Chronic MigrainePhase 4NCT01700387
A Study to Evaluate the Tolerability of Botox and Topiramate or Botox and Placebo and Effect on Cognitive Efficiency
A Phase 4 study testing onabotulinumtoxinA and Topiramate in people with Chronic Migraine, run by Cady, Roger, M.D. at 1 site in United States.
Trial summary
The purpose of this study is to evaluate sustained tolerability, quality of life, and change in cognitive efficiency following treatment with OnabotulinumtoxinA and daily topiramate vs. OnabotulinumtoxinA and daily placebo (Group A vs. Group B). Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Chronic Migraine
- What is being tested?
- onabotulinumtoxinA and Topiramate
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 20 participants
- Where
- 1 siteUnited States
- Study dates
- Oct 2012to Aug 2014
- Phase
- Phase 4
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- must be outpatient, male or female, of any race, between 18 and 65 years of age.
- if female of child bearing potential must have a negative pregnancy test result at the Screening Visit and practice a reliable method of contraception.
- A female is considered of childbearing potential unless she is post-menopausal for at least 12 months prior to administration of study drug, without a uterus and/or both ovaries or has been surgically sterilized for at least 6 months prior to study drug administration.
- Reliable methods of contraception are:
- Complete abstinence from intercourse from 2 weeks prior to administration of the investigational product. Throughout the study, and for a time interval (5 days) after completion or premature discontinuation from the study. History of bilateral tubal ligation Sterilization of male partner; or, Implants of levonorgestrel; or, Injectable progestogen, or, Oral contraceptive (combination therapy with ethinyl estradiol plus a progestin) with a placebo week every 1-3 months; or, Any intrauterine device (IUD) with published data showing that the highest expected failure rate is less than 1% per year (not all IUD's meet this criterion) in use at least 30 days prior to study drug administration; or, Spermicide plus a mechanical barrier (e.g., spermicide plus a male condom or a female diaphragm); or, Any other barrier methods (only is used in combination with any of the above acceptable methods) in use at least 14 days prior to study drug administration; or, Any other methods with published data showing that the highest expected failure rate for that method is less than 1% per year.
- must have history of chronic migraine (with or without aura) according to the criteria proposed by the Headache Classification Committee of the International Headache Society (IHS) for at least 3 months prior to enrollment.
Show all 10Show fewer
- must be able to understand the requirements of the study including maintaining a headache Diary, and signing informed consent.
- must be in good general health as determined by investigator.
- if taking migraine preventive, must be on a stable dose of preventive medication for at least 6 weeks prior to screening.
- must have daily access to internet for completion of online daily headache diary.
Who cannot join
- if female, is pregnant, planning to become pregnant during the study period, are breast feeding, or are of childbearing potential and not practicing a reliable form of birth control.
- has headache disorders outside IHS-defined chronic migraine definition.
- has evidence of underlying pathology contributing to their headaches.
- has any medical condition that may increase their risk with exposure to OnabotulinumtoxinA including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other significant disease that might interfere with neuromuscular function.
- has profound atrophy or weakness of muscles in the target areas of injection.
- has skin conditions or infections at any injection site.
Show all 15Show fewer
- has allergy or sensitivities to any component of the test medication.
- has previously received onabotulinumtoxinA for migraine prevention.
- has previously received topiramate.
- who in the opinion of the investigator, has active major psychiatric or depressive disorders including alcohol/drug abuse.
- meets International Headache Society criteria for Medication Overuse Headache with opioid or butalbital containing products.
- who in the opinion of the investigator, is taking opioid or butalbital containing products more than once a week that could be contributing to a pattern of increased headaches or cognitive decline.
- is planning or requiring surgery during the study.
- has a history of poor compliance with medical treatment.
- is currently participating in an investigational drug study or has participated in an investigational drug study within the previous 30 days of the screening visit.
Trial locations and contacts
1 site in 1 country.
United States1 site
Clinvest/A Division of Banyan Group, Inc.
Springfield, Missouri, 65807
About this study
Official title: A Randomized, Pilot Study to Evaluate the Tolerability of OnabotulinumtoxinA Plus Topiramate vs. OnabotulinumtoxinA Plus Placebo and Long Term Effect of Treatment on Cognitive Efficiency and Continuation of Care
The purpose of this study is to evaluate sustained tolerability, quality of life, and change in cognitive efficiency following treatment with OnabotulinumtoxinA and daily topiramate vs. OnabotulinumtoxinA and daily placebo (Group A vs. Group B).
Read the detailed description
Numerous migraine preventive medications are well known to be associated with cognitive impairment and disruption of mood.
Clinvest would propose a pilot study of chronic migraine patients randomized 1:1 to onabotulinumtoxinA and daily topiramate or onabotulinumtoxinA and placebo. This pilot study will examine the degree to which subjects are able to tolerate and are satisfied with a migraine preventive medication in addition to onabotulinumtoxinA over an extended period of time and the effect of the subjects' quality of life compared with onabotulinumtoxinA as a single therapy. It will also assess short and long term effects of these two treatments on cognition. Cognitive performance will be measured by the Mental Efficiency Workload Test (MEWT), a repeated measures handheld neuropsychological test battery that measures mental efficiency via 4 sub-tests (Simple Reaction Time, Running Memory, Continuous Performance Task, Matching to Sample, and Mathematical Processing) to demonstrate short and long term changes in mental status compared to their baseline. The Controlled Oral Word Association Test (COWAT) will be used to test verbal fluency and screen for anomic aphasia, a known side effect of several migraine prophylactic medications including topiramate.
Visit 1 - Screening / Baseline Following Informed Consent a medical, headache, and medication history will be collected and a physical and neurological exam performed on all subjects. A urine pregnancy test will be collected from any subject of child-bearing potential. Vital signs and ECG (at the discretion of the investigator) will be completed. The Mental Efficiency Workload Test (MEWT) will be administered 3 times to establish a cognitive efficiency baseline. The COWAT will be completed. Subjects will be instructed regarding completion of the online 1-month Baseline Period Migraine Diary and be instructed to treat headaches during the 1-month Baseline Period with their usual acute migraine medication in their usual manner.
Visit 2 - Randomization / Injection Following the 1-month Baseline Period, any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. Subjects continuing to meet eligibility criteria will be instructed to complete the online Treatment Period Migraine Diary daily. The MEWT, HIT-6, Migraine Specific Questionnaire (MSQ) and COWAT will be completed. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site. If in the investigator's opinion, the subject maintained a high level of compliance with the online headache diary, subjects will then be randomized into the study.
Eligible subjects will be randomized 1:1 in a blinded fashion to receive onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas and daily topiramate (Group A) or onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas and placebo to match topiramate (Group B).
Daily study medication (topiramate or placebo) will be dispensed for the following 3 months.
The Group A topiramate titration schedule will be as follows:
Week 1: topiramate 25 mg qhs (every night at bedtime) Week 2: topiramate 25 mg bid (twice a day) Week 3: topiramate 25 mg q am (everyday before noon) + topiramate 50 mg qhs Week 4: topiramate 50mg bid
Only one dosage adjustment (increase or decrease), based on efficacy or tolerability, may be made at the investigator's discretion. Subjects must maintain a dose of at least 50 mg/day to remain in the Treatment Period.
The Group B placebo schedule will be as following:
Week 1: 1 tab qhs Week 2: 1 tab bid Week 3: 1 tab q am + 2 tabs qhs Week 4: 2 tabs bid
Subjects will be instructed to complete the online daily Treatment Period Migraine Diary during the next 3-month period.
Following Visit 2, subjects will be phoned monthly and any adverse events collected. Subjects will also be sent weekly reminders for 8 weeks following Visit 2 via email to take study medication, complete online diary and contact their coordinator for any questions or concerns they may have. During the titration period, any subject in Group A experiencing an adverse event thought to be related to study medication dosage will return to the clinic at an Unscheduled Visit for dosage adjustment.
Visit 3
Three months following Visit 2, subjects will return and complete the MEWT, HIT-6, MSQ, COWAT, and Subject's Global Impression of Change (SGIC). The Investigator will complete a Physician's Global Impression of Change (PGIC). Any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site. If in the investigator's opinion, the subject maintained a high level of compliance with the online headache diary, subjects will be allowed to continue in the study.
All subjects will be administered a dose of 155 U onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas.
Any unused study medication and used packaging will be collected, drug accountability will be performed, and daily study medication (topiramate or placebo) will be dispensed for the following 3 months.
Subjects will be instructed to complete the online daily Treatment Period Migraine Diary during the next 3-month period.
Following Visit 3, subjects will be phoned monthly and any adverse events collected.
Visit 4
Three months following Visit 3, subjects will return and complete the MEWT, HIT-6, MSQ, COWAT, and Subject's Global Impression of Change (SGIC). The Investigator will complete a Physician's Global Impression of Change (PGIC). Any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site.
All subjects will be administered a dose of 155 U onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas.
Any unused study medication and used packaging will be collected, drug accountability will be performed, and daily study medication (topiramate or placebo) will be dispensed for the following 3 months.
Subjects will be instructed to complete the online daily Treatment Period Migraine Diary during the next 3-month period.
Following Visit 4, subjects will be phoned monthly and any adverse events collected.
Visit 5
Three months following Visit 4, subjects will return and complete the MEWT, HIT-6, MSQ, COWAT, and Subject's Global Impression of Change (SGIC). The Investigator will complete a Physician's Global Impression of Change (PGIC). Any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site.
All subjects will be administered a dose of 155 U onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas.
Any unused study medication and used packaging will be collected, drug accountability will be performed, and daily study medication (topiramate or placebo) will be dispensed for the following 3 months.
Subjects will be instructed to complete the online daily Treatment Period Migraine Diary during the next 3-month period.
Following Visit 5, subjects will be phoned monthly and any adverse events collected.
Visit 6
Three months following Visit 5, subjects will return and complete the MEWT, HIT-6, MSQ, COWAT, and Subject's Global Impression of Change. The Investigator will complete a Physician's Global Impression of Change. Any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site.
Any unused study medication and used packaging will be collected and drug accountability will be performed.
Subjects will exit the study at Visit 6.
- Conditions
- Chronic Migraine
- Being tested
- onabotulinumtoxinA, Topiramate, Placebo
- Keywords
- Migraine, Chronic Migraine, Cognitive Efficiency, Pilot Study, Long Term Effect
- Medical subject headings
- Migraine Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
onabotulinumtoxinADrug
Also called Botox, Botulinum Toxin Type A Purified Neurotoxin Complex
All subjects will receive a minimum dose of 155 U Botulinum Toxin Type A Purified Neurotoxin Complex administered at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas at Visits 2-5.
TopiramateDrug
Also called Topamax
Subjects randomized to the onabotulinumtoxinA + topiramate group will receive:
Week 1: topiramate 25 mg qhs Week 2: topiramate 25 mg bid Week 3: topiramate 25 mg q am + topiramate 50 mg qhs Week 4: topiramate 50 mg bid Only one dosage adjustment (increase or decrease), based on efficacy or tolerability, may be made at the investigator's discretion. Subjects must maintain a dose of at least 50 mg/day to remain in the Treatment Period.
PlaceboDrug
Subjects randomized to the onabotulinumtoxinA + placebo group will receive:
Week 1: placebo 25 mg qhs Week 2: placebo 25 mg bid Week 3: placebo 25 mg q am + placebo 50 mg qhs Week 4: placebo 50 mg bid Only one dosage adjustment (increase or decrease), based on efficacy or tolerability, may be made at the investigator's discretion. Subjects must maintain a dose of at least 50 mg/day to remain in the Treatment Period.
| Study group | Role | What they receive |
|---|---|---|
| OnabotulinumtoxinA + Topiramate | Experimental | Subject will receive 155 U onabotulinumtoxinA injections at 31 sites every 3 months for 12 months and treat daily with topiramate. During the first month of the treatment period, subjects will titrate as follows:
Week 1: topiramate 25 mg qhs Week 2: topiramate 25 mg bid Week 3: topiramate 25 mg q am + topiramate 50 mg qhs Week 4: topiramate 50 mg bid Only one dosage adjustment (increase or decrease), based on efficacy or tolerability, may be made at the investigator's discretion. Subjects must maintain a dose of at least 50 mg/day to remain in the Treatment Period. Receives: Drug: onabotulinumtoxinA; Drug: Topiramate |
| OnabotulinumtoxinA + Placebo | Placebo comparator | Subject will receive 155 U onabotulinumtoxinA injections at 31 sites every 3 months for 12 months and treat daily with placebo. During the first month of the treatment period, subjects will titrate as follows:
Week 1: 1 tab qhs Week 2: 1 tab bid Week 3: 1 tab q am + 2 tabs qhs Week 4: 2 tabs bid Receives: Drug: onabotulinumtoxinA; Drug: Placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
Subject Attrition Post Randomization
Count of subject attrition following randomization and reason for attrition (Consent withdrawn, Withdrawn due to adverse event, Lost to follow up)
Measured: Collected on Visit 2 (Day 29) through Visit 6 (Day 365)
Subject Global Impression of Change (SGIC)
Score on Subject Global Impression of Change at Visits 3-6 (Day 113 and 365). Likert scale ranging from 1-7, where 1 = extremely worse and 7 = extremely better.
Measured: Collected on Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
Physician Global Impression of Change (PGIC)
Score on Physician Global Impression of Change at Visits 3-6 (Day 113 and 365). Likert scale ranging from 1-7, where 1 = extremely worse and 7 = extremely better.
Measured: Collected on Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
Subject's Controlled Oral Word Association Test (COWAT) Score Percent Change Compared From Baseline to Visits 3-6
The Controlled Oral Word Association Test (COWAT) is a measure of verbal fluency. Raw COWAT scores have a lower bound of 0 with no upper bound. Higher scores indicate better verbal fluency. COWAT score percent change from baseline will be reported. Positive change scores represent better verbal fluency compared to baseline.
Measured: Baseline, Visit 3 (Day 113) through Visit 6 (Day 365)
Secondary outcomes (9)
Number of Headache Days
Number of Headache Days reported in 30-day Baseline Period and Treatment Period Months 1-12
Measured: Baseline and Months 1-12
Headache Impact Test (HIT-6) Scores at Visits 2-6 to Measure Effect of Headache in Subject's Life
The Headache Impact Test (HIT-6) is a tool used to measure the impact headaches have on an individual's ability to function on the job, at school, at home and in social situations. The HIT-6 score range is from 36 to 78 with higher scores indicating greater impact (worse outcome).
Measured: Collected on Visit 2 (Day 29), 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
MEWT Simple Reaction Time Sub-test Score Percent Change Compared From Baseline to Visits 3-6
The Mental Efficiency Workload Test (MEWT) is a cognitive functioning scale with four sub-scales (Simple Reaction Time, Running Memory Continuous Performance Task, Matching to Sample, and Mathematical Processing). Each sub-scale has a minimum and maximum values of 1 to 10, 1 indicates the poorest level and 10 indicates the best level of cognitive functioning. MEWT sub-scale score percent change from baseline will be reported. Positive change scores represent better cognitive functioning compared to baseline.
Measured: Baseline, Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
MEWT Running Memory Continuous Performance Task Sub-test Score Percent Change Compared From Baseline to Visits 3-6
The Mental Efficiency Workload Test (MEWT) is a cognitive functioning scale with four sub-scales (Simple Reaction Time, Running Memory Continuous Performance Task, Matching to Sample, and Mathematical Processing). Each sub-scale has a minimum and maximum values of 1 to 10, 1 indicates the poorest level and 10 indicates the best level of cognitive functioning. MEWT sub-scale score percent change from baseline will be reported. Positive change scores represent better cognitive functioning compared to baseline.
Measured: Baseline, Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
MEWT Matching to Sample Sub-test Score Percent Change Compared From Baseline to Visits 3-6
The Mental Efficiency Workload Test (MEWT) is a cognitive functioning scale with four sub-scales (Simple Reaction Time, Running Memory Continuous Performance Task, Matching to Sample, and Mathematical Processing). Each sub-scale has a minimum and maximum values of 1 to 10, 1 indicates the poorest level and 10 indicates the best level of cognitive functioning. MEWT sub-scale score percent change from baseline will be reported. Positive change scores represent better cognitive functioning compared to baseline.
Measured: Baseline, Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
MEWT Mathematical Processing Sub-test Score Percent Change Compared From Baseline to Visits 3-6
The Mental Efficiency Workload Test (MEWT) is a cognitive functioning scale with four sub-scales (Simple Reaction Time, Running Memory Continuous Performance Task, Matching to Sample, and Mathematical Processing). Each sub-scale has a minimum and maximum values of 1 to 10, 1 indicates the poorest level and 10 indicates the best level of cognitive functioning. MEWT sub-scale score percent change from baseline will be reported. Positive change scores represent better cognitive functioning compared to baseline.
Measured: Baseline, Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
Subject Estimation of Compliance With Daily Study Drug
Subject estimation of compliance with daily study drug during the study period. Compliance ranges from 0% to 100% with higher percentages indicating greater compliance with study drug.
Measured: Collected on Visit 2 (Day 29), 3 (Day 113), Visit 4 (Day 197), and Visit 5 (281)
Number of Non-Serious Adverse Events Between Groups
Measured: 13 Months (Visit 1 to Visit 6)
Subject's Migraine Specific Quality of Life Questionnaire (MSQ) Scores at Baseline, 3, 6, 9 and 12 Months to Measure Subject's Quality of Life
The Migraine-Specific Quality of Life Questionnaire (MSQ) is a scale that measures the impact of migraine across three aspects: role function-restrictive (RR), role function-preventive (RP), and emotional function (EF). Possible scores on each sub-scale range from a 0 to 100 scale such that higher scores indicate better quality of life.
Measured: Baseline, Months: 3, 6, 9 and 12
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 Oct 2012 (estimated)
- Study startOct 2012
- Primary completionAug 2014
- Study completionAug 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Chronic MigraineStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Investigator
- Enrolment
- 20 participants (actual)
Sponsor and investigators
- Lead sponsor
- Cady, Roger, M.D.
- Collaborators
- Allergan
- Responsible party
- Sponsor
- Investigators
- Roger K Cady, MD, Principal investigator, Clinvest
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01700387
- Sponsor's protocol ID
- 12-001AL
- Other IDs
- 71403
- Status last verified
- Aug 2020
- First submitted
- 1 Oct 2012
- Last updated
- 18 Aug 2020
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
Publications
Bootsma HP, Aldenkamp AP, Diepman L, Hulsman J, Lambrechts D, Leenen L, Majoie M, Schellekens A, de Krom M. The Effect of Antiepileptic Drugs on Cognition: Patient Perceived Cognitive Problems of Topiramate versus Levetiracetam in Clinical Practice. Epilepsia. 2006;47 Suppl 2:24-7. doi: 10.1111/j.1528-1167.2006.00683.x.
PubMed 17105455Kim SY, Lee HW, Jung DK, Suh CK, Park SP. Cognitive Effects of Low-dose Topiramate Compared with Oxcarbazepine in Epilepsy Patients. J Clin Neurol. 2006 Jun;2(2):126-33. doi: 10.3988/jcn.2006.2.2.126. Epub 2006 Jun 20.
PubMed 20396496Meador KJ, Loring DW, Vahle VJ, Ray PG, Werz MA, Fessler AJ, Ogrocki P, Schoenberg MR, Miller JM, Kustra RP. Cognitive and behavioral effects of lamotrigine and topiramate in healthy volunteers. Neurology. 2005 Jun 28;64(12):2108-14. doi: 10.1212/01.WNL.0000165994.46777.BE.
PubMed 15985582
Study at a glance
From the registry record, last updated by the sponsor on 18 Aug 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized, Pilot Study to Evaluate the Tolerability of OnabotulinumtoxinA Plus Topiramate vs. OnabotulinumtoxinA Plus Placebo and Long Term Effect of Treatment on Cognitive Efficiency and Continuation of Care
- ClinicalTrials.gov ID
- NCT01700387
- Acronym / sponsor ID
- 12-001AL
- Conditions
- Chronic Migraine
- Keywords
- Migraine, Chronic Migraine, Cognitive Efficiency, Pilot Study, Long Term Effect
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 20 participants (actual)
- Lead sponsor
- Cady, Roger, M.D.
- Collaborators
- Allergan
- Study start
- Oct 2012
- Primary completion
- Aug 2014 (actual)
- Study completion
- Aug 2014 (actual)
- First posted
- 4 Oct 2012 (estimated)
- Results
- Posted 13 Oct 2014
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to evaluate sustained tolerability, quality of life, and change in cognitive efficiency following treatment with OnabotulinumtoxinA and daily topiramate vs. OnabotulinumtoxinA and daily placebo (Group A vs. Group B).
Detailed description
Numerous migraine preventive medications are well known to be associated with cognitive impairment and disruption of mood.
Clinvest would propose a pilot study of chronic migraine patients randomized 1:1 to onabotulinumtoxinA and daily topiramate or onabotulinumtoxinA and placebo. This pilot study will examine the degree to which subjects are able to tolerate and are satisfied with a migraine preventive medication in addition to onabotulinumtoxinA over an extended period of time and the effect of the subjects' quality of life compared with onabotulinumtoxinA as a single therapy. It will also assess short and long term effects of these two treatments on cognition. Cognitive performance will be measured by the Mental Efficiency Workload Test (MEWT), a repeated measures handheld neuropsychological test battery that measures mental efficiency via 4 sub-tests (Simple Reaction Time, Running Memory, Continuous Performance Task, Matching to Sample, and Mathematical Processing) to demonstrate short and long term changes in mental status compared to their baseline. The Controlled Oral Word Association Test (COWAT) will be used to test verbal fluency and screen for anomic aphasia, a known side effect of several migraine prophylactic medications including topiramate.
Visit 1 - Screening / Baseline Following Informed Consent a medical, headache, and medication history will be collected and a physical and neurological exam performed on all subjects. A urine pregnancy test will be collected from any subject of child-bearing potential. Vital signs and ECG (at the discretion of the investigator) will be completed. The Mental Efficiency Workload Test (MEWT) will be administered 3 times to establish a cognitive efficiency baseline. The COWAT will be completed. Subjects will be instructed regarding completion of the online 1-month Baseline Period Migraine Diary and be instructed to treat headaches during the 1-month Baseline Period with their usual acute migraine medication in their usual manner.
Visit 2 - Randomization / Injection Following the 1-month Baseline Period, any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. Subjects continuing to meet eligibility criteria will be instructed to complete the online Treatment Period Migraine Diary daily. The MEWT, HIT-6, Migraine Specific Questionnaire (MSQ) and COWAT will be completed. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site. If in the investigator's opinion, the subject maintained a high level of compliance with the online headache diary, subjects will then be randomized into the study.
Eligible subjects will be randomized 1:1 in a blinded fashion to receive onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas and daily topiramate (Group A) or onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas and placebo to match topiramate (Group B).
Daily study medication (topiramate or placebo) will be dispensed for the following 3 months.
The Group A topiramate titration schedule will be as follows:
Week 1: topiramate 25 mg qhs (every night at bedtime) Week 2: topiramate 25 mg bid (twice a day) Week 3: topiramate 25 mg q am (everyday before noon) + topiramate 50 mg qhs Week 4: topiramate 50mg bid
Only one dosage adjustment (increase or decrease), based on efficacy or tolerability, may be made at the investigator's discretion. Subjects must maintain a dose of at least 50 mg/day to remain in the Treatment Period.
The Group B placebo schedule will be as following:
Week 1: 1 tab qhs Week 2: 1 tab bid Week 3: 1 tab q am + 2 tabs qhs Week 4: 2 tabs bid
Subjects will be instructed to complete the online daily Treatment Period Migraine Diary during the next 3-month period.
Following Visit 2, subjects will be phoned monthly and any adverse events collected. Subjects will also be sent weekly reminders for 8 weeks following Visit 2 via email to take study medication, complete online diary and contact their coordinator for any questions or concerns they may have. During the titration period, any subject in Group A experiencing an adverse event thought to be related to study medication dosage will return to the clinic at an Unscheduled Visit for dosage adjustment.
Visit 3
Three months following Visit 2, subjects will return and complete the MEWT, HIT-6, MSQ, COWAT, and Subject's Global Impression of Change (SGIC). The Investigator will complete a Physician's Global Impression of Change (PGIC). Any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site. If in the investigator's opinion, the subject maintained a high level of compliance with the online headache diary, subjects will be allowed to continue in the study.
All subjects will be administered a dose of 155 U onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas.
Any unused study medication and used packaging will be collected, drug accountability will be performed, and daily study medication (topiramate or placebo) will be dispensed for the following 3 months.
Subjects will be instructed to complete the online daily Treatment Period Migraine Diary during the next 3-month period.
Following Visit 3, subjects will be phoned monthly and any adverse events collected.
Visit 4
Three months following Visit 3, subjects will return and complete the MEWT, HIT-6, MSQ, COWAT, and Subject's Global Impression of Change (SGIC). The Investigator will complete a Physician's Global Impression of Change (PGIC). Any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site.
All subjects will be administered a dose of 155 U onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas.
Any unused study medication and used packaging will be collected, drug accountability will be performed, and daily study medication (topiramate or placebo) will be dispensed for the following 3 months.
Subjects will be instructed to complete the online daily Treatment Period Migraine Diary during the next 3-month period.
Following Visit 4, subjects will be phoned monthly and any adverse events collected.
Visit 5
Three months following Visit 4, subjects will return and complete the MEWT, HIT-6, MSQ, COWAT, and Subject's Global Impression of Change (SGIC). The Investigator will complete a Physician's Global Impression of Change (PGIC). Any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site.
All subjects will be administered a dose of 155 U onabotulinumtoxinA at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas.
Any unused study medication and used packaging will be collected, drug accountability will be performed, and daily study medication (topiramate or placebo) will be dispensed for the following 3 months.
Subjects will be instructed to complete the online daily Treatment Period Migraine Diary during the next 3-month period.
Following Visit 5, subjects will be phoned monthly and any adverse events collected.
Visit 6
Three months following Visit 5, subjects will return and complete the MEWT, HIT-6, MSQ, COWAT, and Subject's Global Impression of Change. The Investigator will complete a Physician's Global Impression of Change. Any change in medical or medication history since the previous visit will be collected and a pregnancy test collected if appropriate. Vital signs will be recorded. The coordinator will assess compliance with online headache diary and any deviation outside of 100% compliance should be documented at the site.
Any unused study medication and used packaging will be collected and drug accountability will be performed.
Subjects will exit the study at Visit 6.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, care provider, investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| OnabotulinumtoxinA + Topiramate | Experimental | Drug: onabotulinumtoxinA, Drug: TopiramateSubject will receive 155 U onabotulinumtoxinA injections at 31 sites every 3 months for 12 months and treat daily with topiramate. During the first month of the treatment period, subjects will titrate as follows: Week 1: topiramate 25 mg qhs Week 2: topiramate 25 mg bid Week 3: topiramate 25 mg q am + topiramate 50 mg qhs Week 4: topiramate 50 mg bid Only one dosage adjustment (increase or decrease), based on efficacy or tolerability, may be made at the investigator's discretion. Subjects must maintain a dose of at least 50 mg/day to remain in the Treatment Period. |
| OnabotulinumtoxinA + Placebo | Placebo comparator | Drug: onabotulinumtoxinA, Drug: PlaceboSubject will receive 155 U onabotulinumtoxinA injections at 31 sites every 3 months for 12 months and treat daily with placebo. During the first month of the treatment period, subjects will titrate as follows: Week 1: 1 tab qhs Week 2: 1 tab bid Week 3: 1 tab q am + 2 tabs qhs Week 4: 2 tabs bid |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (10 listed)
- must be outpatient, male or female, of any race, between 18 and 65 years of age.
- if female of child bearing potential must have a negative pregnancy test result at the Screening Visit and practice a reliable method of contraception.
- A female is considered of childbearing potential unless she is post-menopausal for at least 12 months prior to administration of study drug, without a uterus and/or both ovaries or has been surgically sterilized for at least 6 months prior to study drug administration.
- Complete abstinence from intercourse from 2 weeks prior to administration of the investigational product. Throughout the study, and for a time interval (5 days) after completion or premature discontinuation from the study. History of bilateral tubal ligation Sterilization of male partner; or, Implants of levonorgestrel; or, Injectable progestogen, or, Oral contraceptive (combination therapy with ethinyl estradiol plus a progestin) with a placebo week every 1-3 months; or, Any intrauterine device (IUD) with published data showing that the highest expected failure rate is less than 1% per year (not all IUD's meet this criterion) in use at least 30 days prior to study drug administration; or, Spermicide plus a mechanical barrier (e.g., spermicide plus a male condom or a female diaphragm); or, Any other barrier methods (only is used in combination with any of the above acceptable methods) in use at least 14 days prior to study drug administration; or, Any other methods with published data showing that the highest expected failure rate for that method is less than 1% per year.
- must have history of chronic migraine (with or without aura) according to the criteria proposed by the Headache Classification Committee of the International Headache Society (IHS) for at least 3 months prior to enrollment.
Key exclusion criteria (15 listed)
- if female, is pregnant, planning to become pregnant during the study period, are breast feeding, or are of childbearing potential and not practicing a reliable form of birth control.
- has headache disorders outside IHS-defined chronic migraine definition.
- has evidence of underlying pathology contributing to their headaches.
- has any medical condition that may increase their risk with exposure to OnabotulinumtoxinA including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other significant disease that might interfere with neuromuscular function.
- has profound atrophy or weakness of muscles in the target areas of injection.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| onabotulinumtoxinAAlso: Botox, Botulinum Toxin Type A Purified Neurotoxin ComplexAll subjects will receive a minimum dose of 155 U Botulinum Toxin Type A Purified Neurotoxin Complex administered at 31 fixed-site, fixed-dose injections across seven (7) specific head/neck muscle areas at Visits 2-5. | Drug | OnabotulinumtoxinA + Placebo, OnabotulinumtoxinA + Topiramate |
| TopiramateAlso: TopamaxSubjects randomized to the onabotulinumtoxinA + topiramate group will receive: Week 1: topiramate 25 mg qhs Week 2: topiramate 25 mg bid Week 3: topiramate 25 mg q am + topiramate 50 mg qhs Week 4: topiramate 50 mg bid Only one dosage adjustment (increase or decrease), based on efficacy or tolerability, may be made at the investigator's discretion. Subjects must maintain a dose of at least 50 mg/day to remain in the Treatment Period. | Drug | OnabotulinumtoxinA + Topiramate |
| PlaceboSubjects randomized to the onabotulinumtoxinA + placebo group will receive: Week 1: placebo 25 mg qhs Week 2: placebo 25 mg bid Week 3: placebo 25 mg q am + placebo 50 mg qhs Week 4: placebo 50 mg bid Only one dosage adjustment (increase or decrease), based on efficacy or tolerability, may be made at the investigator's discretion. Subjects must maintain a dose of at least 50 mg/day to remain in the Treatment Period. | Drug | OnabotulinumtoxinA + Placebo |
Primary outcome
Subject Attrition Post Randomization
Time frame: Collected on Visit 2 (Day 29) through Visit 6 (Day 365)
Count of subject attrition following randomization and reason for attrition (Consent withdrawn, Withdrawn due to adverse event, Lost to follow up)
Subject Global Impression of Change (SGIC)
Time frame: Collected on Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
Score on Subject Global Impression of Change at Visits 3-6 (Day 113 and 365). Likert scale ranging from 1-7, where 1 = extremely worse and 7 = extremely better.
Physician Global Impression of Change (PGIC)
Time frame: Collected on Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
Score on Physician Global Impression of Change at Visits 3-6 (Day 113 and 365). Likert scale ranging from 1-7, where 1 = extremely worse and 7 = extremely better.
Subject's Controlled Oral Word Association Test (COWAT) Score Percent Change Compared From Baseline to Visits 3-6
Time frame: Baseline, Visit 3 (Day 113) through Visit 6 (Day 365)
The Controlled Oral Word Association Test (COWAT) is a measure of verbal fluency. Raw COWAT scores have a lower bound of 0 with no upper bound. Higher scores indicate better verbal fluency. COWAT score percent change from baseline will be reported. Positive change scores represent better verbal fluency compared to baseline.
9 secondary outcomes
Number of Headache Days
Time frame: Baseline and Months 1-12
Headache Impact Test (HIT-6) Scores at Visits 2-6 to Measure Effect of Headache in Subject's Life
Time frame: Collected on Visit 2 (Day 29), 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
MEWT Simple Reaction Time Sub-test Score Percent Change Compared From Baseline to Visits 3-6
Time frame: Baseline, Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
MEWT Running Memory Continuous Performance Task Sub-test Score Percent Change Compared From Baseline to Visits 3-6
Time frame: Baseline, Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
MEWT Matching to Sample Sub-test Score Percent Change Compared From Baseline to Visits 3-6
Time frame: Baseline, Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
MEWT Mathematical Processing Sub-test Score Percent Change Compared From Baseline to Visits 3-6
Time frame: Baseline, Visit 3 (Day 113), Visit 4 (Day 197), Visit 5 (281), and Visit 6 (Day 365)
Subject Estimation of Compliance With Daily Study Drug
Time frame: Collected on Visit 2 (Day 29), 3 (Day 113), Visit 4 (Day 197), and Visit 5 (281)
Number of Non-Serious Adverse Events Between Groups
Time frame: 13 Months (Visit 1 to Visit 6)
Subject's Migraine Specific Quality of Life Questionnaire (MSQ) Scores at Baseline, 3, 6, 9 and 12 Months to Measure Subject's Quality of Life
Time frame: Baseline, Months: 3, 6, 9 and 12
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Aug 2020.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Results publication: PubMed 17105455Bootsma HP, Aldenkamp AP, Diepman L, Hulsman J, Lambrechts D, Leenen L, Majoie M, Schellekens A, de Krom M. The Effect of Antiepileptic Drugs on Cognition: Patient Perceived Cognitive Problems of Topiramate versus Levetiracetam in Clinical Practice. Epilepsia. 2006;47 Suppl 2:24-7. doi: 10.1111/j.1528-1167.2006.00683.x.
- Results publication: PubMed 20396496Kim SY, Lee HW, Jung DK, Suh CK, Park SP. Cognitive Effects of Low-dose Topiramate Compared with Oxcarbazepine in Epilepsy Patients. J Clin Neurol. 2006 Jun;2(2):126-33. doi: 10.3988/jcn.2006.2.2.126. Epub 2006 Jun 20.
- Results publication: PubMed 15985582Meador KJ, Loring DW, Vahle VJ, Ray PG, Werz MA, Fessler AJ, Ogrocki P, Schoenberg MR, Miller JM, Kustra RP. Cognitive and behavioral effects of lamotrigine and topiramate in healthy volunteers. Neurology. 2005 Jun 28;64(12):2108-14. doi: 10.1212/01.WNL.0000165994.46777.BE.
Related trials for Chronic Migraine
Recruiting
Marine Lipids Ease Painful TMD
Temporomandibular Disorder (TMD)
Enrolling by invitation
App-based Breathing Program for Migraine Relief
Migraine, Heart Rate Variability (HRV)
RecruitingPhase 2
Study of EVO756 in Adults With Migraine
Migraine
Active, not recruiting
MMA Embolization for Refractory Chronic Migraine
Migraine Disorders
Active, not recruiting
Intra-Nasal Mechanical Stimulation (INMEST) as a Potential Preventative Treatment for Migraine
Migraine
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Roger K Cady, MD principal investigator
Clinvest
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing onabotulinumtoxinA and Topiramate in people with Chronic Migraine, run by Cady, Roger, M.D. at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 10 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 18 Aug 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 13 Oct 2014). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Subject Attrition Post Randomization (time frame: Collected on Visit 2 (Day 29) through Visit 6 (Day 365)). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01700387, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Aug 2020.