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"Completeness of Response" Following Treatment With Treximet™ for Migraine

Primary Purpose

Migraine

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
sumatriptan succinate 85 mg/naproxen sodium 500 mg (Treximet)
Sponsored by
Cady, Roger, M.D.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Migraine focused on measuring Migraine, Headache, Migraine

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

Subject must be/have

  • age 18 to 65
  • able to read, understand, and sign informed consent
  • willing to record migraine headaches and response to treatment in diary
  • diagnosis of migraine headache (IHS 1.1 or 1.2), without and/or with aura
  • at least one year history of migraine
  • 3-8 attacks per month in past 3 months
  • onset of migraine before age 50
  • current triptan user (treated with triptan as primary migraine therapy at least 2 times per month in 3 months prior to screening)
  • history of migraine starting at mild pain for at least 75% of migraine attacks
  • use reliable method of birth control if female and childbearing potential (i.e. reliable barrier method, oral contraceptive, implant, contraceptive patch, long term injectable contraceptive, intrauterine device or tubal ligation)
  • on stabilized dosages of current concomitant medications at least 90 days (may include migraine preventive medications), and willing to continue during study period

Exclusion Criteria:

Subject has/is

  • history of serotonin syndrome
  • medical condition that, in opinion of the investigator, could confound results of the study
  • female of childbearing potential not using adequate contraceptive measures
  • 15 or more headache days per month in total, or history of retinal,, basilar or hemiplegic migraine, cluster headache, or secondary headaches (such as due to trauma, infection, alterations of homeostasis, ENT or psychiatric disorders, cranial or cervical disorders or neuralgias)
  • in investigator's opinion, is likely to have unrecognized cardiovascular or cerebrovascular disease (based on history or presence of risk factors including but not limited to, hypertension, hypercholesterolemia, smoker, obesity, diabetes, or family history of coronary artery disease)
  • blood pressure ≥ 140/90 mmHg in 2 of 3 BP measurements at screening or is taking any angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker
  • a history of congenital heart disease, cardiac arrhythmias requiring medication, or history of clinically significant electrocardiogram abnormality that, in investigator's opinion, contraindicates participation in this study
  • evidence or history of ischemic vascular disease including: ischemic heart disease, ischemic abdominal syndromes, peripheral vascular disease or Raynaud's Syndrome, or signs/symptoms consistent with any of above
  • evidence or history of central nervous system pathology including stroke and/or transient ischemic attacks (TIAs), epilepsy or structural brain lesions which lower convulsive threshold; or has been treated with antiepileptic drug for seizure control within 5 years prior to screening
  • history of impaired hepatic or renal function that, in investigator's opinion, contraindicates participation in study
  • hypersensitivity, intolerance, or contraindication to use of any triptan, NSAID or aspirin (including all sumatriptan and naproxen preparations) or has nasal polyps and asthma
  • currently taking, or has taken in previous three months, migraine prophylactic medication containing methysergide; or is taking migraine or menstrual migraine prophylactic medication that is not stabilized (i.e., change of dose within the past 2 months)
  • recent history of regular use of opioids or barbiturates for treatment of migraine headache and/or other non-migraine pain (regular use defined as an average of 4 days per month over last 6 months)
  • taken, or plans to take, a monoamine oxidase inhibitor (MAOI), including herbal preparations containing St. John's Wort (Hypericum perforatum), anytime within 2 weeks prior to screening through 2 weeks post final study treatment
  • history of any bleeding disorder or is currently taking anti-coagulant or antiplatelet agent
  • evidence or history of gastrointestinal surgery or GI ulceration or perforation in past six months, gastrointestinal bleeding in past year; or evidence or history of inflammatory bowel disease
  • pregnant, actively trying to become pregnant, or breast feeding
  • evidence of alcohol or substance abuse within last year or any concurrent medical or psychiatric condition which, in investigator's judgment, will likely interfere with study conduct, subject cooperation, or evaluation and interpretation of study results, or which otherwise contraindicates participation in this clinical trial
  • participated in an investigational drug trial within previous four weeks or plans to participate in another study at any time during this study

Sites / Locations

  • San Francisco Clinical Research Center
  • Westside Family Medical Center
  • Clinvest
  • Mercy Health Research/Ryan Headache Center
  • Island Neurological Associates, PC
  • Preferred Primary Care Physicians
  • Wesley Headache Clinic and Research Center
  • Texas Headache Associates

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treximet

Arm Description

Treximet (a combination of sumatriptan 85 mg and naproxen sodium 500 mg) 1 tablet to be administered as soon as patient has headache indicative of migraine. Patient may treat up to 16 migraine attacks in 2 month study period.

Outcomes

Primary Outcome Measures

Change in Scores From Completeness of Response Survey (CORS)
CORS scores for Pain (0-4), Associated Symptoms (0-4), Limbic/Affective Symptoms (0-5), and Speed of Return to Functionality (1-5), represent outcome measures that are relevant to patients. Higher scores represent better treatment efficacy. The analysis compares CORS scores for usual triptan (pre-study) versus (vs.) Treximet (study medication).

Secondary Outcome Measures

Percent of Participants Reporting Treximet Provides Therapeutic Advantage Over Usual Pre-study Triptan
CORS completed at Visit 1 regarding participant pre-study triptan and at Visit 2 regarding Treximet taken in study. Areas of therapeutic advantage evaluated: How often does 1 dose completely relieve (1) headache pain (2) neck/shoulder pain (3) nausea (4) light sensitivity (5) sound sensitivity (6) irritability. How quickly can/do you (1) concentrate or think clearly (2) resume normal activities (3) function normally (4) feel completely normal. How confident are you that (1) one dose will completely relieve migraine within 2 hours (2) once relieved, migraine will not return within 24 hours.
Paired T-test Indicating Greater Subject Satisfaction With Treximet Over Usual Pre-study Triptan as Determined by the Revised Patient Perception of Migraine Questionnaire (PPMQ-R)
Scores calculated for (1) Efficacy (2) Functionality (3) Ease of use (4) Cost. Higher score represents better treatment satisfaction.

Full Information

First Posted
May 5, 2009
Last Updated
January 4, 2011
Sponsor
Cady, Roger, M.D.
Collaborators
GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT00893737
Brief Title
"Completeness of Response" Following Treatment With Treximet™ for Migraine
Official Title
An Open-label Study to Evaluate "Completeness of Response" Following Treatment With Treximet™ for Migraine
Study Type
Interventional

2. Study Status

Record Verification Date
January 2011
Overall Recruitment Status
Completed
Study Start Date
June 2009 (undefined)
Primary Completion Date
January 2010 (Actual)
Study Completion Date
January 2010 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Cady, Roger, M.D.
Collaborators
GlaxoSmithKline

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Many clinical trials may not fully explore criteria that are important to some migraine patients' definition of "complete response." This study offers the opportunity to evaluate the effectiveness of Treximet™ when non-standard criteria are examined (for example, neck pain, irritability or fatigue). Subjects enrolled at 8 investigative sites will complete 2 visits. Subjects will complete a Completeness of Response Survey at Visit 1 considering their usual migraine medication (a triptan) and a Completeness of Response Survey at Visit 2 considering their study medication (Treximet™).
Detailed Description
At the screening visit (Visit 1), following written informed consent, subjects will provide a medical, medication and migraine history. A physical and neurological exam and pregnancy test (if appropriate) will be performed. Vital signs will be recorded for all subjects. The Headache Impact Test (HIT-6) and Baseline Patient Perception of Migraine Questionnaire (PPMQ-R) will be completed with the Baseline Completeness of Response Survey (CORS) considering migraine therapy (triptan) utilized during the 3 months prior to enrollment. The Completeness of Response Survey will collect traditional and non-traditional symptoms. Subjects are instructed to treat all migraines that occur in the next 2 months. Subjects will treat with a single tablet of Treximet™ as soon as they have a headache indicative of migraine and are encouraged to treat when the headache is mild. A Headache Diary documenting onset of headache pain and associated symptoms, time of treatment with study medication, symptoms at 2 hours following treatment, time of relief, recurrence of symptoms within 24 hours post-treatment, and adverse events will be dispensed with study medication. Subjects may take a 2nd dose of study medication or medication determined by the investigator for rescue of persistent or recurring headache at 2 or more hours following the 1st dose of study medication. Alternate rescue medication can be provided at the discretion of the investigator but may not include triptan, non-steroidal anti-inflammatory (short-acting NSAID between 6 hours before and 2 hours after study medication or long-acting NSAID between 24 hours before and 24 hours after study medication), or ergotamine-containing or ergot-type medication. Subjects must be headache-free for 24 hours before recording the onset of a "new" migraine attack. The study coordinator will contact subjects at Month 1 to verify treatment and diary compliance. At Visit 2, following 2 months of treatment with Treximet™, the subject will return to the study site and return completed Headache Diaries. The End of Study CORS, CORS Comparator and End of Study PPMQ-R will be completed considering response with study medication. Adverse events will be documented and Diaries and Questionnaires will be reviewed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Migraine
Keywords
Migraine, Headache, Migraine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
147 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treximet
Arm Type
Experimental
Arm Description
Treximet (a combination of sumatriptan 85 mg and naproxen sodium 500 mg) 1 tablet to be administered as soon as patient has headache indicative of migraine. Patient may treat up to 16 migraine attacks in 2 month study period.
Intervention Type
Drug
Intervention Name(s)
sumatriptan succinate 85 mg/naproxen sodium 500 mg (Treximet)
Intervention Description
Treximet 1 tablet as soon as the patient has headache indicative of migraine. May be repeated between 2 and 24 hours post-treatment for persistent or recurring headache. Subjects should not take more than 2 Treximet tablets in 24 hours.
Primary Outcome Measure Information:
Title
Change in Scores From Completeness of Response Survey (CORS)
Description
CORS scores for Pain (0-4), Associated Symptoms (0-4), Limbic/Affective Symptoms (0-5), and Speed of Return to Functionality (1-5), represent outcome measures that are relevant to patients. Higher scores represent better treatment efficacy. The analysis compares CORS scores for usual triptan (pre-study) versus (vs.) Treximet (study medication).
Time Frame
Visit 1 (screening) and Visit 2 (study completion following 2-month treatment period)
Secondary Outcome Measure Information:
Title
Percent of Participants Reporting Treximet Provides Therapeutic Advantage Over Usual Pre-study Triptan
Description
CORS completed at Visit 1 regarding participant pre-study triptan and at Visit 2 regarding Treximet taken in study. Areas of therapeutic advantage evaluated: How often does 1 dose completely relieve (1) headache pain (2) neck/shoulder pain (3) nausea (4) light sensitivity (5) sound sensitivity (6) irritability. How quickly can/do you (1) concentrate or think clearly (2) resume normal activities (3) function normally (4) feel completely normal. How confident are you that (1) one dose will completely relieve migraine within 2 hours (2) once relieved, migraine will not return within 24 hours.
Time Frame
Visit 1 (screening) and Visit 2 (study completion following 2-month treatment period)
Title
Paired T-test Indicating Greater Subject Satisfaction With Treximet Over Usual Pre-study Triptan as Determined by the Revised Patient Perception of Migraine Questionnaire (PPMQ-R)
Description
Scores calculated for (1) Efficacy (2) Functionality (3) Ease of use (4) Cost. Higher score represents better treatment satisfaction.
Time Frame
Visit 1 (screening) and Visit 2 (study completion following 2-month treatment period)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Subject must be/have age 18 to 65 able to read, understand, and sign informed consent willing to record migraine headaches and response to treatment in diary diagnosis of migraine headache (IHS 1.1 or 1.2), without and/or with aura at least one year history of migraine 3-8 attacks per month in past 3 months onset of migraine before age 50 current triptan user (treated with triptan as primary migraine therapy at least 2 times per month in 3 months prior to screening) history of migraine starting at mild pain for at least 75% of migraine attacks use reliable method of birth control if female and childbearing potential (i.e. reliable barrier method, oral contraceptive, implant, contraceptive patch, long term injectable contraceptive, intrauterine device or tubal ligation) on stabilized dosages of current concomitant medications at least 90 days (may include migraine preventive medications), and willing to continue during study period Exclusion Criteria: Subject has/is history of serotonin syndrome medical condition that, in opinion of the investigator, could confound results of the study female of childbearing potential not using adequate contraceptive measures 15 or more headache days per month in total, or history of retinal,, basilar or hemiplegic migraine, cluster headache, or secondary headaches (such as due to trauma, infection, alterations of homeostasis, ENT or psychiatric disorders, cranial or cervical disorders or neuralgias) in investigator's opinion, is likely to have unrecognized cardiovascular or cerebrovascular disease (based on history or presence of risk factors including but not limited to, hypertension, hypercholesterolemia, smoker, obesity, diabetes, or family history of coronary artery disease) blood pressure ≥ 140/90 mmHg in 2 of 3 BP measurements at screening or is taking any angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker a history of congenital heart disease, cardiac arrhythmias requiring medication, or history of clinically significant electrocardiogram abnormality that, in investigator's opinion, contraindicates participation in this study evidence or history of ischemic vascular disease including: ischemic heart disease, ischemic abdominal syndromes, peripheral vascular disease or Raynaud's Syndrome, or signs/symptoms consistent with any of above evidence or history of central nervous system pathology including stroke and/or transient ischemic attacks (TIAs), epilepsy or structural brain lesions which lower convulsive threshold; or has been treated with antiepileptic drug for seizure control within 5 years prior to screening history of impaired hepatic or renal function that, in investigator's opinion, contraindicates participation in study hypersensitivity, intolerance, or contraindication to use of any triptan, NSAID or aspirin (including all sumatriptan and naproxen preparations) or has nasal polyps and asthma currently taking, or has taken in previous three months, migraine prophylactic medication containing methysergide; or is taking migraine or menstrual migraine prophylactic medication that is not stabilized (i.e., change of dose within the past 2 months) recent history of regular use of opioids or barbiturates for treatment of migraine headache and/or other non-migraine pain (regular use defined as an average of 4 days per month over last 6 months) taken, or plans to take, a monoamine oxidase inhibitor (MAOI), including herbal preparations containing St. John's Wort (Hypericum perforatum), anytime within 2 weeks prior to screening through 2 weeks post final study treatment history of any bleeding disorder or is currently taking anti-coagulant or antiplatelet agent evidence or history of gastrointestinal surgery or GI ulceration or perforation in past six months, gastrointestinal bleeding in past year; or evidence or history of inflammatory bowel disease pregnant, actively trying to become pregnant, or breast feeding evidence of alcohol or substance abuse within last year or any concurrent medical or psychiatric condition which, in investigator's judgment, will likely interfere with study conduct, subject cooperation, or evaluation and interpretation of study results, or which otherwise contraindicates participation in this clinical trial participated in an investigational drug trial within previous four weeks or plans to participate in another study at any time during this study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roger K Cady, MD
Organizational Affiliation
Clinvest
Official's Role
Principal Investigator
Facility Information:
Facility Name
San Francisco Clinical Research Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94109
Country
United States
Facility Name
Westside Family Medical Center
City
Kalamazoo
State/Province
Michigan
ZIP/Postal Code
49009
Country
United States
Facility Name
Clinvest
City
Springfield
State/Province
Missouri
ZIP/Postal Code
65807
Country
United States
Facility Name
Mercy Health Research/Ryan Headache Center
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63141
Country
United States
Facility Name
Island Neurological Associates, PC
City
Plainview
State/Province
New York
ZIP/Postal Code
11803
Country
United States
Facility Name
Preferred Primary Care Physicians
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15236
Country
United States
Facility Name
Wesley Headache Clinic and Research Center
City
Cordova
State/Province
Tennessee
ZIP/Postal Code
38018
Country
United States
Facility Name
Texas Headache Associates
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78258
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
16109111
Citation
Smith TR, Sunshine A, Stark SR, Littlefield DE, Spruill SE, Alexander WJ. Sumatriptan and naproxen sodium for the acute treatment of migraine. Headache. 2005 Sep;45(8):983-91. doi: 10.1111/j.1526-4610.2005.05178.x.
Results Reference
background
PubMed Identifier
17405970
Citation
Brandes JL, Kudrow D, Stark SR, O'Carroll CP, Adelman JU, O'Donnell FJ, Alexander WJ, Spruill SE, Barrett PS, Lener SE. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA. 2007 Apr 4;297(13):1443-54. doi: 10.1001/jama.297.13.1443.
Results Reference
background
PubMed Identifier
10993991
Citation
Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000 Sep 26;55(6):754-62. doi: 10.1212/wnl.55.6.754. No abstract available. Erratum In: Neurology 2000 Jan 9;56(1):142.
Results Reference
background
PubMed Identifier
21592098
Citation
Cady R, Banks J, Nett RB, Goldstein J, Bennett N, Turner IM, Ruoff GE, Landy SH, Farmer K, Juhasz M, Tarrasch J, Runken MC. Multi-center comparison of response to a single tablet of sumatriptan 85 mg and naproxen 500 mg vs usual therapy treating multiple migraine attacks as measured by the completeness of response survey. Headache. 2011 Jun;51(6):961-70. doi: 10.1111/j.1526-4610.2011.01912.x. Epub 2011 May 17.
Results Reference
derived

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"Completeness of Response" Following Treatment With Treximet™ for Migraine

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