (4) and Warnings and Precautions (5.1)].
Skin and Subcutaneous Tissue Disorders — Rash.
8

USE IN SPECIFIC POPULATIONS

8.1

Pregnancy

Pregnancy Exposure Registry
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to EMGALITY during
pregnancy. Healthcare providers are encouraged to register pregnant patients, or pregnant women may enroll themselvesin the registry by calling 1-833-464-4724 or by contacting the company at www.migrainepregnancyregistry.com.
Risk Summary
There are no adequate data on the developmental risk associated with the use of EMGALITY in pregnant women.
Administration of galcanezumab-gnlm to rats and rabbits during the period of organogenesis or to rats throughout
pregnancy and lactation at plasma exposures greater than that expected clinically did not result in adverse effects ondevelopment (see Animal Data).
In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinicallyrecognized 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.

5
Data
Animal Data
When galcanezumab-gnlm was administered to female rats by subcutaneous injection in two studies (0, 30, or 100 mg/kg;
0 or 250 mg/kg) prior to and during mating and continuing throughout organogenesis, no adverse effects on embryofetal
development were observed. The highest dose tested (250 mg/kg) was associated with a plasma exposure (Cave, ss) 38 or
18 times that in humans at the recommended human dose (RHD) for migraine (120 mg) or episodic cluster headache(300 mg), respectively. Administration of galcanezumab-gnlm (0, 30, or 100 mg/kg) by subcutaneous injection to pregnant
rabbits throughout the period of organogenesis produced no adverse effects on embryofetal development. The higher
dose tested was associated with a plasma Cave, ss 64 or 29 times that in humans at 120 mg or 300 mg, respectively.
Administration of galcanezumab-gnlm (0, 30, or 250 mg/kg) by subcutaneous injection to rats throughout pregnancy andlactation produced no adverse effects on pre- and postnatal development. The higher dose tested was associated with aplasma Cave, ss 34 or 16 times that in humans at 120 mg or 300 mg, respectively.
8.2

Lactation

Risk Summary
There are no data on the presence of galcanezumab-gnlm 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’sclinical need for EMGALITY and any potential adverse effects on the breastfed infant from EMGALITY or from theunderlying maternal condition.
8.4

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.
8.5

Geriatric Use

Clinical studies of EMGALITY did not include sufficient numbers of patients aged 65 and over to determine whether they
respond differently from younger patients.
11

DESCRIPTION

Galcanezumab-gnlm is a humanized IgG4 monoclonal antibody specific for calcitonin-gene related peptide (CGRP)
ligand. Galcanezumab-gnlm is produced in Chinese Hamster Ovary (CHO) cells by recombinant DNA technology.
Galcanezumab-gnlm is composed of two identical immunoglobulin kappa light chains and two identical immunoglobulin
gamma heavy chains and has an overall molecular weight of approximately 147 kDa.
EMGALITY (galcanezumab-gnlm) injection is a sterile, preservative-free, clear to opalescent and colorless to slightly
yellow to slightly brown solution, for subcutaneous use. EMGALITY is supplied in a 1 mL single-dose prefilled pen todeliver 120 mg of galcanezumab-gnlm or a 1 mL single-dose prefilled syringe to deliver 100 mg or 120 mg of
galcanezumab-gnlm. Each mL of solution contains 100 mg or 120 mg of galcanezumab-gnlm; L-histidine (0.5 mg); Lhistidine hydrochloride monohydrate (1.5 mg); Polysorbate 80 (0.5 mg); Sodium Chloride (8.8 mg); Water for Injection,
USP. The pH range is 5.3 - 6.3.
12

CLINICAL PHARMACOLOGY

12.1

Mechanism of Action

Galcanezumab-gnlm is a humanized monoclonal antibody that binds to calcitonin gene-related peptide (CGRP) ligand
and blocks its binding to the receptor.
12.2

Pharmacodynamics

There are no relevant data on the pharmacodynamic effects of galcanezumab-gnlm.
12.3

Pharmacokinetics

Galcanezumab-gnlm exhibits linear pharmacokinetics and exposure increases proportionally with doses between 1 and
600 mg.

6
A loading dose of 240 mg achieved the serum galcanezumab-gnlm steady-state concentration after the first dose. A doseof 300 mg monthly would achieve steady-state concentration after the fourth dose. The time to maximum concentration is
5 days, and the elimination half-life is 27 days.
There was no difference in pharmacokinetic parameters between healthy volunteers, patients with episodic or chronic
migraine, and patients with episodic cluster headache.
Absorption
Following a subcutaneous dose of galcanezumab-gnlm, the time to maximum concentration was about 5 days.
Injection site location did not significantly influence the absorption of galcanezumab-gnlm.
Distribution
The apparent volume of distribution (V/F) of galcanezumab-gnlm was 7.3 L (34% Inter Individual Variability [IIV]).
Metabolism and Elimination
Galcanezumab-gnlm is expected to be degraded into small peptides and amino acids via catabolic pathways in the samemanner as endogenous IgG.
The apparent clearance (CL/F) of galcanezumab-gnlm was 0.008 L/h and the elimination half-life of galcanezumab wasapproximately 27 days.
Specific Populations
Age, Sex, Weight, Race, Ethnicity
The pharmacokinetics of galcanezumab-gnlm were not affected by age, sex, race, subtypes of migraine spectrum(episodic or chronic migraine), or headache diagnosis (migraine vs. episodic cluster headache) based on a population
pharmacokinetics analysis. Body weight has no clinically relevant effect on the pharmacokinetics of galcanezumab-gnlm.
Patients with Renal or Hepatic Impairment
Renal and hepatic impairment are not expected to affect the pharmacokinetics of galcanezumab-gnlm. Population
pharmacokinetic analysis of integrated data from the galcanezumab-gnlm clinical studies revealed that creatinine
clearance did not affect the pharmacokinetics of galcanezumab-gnlm in patients with mild or moderate renal impairment.
Patients with severe renal impairment (creatinine clearance <30 mL/min) have not been studied. Based on a population
PK analysis, bilirubin concentration did not significantly influence the CL/F of galcanezumab-gnlm.
No dedicated clinical studies were conducted to evaluate the effect of hepatic impairment or renal impairment on thepharmacokinetics of galcanezumab-gnlm.
Drug Interaction Studies
P450 Enzymes
Galcanezumab-gnlm is not metabolized by cytochrome P450 enzymes; therefore, interactions with concomitant
medications that are substrates, inducers, or inhibitors of cytochrome P450 enzymes are unlikely.
13

NONCLINICAL TOXICOLOGY

13.1

Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenesis
The carcinogenic potential of galcanezumab-gnlm has not been assessed.
Mutagenesis

7
Genetic toxicology studies of galcanezumab-gnlm have not been conducted.
Impairment of Fertility
When galcanezumab-gnlm (0, 30, or 250 mg/kg) was administered to male rats by subcutaneous injection prior to andduring mating, no adverse effects on fertility was observed. The higher dose tested was associated with a plasma
exposure (Cave, ss) 8 or 4 times that in humans at the recommended human dose (RHD) for migraine (120 mg) or episodic
cluster headache (300 mg), respectively. When galcanezumab-gnlm was administered to female rats by subcutaneous
injection in two studies (0, 30, or 100 mg/kg; 0 or 250 mg/kg) prior to and during mating and continuing throughout
organogenesis, no adverse effects on fertility were observed. The highest dose tested (250 mg/kg) was associated with aplasma Cave, ss 38 or 18 times that in humans at 120 mg or 300 mg, respectively.
14

CLINICAL STUDIES

14.1

Migraine

The efficacy of EMGALITY was evaluated as a preventive treatment of episodic or chronic migraine in three multicenter,randomized, double-blind, placebo-controlled studies: two 6-month studies in patients with episodic migraine (Studies 1
and 2) and one 3-month study in patients with chronic migraine (Study 3).
Episodic Migraine
Study 1 (NCT02614183) and Study 2 (NCT02614196) included adults with a history of episodic migraine (4 to 14 migrainedays per month). All patients were randomized in a 1:1:2 ratio to receive once-monthly subcutaneous injections of
EMGALITY 120 mg, EMGALITY 240 mg, or placebo. All patients in the 120 mg EMGALITY group received an initial
240 mg loading dose. Patients were allowed to use acute headache treatments, including migraine-specific medications(i.e., triptans, ergotamine derivatives), NSAIDs, and acetaminophen during the study.
The studies excluded patients on any other migraine preventive treatment, patients with medication overuse headache,patients with ECG abnormalities compatible with an acute cardiovascular event and patients with a history of stroke,
myocardial infarction, unstable angina, percutaneous coronary intervention, coronary artery bypass grafting, deep veinthrombosis, or pulmonary embolism within 6 months of screening.
The primary efficacy endpoint for Studies 1 and 2 was the mean change from baseline in the number of monthly migraine
headache days over the 6-month treatment period. Key secondary endpoints included response rates (the mean
percentages of patients reaching at least 50%, 75%, and 100% reduction from baseline in the number of monthly migraine
headache days over the 6-month treatment period), the mean change from baseline in the number of monthly migraine
headache days with use of any acute headache medication during the 6-month treatment period, and the impact of
migraine on daily activities, as assessed by the mean change from baseline in the average Migraine-Specific Quality ofLife Questionnaire version 2.1 (MSQ v2.1) Role Function-Restrictive domain score during the last 3 months of treatment(Months 4 to 6). Scores are scaled from 0 to 100, with higher scores indicating less impact of migraine on daily activities.
In Study 1, a total of 858 patients (718 females, 140 males) ranging in age from 18 to 65 years, were randomized. A totalof 703 patients completed the 6-month double-blind phase. In Study 2, a total of 915 patients (781 female, 134 male)ranging in age from 18 to 65 years, were randomized. A total of 785 patients completed the 6-month double-blind phase.
In Study 1 and Study 2, the mean migraine frequency at baseline was approximately 9 migraine days per month, and was
similar across treatment groups.
EMGALITY 120 mg demonstrated statistically significant improvements for efficacy endpoints compared to placebo overthe 6-month period, as summarized in Table 2. EMGALITY treatment with the 240 mg once-monthly dose showed no
additional benefit over the EMGALITY 120 mg once-monthly dose.

8
Table 2: Efficacy Endpoints in Studies 1 and 2
Study 1EMGALITY
120 mgN = 210Monthly Migraine Headache Days (over Months 1 to 6)

Study 2
Placebo

Placebo

N = 425EMGALITY
120 mgN = 226

N = 450

Baseline migraine headache days

9.2

9.1

9.1

9.2

Mean change from baseline

-4.7

-2.8

-4.3

-2.3

Difference from placeboa-1.9≥50% Migraine Headache Days Responders (over Months 1 to 6)% Respondersa

62%≥75% Migraine Headache Days Responders (over Months 1 to 6)% Respondersa
39%

-2.0
39%

59%

36%

19%

34%

18%

16%
6%
12%
Monthly Migraine Headache Days that Acute Medication was Taken (over Months 1 to 6)

6%

100% Migraine Headache Days Responders (over Months 1 to 6)% Respondersa

Mean change from baseline (days)a

-4.0
-2.2
MSQ Role Function-Restrictive Domain Score (over Months 4 to 6)

a
b

-3.7

-1.9

Baseline

51.4

52.9

52.5

51.4

Mean change from baselineb

32.4

24.7

28.5

19.7

Difference from placeboa

7.7

8.8

p<0.001
N = 189 for EMGALITY 120 mg and N = 377 for placebo in Study 1; N = 213 for EMGALITY 120 mg and N = 396 forplacebo in Study 2.
Figure 1: Change from Baseline in Monthly Migraine Headache Days in Study 1aaLeast-square means and 95% confidence intervals are presented.

Figure 2: Change from Baseline in Monthly Migraine Headache Days in Study 2aa9Least-square means and 95% confidence intervals are presented.

Figure 3 shows the distribution of change from baseline in the mean number of monthly migraine headache days in binsof 2 days, by treatment group, in Study 1. A treatment benefit over placebo for EMGALITY is seen across a range ofchanges from baseline in monthly migraine headache days.
Figure 3: Distribution of Change from Baseline in Mean Monthly Migraine Headache Days over Months 1 to 6 byTreatment Group in Study 1

Figure 4 shows the distribution of change from baseline in the mean number of monthly migraine headache days in binsof 2 days, by treatment group, in Study 2. A treatment benefit over placebo for EMGALITY is seen across a range ofchanges from baseline in monthly migraine headache days.

10
Figure 4: Distribution of Change from Baseline in Mean Monthly Migraine Headache Days over Months 1 to 6 byTreatment Group in Study 2

Chronic Migraine
Study 3 (NCT02614261) included adults with a history of chronic migraine (≥15 headache days per month with
≥8 migraine days per month). All patients were randomized in a 1:1:2 ratio to receive once-monthly subcutaneous
injections of EMGALITY 120 mg, EMGALITY 240 mg, or placebo over a 3-month treatment period. All patients in the
120 mg EMGALITY group received an initial 240 mg loading dose.
Patients were allowed to use acute headache treatments including migraine-specific medications (i.e., triptans,ergotamine derivatives), NSAIDs, and acetaminophen. A subset of patients (15%) was allowed to use one concomitantmigraine preventive medication. Patients with medication overuse headache were allowed to enroll.
The study excluded patients with ECG abnormalities compatible with an acute cardiovascular event, and patients with ahistory of stroke, myocardial infarction, unstable angina, percutaneous coronary intervention, coronary artery bypass
grafting, deep vein thrombosis, or pulmonary embolism within 6 months of screening.
The primary endpoint was the mean change from baseline in the number of monthly migraine headache days over the 3month treatment period. The secondary endpoints were response rates (the mean percentages of patients reaching atleast 50%, 75% and 100% reduction from baseline in the number of monthly migraine headache days over the 3-monthtreatment period), the mean change from baseline in the number of monthly migraine headache days with use of any
acute headache medication during the 3-month treatment period, and the impact of migraine on daily activities asassessed by the mean change from baseline in the MSQ v2.1 Role Function-Restrictive domain score at Month 3. Scores
are scaled from 0 to 100, with higher scores indicating less impact of migraine on daily activities.
In Study 3, a total of 1113 patients (946 female, 167 male) ranging in age from 18 to 65 years, were randomized. A total of1037 patients completed the 3-month double-blind phase. The mean number of monthly migraine headache days atbaseline was approximately 19.
EMGALITY 120 mg demonstrated statistically significant improvement for the mean change from baseline in the numberof monthly migraine headache days over the 3-month treatment period, and in the mean percentage of patients reachingat least 50% reduction from baseline in the number of monthly migraine headache days over the 3-month treatment

11
period, as summarized in Table 3. EMGALITY treatment with the 240 mg once-monthly dose showed no additional benefit
over the EMGALITY 120 mg once-monthly dose.
Table 3: Efficacy Endpoints in Study 3

Monthly Migraine Headache Days (over Months 1 to 3)
Baseline migraine headache days
Mean change from baseline

EMGALITY
120 mgN = 273

Placebo

19.4

19.6

-4.8

-2.7

N =538Difference from placeboa-2.1≥50% Migraine Headache Days Responders (over Months 1 to 3)% Respondersa
a

28%

15%

p<0.001

Study 3 utilized a sequential testing procedure to control the Type-I error rate for the multiple secondary endpoints. Oncea secondary endpoint failed to reach the required level for statistical significance, formal hypothesis testing was
terminated for subsequent endpoints, and p-values were considered nominal only. In Study 3, EMGALITY 120 mg was
not significantly better than placebo for the proportion of patients with ≥75% or 100% reduction in migraine headachedays. Patients treated with EMGALITY 120 mg showed a nominally greater reduction in the number of monthly migraine
headache days that acute medication was taken (-4.7 for EMGALITY 120 mg vs. -2.2 for placebo; nominal p-value<0.001), and the mean change from baseline in the MSQ Role Function-Restrictive Domain score at Month 3 wasnominally greater in patients treated with EMGALITY 120 mg than in patients on placebo (21.8 for EMGALITY 120 mg vs.
16.8 for placebo; nominal p-value <0.001).
Figure 5: Change from Baseline in Monthly Migraine Headache Days in Study 3aaLeast-square means and 95% confidence intervals are presented.

12
Figure 6 shows the distribution of change from baseline in the mean number of monthly migraine headache days for the
3-month study period in bins of 3 days by treatment group. A treatment benefit over placebo for EMGALITY is seen
across a range of changes from baseline in monthly migraine headache days.
Figure 6: Distribution of Change from Baseline in Mean Monthly Migraine Headache Days over Months 1 to 3 byTreatment Group in Study 3

14.2

Episodic Cluster Headache

The efficacy of EMGALITY was evaluated for the treatment of episodic cluster headache in a randomized, 8-week,
double-blind, placebo-controlled study (Study 4).
Study 4 (NCT02397473) included adults who met the International Classification of Headache Disorders 3rd edition (betaversion) diagnostic criteria for episodic cluster headache and had a maximum of 8 attacks per day, a minimum of one
attack every other day, and at least 4 attacks during the prospective 7-day baseline period. All patients were randomized
in a 1:1 ratio to receive once-monthly subcutaneous injections of EMGALITY 300 mg or placebo. Patients were allowed touse certain specified acute/abortive cluster headache treatments, including triptans, oxygen, acetaminophen, and NSAIDs
during the study.
The study excluded patients on other treatments intended to reduce the frequency of cluster headache attacks; patientswith medication overuse headache; patients with ECG abnormalities compatible with an acute cardiovascular event or
conduction delay; and patients with a history of myocardial infarction, unstable angina, percutaneous coronary
intervention, coronary artery bypass grafting, deep vein thrombosis, or pulmonary embolism within 6 months of screening.
In addition, patients with any history of stroke, intracranial or carotid aneurysm, intracranial hemorrhage, or vasospastic
angina; clinical evidence of peripheral vascular disease; or diagnosis of Raynaud’s disease were excluded.
The primary efficacy endpoint for Study 4 was the mean change from baseline in weekly cluster headache attack
frequency across Weeks 1 to 3. A secondary endpoint was the percentage of patients who achieved a response (defined
as a reduction from baseline of 50% or greater in the weekly cluster headache attack frequency) at Week 3.
In Study 4, a total of 106 patients (88 males, 18 females) ranging in age from 19 to 65 years were randomized andtreated. A total of 90 patients completed the 8-week double-blind phase. In the prospective baseline phase, the mean
number of weekly cluster headache attacks was 17.5, and was similar across treatment groups.

13
EMGALITY 300 mg demonstrated statistically significant improvements for efficacy endpoints compared to placebo, assummarized in Table 4.
Table 4: Efficacy Endpoints in Study 4
EMGALITY
300 mgN = 49Mean Reduction in Weekly Cluster Headache Attack Frequency (over Weeks 1 to 3)

Placebo
N = 57

Prospective Baseline Cluster Headache
Attack Frequency
Mean change from baseline

17.8

17.3

-8.7

-5.2

Difference from placebo-3.5

p-value

0.036≥50% Weekly Cluster Headache Attack Frequency Responders (at Week 3)% Responders

71.4%

Difference from placebo

18.8%

p-value

0.046

52.6%

Figure 7: Mean Change in Weekly Cluster Headache Attack Frequency over Weeks 1 to 3 in Study 4aaAbbreviations: BL = baseline; LS = least square; SE = standard error.

Figure 8 shows the distribution of the average percent change from baseline in weekly cluster headache attack frequency
across Weeks 1 to 3 in bins of 25%, by treatment group, in Study 4.

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Figure 8: Distribution of the Average Percent Change from Baseline in Weekly Cluster Headache Attack
Frequency over Weeks 1 to 3 in Study 4aa

N = number of intent to treat patients with non-missing average percentage change from baseline in weekly cluster
headache attack frequency over weeks 1 to 3.

16

HOW SUPPLIED/STORAGE AND HANDLING

16.1

How Supplied

EMGALITY (galcanezumab-gnlm) injection is a sterile, preservative-free, clear to opalescent, colorless to slightly yellow toslightly brown solution for subcutaneous administration.
EMGALITY is not made with natural rubber latex.
EMGALITY is supplied as follows:
Pack Size

NDC

Prefilled pen
120 mg/mL single-dose

Carton of 1

0002-1436-11

120 mg/mL single-dose

Carton of 20002-1436-27

100 mg/mL single-dose

Carton of 30002-3115-09

120 mg/mL single-dose

Carton of 1

0002-2377-11

120 mg/mL single-dose

Carton of 20002-2377-27

Prefilled syringe

16.2

Storage and Handling•••Store refrigerated at 2°C to 8°C (36°F to 46°F) in the original carton to protect EMGALITY from light until use.
Do not freeze.
Do not shake.

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•
•
•
17

EMGALITY may be stored out of refrigeration in the original carton at temperatures up to 30°C (86°F) for up to
7 days. Once stored out of refrigeration, do not place back in the refrigerator.
If these conditions are exceeded, EMGALITY must be discarded.
Discard the EMGALITY single-dose prefilled pen or syringe after use in a puncture-resistant container.

PATIENT COUNSELING INFORMATION

Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use).
Instructions on Self-Administration: Provide guidance to patients and/or caregivers on proper subcutaneous injection
technique, including aseptic technique, and how to use the prefilled pen or prefilled syringe correctly [see Instructions forUse]. Instruct patients and/or caregivers to read and follow the Instructions for Use each time they use EMGALITY.
Hypersensitivity Reactions: Advise patients to seek immediate medical attention if they experience any symptoms ofserious or severe hypersensitivity reactions [see Warnings and Precautions (5.1)].
Pregnancy Exposure Registry: Advise patients that there is a pregnancy exposure registry that monitors pregnancy
outcomes in women exposed to EMGALITY during pregnancy [see Use in Specific Populations (8.1)].
For more information go to www.emgality.com or call 1-833-EMGALITY (1-833-364-2548).
Literature revised: 03/2021
Eli Lilly and Company, Indianapolis, IN 46285, USA
US License Number 1891
Copyright © 2018, 2021, Eli Lilly and Company. All rights reserved.
EMG-0006-USPI-20210311